育龄期高三酰甘油血症性急性胰腺炎患者发生感染性胰腺坏死的危险因素分析  

Risk factor analysis for developing infected pancreatic necrosis in female hypertriglyceridemia-induced acute pancreatitis patients with childbearing age

作　　者：胡悦朋 施笑蕾 杨琦 李维勤 Hu Yuepeng;Shi Xiaolei;Yang Qi;Li Weiqin(Department of Critical Care Medicine,Eastern Theater General Hospital of the Chinese People's Liberation Army(Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University),Severe Acute Pancreatitis Center,Nanjing 230002,China;Department of Emergency Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Gastroenterology,Affiliated Hospital of Yangzhou University,Yangzhou 225012,China)

机构地区：[1]中国人民解放军东部战区总医院(南京大学医学院附属金陵医院)重症医学科重症胰腺炎中心,南京230002 [2]郑州大学第一附属医院急诊医学部,郑州450052 [3]扬州大学附属医院消化内科,扬州225012

出　　处：《中华胰腺病杂志》2025年第1期38-43,共6页Chinese Journal of Pancreatology

基　　金：江苏省自然科学基金(BK20231506)。

摘　　要：目的探讨育龄期高三酰甘油血症性急性胰腺炎(HTG-AP)患者发生感染性胰腺坏死(IPN)的危险因素。方法回顾性分析2013年12月至2022年12月间中国人民解放军东部战区总医院460例育龄期HTG-AP患者的临床资料。依据是否发生IPN,将患者分为IPN组(140例)和非IPN组(320例),比较两组患者的一般临床资料、实验室检查指标及临床结局。采用单因素及多因素logistic回归模型分析育龄期HTG-AP患者发生IPN的危险因素。结果460例育龄期HTG-AP患者中,140例患者发生IPN,发生率为30.4%。与非IPN组比较,IPN组患者的妊娠占比更高(30.0%比10.9%,P<0.001),而既往有AP病史的占比更低(12.9%比31.3%,P<0.001)。实验室检查指标方面,IPN组患者血红蛋白、白蛋白水平更低,而尿素氮、血肌酐水平更高;临床结局方面,与非IPN患者比较,IPN组患者重症急性胰腺炎占比及死亡率显著更高;同时,IPN组患者重症监护室入住时间和总住院中位时间均显著高于非IPN组,分别高达16.5、32.0 d。单因素logistic回归分析结果显示,妊娠、既往存在AP病史及血红蛋白、总胆红素、白蛋白、尿素氮、肌酐水平与IPN发生显著相关。多因素logistic回归分析结果显示,妊娠(OR=2.617,95%CI 1.494~4.210,P=0.001)、AP既往史(OR=0.339,95%CI 0.189~0.711,P=0.002)、血红蛋白水平(OR=0.945,95%CI 0.939~0.987,P<0.001)以及血尿素氮水平(OR=1.173,95%CI 1.056~1.198,P=0.004)与IPN发生显著相关。结论妊娠、首次患AP、更低的血红蛋白水平及更高的血尿素氮水平是育龄期HTG-AP患者发生IPN的独立危险因素。ObjectiveTo identify risk factors for developing infected pancreatic necrosis(IPN)in female hypertriglyceridemia-induced acute pancreatitis(HTG-AP)patients with childbearing age.MethodsA retrospective analysis was conducted on clinical data from 460 female HTG-AP patients with childbearing age admitted to Eastern Theater General Hospital of the Chinese People's Liberation Army between December 2013 and December 2022.Patients were divided into the IPN group(n=140)and non-IPN group(n=320)based on the occurrence of IPN.General clinical data,laboratory test results and clinical outcomes were compared between the two groups.Univariate and multivariate logistic regression models were used to analyze the risk factors for IPN in reproductive-age HTG-AP patients.ResultsAmong the 460 patients,140(30.4%)developed IPN.Compared with the non-IPN group,the IPN group had a significantly higher proportion of pregnant patients(30.0%vs 10.9%,P<0.001)and a lower proportion with a history of acute pancreatitis(12.9%vs 31.3%,P<0.001).Laboratory findings showed that patients in the IPN group had lower levels of hemoglobin and albumin,but higher levels of blood urea nitrogen and serum creatinine.Clinical outcomes showed that the IPN group had significantly higher rates of severe acute pancreatitis and mortality compared to the non-IPN group.Additionally,the median length of ICU stay and total hospital stay in the IPN group were significantly longer,at 16.5 days and 32.0 days,respectively.Univariate logistic regression analyses showed that pregnancy,previous history of acute pancreatitis,and levels of hemoglobin,total bilirubin,albumin,blood urea nitrogen and creatinine were significantly associated with IPN.Multivariate logistic regression analysis revealed that pregnancy(OR=2.617,95%CI 1.494-4.210,P=0.001),a history of acute pancreatitis(OR=0.339,95%CI 0.189-0.711,P=0.002),hemoglobin level(OR=0.945,95%CI 0.939-0.987,P<0.001),and blood urea nitrogen level(OR=1.173,95%CI 1.056-1.198,P=0.004)were independently associated with the occurren

关 键 词：妊娠 急性胰腺炎 高三酰甘油血症 胰腺炎 急性坏死性 

分 类 号：R576[医药卫生—消化系统]