帕瑞昔布减少非轻症高甘油三酯血症性急性胰腺炎患者住院期间胰腺外感染  

Parecoxib reduces extrapancreatic infections in non-mild hypertriglyceridemia-induced acute pancreatitis patients during hospitalization

作　　者：黄晓东 黄贤伟[2] 刘斯瑶 徐志鸿 刘雄 郑清柳 胡俊 蔺际䶮 Huang Xiaodong;Huang Xianwei;Liu Siyao;Xu Zhihong;Liu Xiong;Zheng Qingliu;Hu Jun;Lin Jiyan(The School of Clinical Medicine,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学临床医学部,福建福州350122 [2]厦门大学附属第一医院急诊科、厦门市中医药疗效证据研究重点实验室,福建厦门360003

出　　处：《中国急救医学》2024年第12期1085-1091,共7页Chinese Journal of Critical Care Medicine

基　　金：厦门市医疗卫生指导性项目(3502Z20244ZD1049);厦门市科技计划项目(3502Z202374002);北京协和医学基金会——睿E急诊医学研究基金(PUMF01010010-2024-01);福建中医药大学校管课课题(XB2024200)。

摘　　要：目的评估高甘油三酯血症性急性胰腺炎(HTG-AP)患者在入院早期接受帕瑞昔布治疗对住院期间临床预后(如病死率、器官功能衰竭、局部并发症、胰腺及胰腺外感染等)的影响。方法通过回顾性队列分析,纳入2018年1月1日至2023年12月31日在厦门大学附属第一医院住院治疗的401例HTG-AP患者。根据临床分类,将患者分为轻症组(n=266)和非轻症(n=135)两组。进一步按照入院后24 h内是否使用帕瑞昔布,分为帕瑞昔布组(n=221)和常规组(n=45)。比较两组患者的基本资料、实验室指标及临床结局,利用Kaplan-Meier法进行生存分析,并绘制生存曲线;采用Cox回归分析评估使用帕瑞昔布及其他因素对临床结局的影响。通过倾向性评分匹配(PSM)平衡两组基线差异以验证结果。结果帕瑞昔布对HTG-AP患者住院期间的病死率、器官功能衰竭及局部并发症等主要临床结局无显著影响,但在非轻症患者中,早期使用帕瑞昔布显著降低住院期间胰腺外感染的风险(30.19%vs.63.41%,P<0.001),并缩短腹痛缓解时间[d:1(1,2)vs.2(1,3),P<0.001]。Kaplan-Meier曲线分析显示,非轻症HTG-AP患者中,帕瑞昔布组的胰腺外感染累积发生率显著低于常规组(P<0.05)。多变量Cox回归分析显示,早期使用帕瑞昔布(HR=0.45,95%CI 0.24~0.84,P<0.05)在降低非轻症HTG-AP患者胰腺外感染方面是一个独立的保护因素。PSM调整后,进一步确认早期使用帕瑞昔布可减少非轻症HTG-AP患者住院期间的胰腺外感染(32.14%vs.58.54%,P=0.031),并缩短腹痛缓解时间[d:1.00(0.25,2.00)vs.2.00(1.00,3.00),P<0.001]。结论对于非轻症HTG-AP患者,入院初期使用帕瑞昔布治疗可有效降低住院期间胰腺外感染风险,并缩短腹痛缓解时间。Objective To evaluate the impact of early parecoxib treatment on clinical outcomes during hospitalization,including mortality,organ failure,local complications and pancreatic and extrapancreatic infections,in the patients with hypertriglyceridemia-induced acute pancreatitis(HTG-AP).Methods We conducted a retrospective cohort analysis on 401 HTG-AP patients hospitalized in the First Affiliated Hospital of Xiamen University from January 1,2018 to December 31,2023.Patients were classified into mild group(n=266)and non-mild group(n=135)based on clinical severity.Additionally,they were divided into parecoxib group(n=221)and conventional group(n=45)based on whether parecoxib was used within 24 h after admission.The basic information,laboratory indicators and clinical outcomes of the two groups were compared.Survival analysis was performed by using the Kaplan-Meier method,and survival curves were plotted.Cox regression analysis was used to assess the impact of parecoxib use and other factors on clinical outcomes.Propensity score matching(PSM)was used to balance baseline differences between the two groups to further validate the comparison results.Results The use of parecoxib did not significantly affect major clinical outcomes,such as mortality,organ failure and local complications,in HTG-AP patients during hospitalization.However,early use of parecoxib significantly reduced the risk of extrapancreatic infection(30.19%vs.63.41%,P<0.001)and shortened the time of abdominal pain relief[d:1(1,2)vs.2(1,3),P<0.001]in non-mild patients.Kaplan-Meier curve analysis showed that the cumulative incidence of extrapancreatic infection in the parecoxib group was significantly lower than that in the conventional group among non-mild HTG-AP patients(P<0.05).Multivariate Cox regression analysis revealed that early use of parecoxib(HR=0.45,95%CI 0.24-0.84,P<0.05)was an independent protective factor in reducing extrapancreatic infection in non-mild HTG-AP patients.After PSM adjustment,it was further confirmed that early use of parecoxib re

关 键 词：急性胰腺炎 甘油三酯 帕瑞昔布 腹痛缓解时间 倾向性评分匹配 感染 

分 类 号：R576[医药卫生—消化系统]