摘要
背景急性胰腺炎(AP)是消化系统常见的疾病,该病发病急,病情危重,近年来AP的发生率明显上升。胰腺假性囊肿(PPC)是AP的常见并发症,AP并发PPC的发生率亦明显升高。目前临床上尚无敏感指标有效地预测PPC的发生。目的探讨AP并发PPC的危险因素,从而指导临床对相关危险因素进行防控,积极干预,改善预后。方法选取2016—2018年昆明医科大学第一附属医院消化内科接受治疗的AP患者571例为研究对象。回顾性分析患者的一般资料、实验室检查指标,48 h内急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Ranson评分、CT严重指数(MCTSI)评分、急性胰腺炎严重程度床边指数(BISAP)评分、并发症(腹腔积液、胸腔积液)、住院天数、住院费用等。AP患者根据是否并发PPC,分为病例组78例(13.7%)和对照组493例(86.3%)。采用多因素Logistic回归分析探讨AP并发PPC的影响因素。结果病例组与对照组患者年龄、严重程度分级、病因、体质指数(BMI)、吸烟史、饮酒史、既往胰腺炎发作史、糖尿病病史、清蛋白(ALB)、脂肪酶(LIP)、D-二聚体、APACHEⅡ评分、Ranson评分、MCTSI评分、BISAP评分、腹腔积液、胸腔积液发生率比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,BMI〔OR=4.662,95%CI(1.520,14.304)〕、饮酒史〔OR=3.686,95%CI(1.701,7.987)〕、既往胰腺炎病史〔OR=1.448,95%CI(1.068,1.676)〕、糖尿病病史〔OR=3.741,95%CI(1.927,7.260)〕、D-二聚体〔OR=1.483,95%CI(1.283,1.714)〕是AP并发PPC的独立影响因素(P<0.05)。结论BMI高、饮酒史、既往胰腺炎病史、糖尿病病史、D-二聚体高是AP并发PPC的独立危险因素。对存在上述因素的AP患者,应密切随访。
Background Acute pancreatitis(AP)is an acute pancreatitis that may be critical,which is a digestive system disease commonly seen in clinical settings.In recent years,the incidence of AP has increased significantly.Pancreatic pseudocyst(PPC)is a common complication of AP,whose incidence has also significantly increased.However,there is no sensitive index that can predict the occurrence of PPC effectively.Objective To explore the risk factors of PPC in AP,providing guidance for clinical prevention and control of such factors by active and targeted interventions for improving the prognosis.Methods 571 AP patients who received treatment in Department of Gastroenterology,First Affiliated Hospital of Kunming Medical University were enrolled from 2016 to 2018,including 78(13.7%)with PPC(case group)and 493(86.3%)without(control group).Their general data,laboratory test parameters,APACHEⅡscore within 48 hours after admission,Ranson score,MCTSI,BISAP score,complications(ascites,pleural effusion),length of stay and hospitalization costs were analyzed retrospectively.Univariate and multivariate Logistic regressions were used to analyze the influencing factors of PPC in AP.Results Case group and control group showed significant differences in distribution of age and etiology,prevalence of ever smokers,alcohol consumers,history of previous pancreatitis,and history of diabetes,and mean albumin,lipase,D-dimer,APACHEⅡscore,Ranson score,MCTSI,and BISAP score,and prevalence of ascites and pleural effusion(P<0.05).Multivariate Logistic regression analysis showed that BMI〔OR=4.662,95%CI(1.520,14.304)〕,history of drinking〔OR=3.686,95%CI(1.701,7.987)〕,history of previous pancreatitis〔OR=1.448,95%CI(1.068,1.676)〕,history of diabetes〔OR=3.741,95%CI(1.927,7.260)〕,and D-dimer〔OR=1.483,95%CI(1.283,1.714)〕were the independent influencing factors of PPC associated with AP(P<0.05).Conclusion Increased BMI,drinking history,history of previous pancreatitis,history of diabetes and increased D-dimer were high risk factors independently associated with PPC in AP.Patients with these factors should be followed up closely.
作者
杨子云
张海蓉
何佳薇
张景丽
李若畅
YANG Ziyun;ZHANG Hairong;HE Jiawei;ZHANG Jingli;LI Ruochang(Department of Gastroenterology,First Affiliated Hospital of Kunming Medical University,Kunming 650000,China)
出处
《中国全科医学》
CAS
北大核心
2020年第29期3682-3689,共8页
Chinese General Practice
关键词
急性胰腺炎
胰腺假性囊肿
并发症
影响因素分析
Acute pancreatitis
Pancreatic pseudocyst
Complication
Risk factors analysis
