低钠血症对急性胰腺炎患者疾病程度的评估价值

严永峰; 蒋鑫; 钟瑞; 徐欢; 彭燕; 汤小伟

doi:10.3969/j.issn.1001-5256.2020.12.025

低钠血症对急性胰腺炎患者疾病程度的评估价值

DOI: 10.3969/j.issn.1001-5256.2020.12.025

西南医科大学附属医院消化内科

基金项目:

西南医科大学附属医院博士科研启动基金（16229）；泸州市人民政府西南医科大学科技战略合作项目（2019LZXNYDJ24）；

详细信息

中图分类号: R576
计量
- 文章访问数: 4331
- HTML全文浏览量: 91
- PDF下载量: 91
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-31
- 出版日期: 2020-12-20

Value of hyponatremia in predicting disease severity of patients with acute pancreatitis

Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
目的探讨低钠血症在预测急性胰腺炎（AP）疾病严重程度中的价值。方法收集2019年1月-12月于西南医科大学附属医院就诊的459例AP患者资料,根据患者起病时血清Na+水平,分为低钠血症组（n=123）和非低钠血症组（n=336）,分析及对比两组患者的基线资料、并发症、病死率、AP相关评分等。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher检验。采用多因素logistic回归分析中-重症急性胰腺炎（M-SAP）、急性胰周坏死物聚集（ANC）及全身炎症反应综合征（SIRS）的影响因素,受试者工作特征曲线（ROC曲线）用于分析相关指标的评估价值。结果低钠血症组较非低钠血症组患者年龄小,BMI、合并糖尿病的比例及高脂血症性AP的比例更高（P值均<0.>2分的比例更高（P值均<0. 05）;低钠血症组患者发生M-SAP或重症急性胰腺炎、急性胰周液体聚集、ANC、SIRS、急性呼吸窘迫综合征、多器官功能...
- 胰腺炎 /
- 低钠血症 /
- 危险因素
Abstract:
Objective To investigate the value of hyponatremia in predicting the severity of acute pancreatitis( AP). Methods Clinical data were collected from 459 AP patients who attended The Affiliated Hospital of Southwest Medical University from January to December2019,and according to the serum Na+level at the time of onset,the patients were divided into hyponatremia group with 123 patients and non-hypernatremia group with 336 patients. The two groups were analyzed and compared in terms of baseline data,complications,mortality rate,and AP-related scores. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. The multivariate logistic regression analysis was used to identify the influencing factors for moderate-to-severe AP( M-SAP),acute necrotic collection( ANC),and systemic inflammatory response syndrome( SIRS),and the receiver operating characteristic( ROC) curve was used to evaluate the value of related indices. Results Compared with the non-hyponatremia group,the hyponatremia group had a significantly younger age and significantly higher body mass index and proportion of patients with diabetes,and most patients had hyperlipidemic AP( all P < 0. 05). Compared with the non-hyponatremia group,the hyponatremia group had significantly higher triglyceride,blood glucose,hematocrit,C-reactive protein,procalcitonin,neutrophil-to-lymphocyte ratio,and proportion of patients with CT severity index > 2 on admission( all P<0. 05). Compared with the non-hyponatremia group,the hyponatremia group had a significantly higher proportion of patients with M-SAP or SAP,acute peripancreatic fluid accumulation,ANC,SIRS,acute respiratory distress syndrome,and multiple organ failure( all P <0. 05). The multivariate logistic regression analysis showed that hyponatremia( odds ratio [OR]= 5. 272,95% confidence interval [CI]:2. 771-10. 029,P < 0. 001),age( OR = 0. 976,95% CI: 0. 956-0. 995,P = 0. 011),Ranson score >2( OR = 10. 437,95% CI:4. 116-26. 465,P < 0. 001,and alcoholic AP( OR = 3. 249,95% CI: 1. 214-8. 694,P = 0. 019) were independent risk factors for M-SAP,and the combination of these four indices had an area under the ROC curve( AUC) of 0. 759; hyponatremia( OR = 1. 931,95% CI:1. 007-3. 700,P = 0. 047; OR = 3. 792,95% CI: 2. 193-6. 556,P < 0. 001) and Ranson score > 2( OR = 2. 621,95% CI: 1. 304-5. 271,P = 0. 007; OR = 5. 845,95% CI: 3. 066-11. 143,P < 0. 001) were independent risk factors for ANC and SIRS,and the combination of these two indices had AUCs of 0. 677 and 0. 742,respectively,in predicting ANC and SIRS. Conclusion Hyponatremia can be used as a simple reference index for evaluating disease severity in patients with AP.
- pancreatitis /
- hyponatremia /
- risk factors

HTML全文

参考文献(29)

[1] Pancreas Study Group,Chinese Society of Gastroenterology,Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis(Shenyang,2019)[J]. J Clin Hepatol,2019,35(12):2706-2711.(in Chinese)中华医学会消化病学分会胰腺疾病学组，《中华胰腺病杂志》编委会，《中华消化杂志》编委会．中国急性胰腺炎诊治指南(2019年，沈阳)[J]．临床肝胆病杂志，2019,35(12):2706-2711.

[2] LEPPNIEMI A,TOLONEN M,TARASCONI A,et al. 2019WSES guidelines for the management of severe acute pancreatitis[J]. World J Emerg Surg,2019,14:27.

[3] YAN Y,LUO J,FENG PL. The predictive value of body mass index and neutrophil-to-lymphocyte ratio for the severity of acute pancreatitis[J]. J Hepatobiliary Surg,2019,27(4):289-292.(in Chinese)闻勇，罗杰，丰萍璐．体质指数、中性粒细胞-淋巴细胞比值对急性胰腺炎病情预测价值的研究[J]．肝胆外科杂志，2019,27(4):289-292.

[4] YU SS,JIN K,FU YY,et al. Predictive value of D-dimer combination-related indicators in the severity of acute pancreatitis[J].J Clin Emerg,2019,20(12):925-930.(in Chinese)余姗姗，金魁，付阳阳，等．D-二聚体联合相关指标在急性胰腺炎严重程度预测中的价值研究[J]．临床急诊杂志，2019,20(12):925-930.

[5] CHEN HZ,JI L,LI L,et al. Early prediction of infected pancreatic necrosis secondary to necrotizing pancreatitis[J].Medicine(Baltimore),2017,96(30):e7487.

[6] HONG W,LILLEMOE KD,PAN S,et al. Development and validation of a risk prediction score for severe acute pancreatitis[J]. J Transl Med,2019,17(1):146.

[7] LIN S,HONG W,BASHARAT Z,et al. Blood urea nitrogen as a predictor of severe acute pancreatitis based on the revised Atlanta criteria:Timing of measurement and cutoff points[J].Can J Gastroenterol Hepatol,2017,2017:9592831.

[8] HE WH,ZHU Y,ZHU Y,et al. Comparison of multifactor scoring systems and single serum markers for the early prediction of the severity of acute pancreatitis[J]. J Gastroenterol Hepatol,2017,32(11):1895-1901.

[9] PADHI R,PANDA BN,JAGATI S,et al. Hyponatremia in critically ill patients[J]. Indian J Crit Care Med,2014,18(2):83-87.

[10] SPASOVSKI G,VANHOLDER R,ALLOLIO B,et al. Hyponatraemia diagnosis and treatment clinical practice guidelines[J]. Nefrologia,2017,37(4):370-380.

[11] BROCH PORCAR MJ,RODRGUEZ CUBILLO B,DOMNGUEZROLDN JM,et al. Practical document on the management of hyponatremia in critically ill patients[J]. Med Intensiva,2019,43(5):302-316.

[12] ZHANG SF. Interpretation of 2014 European clinical guidelines for the diagnosis and treatment of hyponatremia[J]. Chin J Respir Crit Care Med,2015,14(1):103-106.(in Chinese)张劭夫．2014欧洲低钠血症诊疗临床实践指南解读[J]．中国呼吸与危重监护杂志，2015,14(1):103-106.

[13] ALSALEH A,PELLINO G,CHRISTODOULIDES N,et al. Hyponatremia could identify patients with intrabdominal sepsis and anastomotic leak after colorectal surgery:A systematic review of the literature[J]. Updates Surg,2019,71(1):17-20.

[14] SU FD,LI B. Relationship between admission serum sodium concentration and clinical outcomes in patients with heart failure[J]. Clin Med,2019,39(4):25-27.(in Chinese)苏福娣，李彪．住院心力衰竭患者血清钠水平与病情的相关性分析[J]．临床医学，2019,39(4):25-27.

[15] CHAWLA A,STERNS RH,NIGWEKAR SU,et al. Mortality and serum sodium:Do patients die from or with hyponatremia?[J]. Clin J Am Soc Nephrol,2011,6(5):960-965.

[16] MARCHETTI V,GORI E,LIPPI I,et al. Elevated serum creatinine and hyponatraemia as prognostic factors in canine acute pancreatitis[J]. Aust Vet J,2017,95(11):444-447.

[17] DUNNE MJ,SHENKIN A,IMRIE CW. Misleading hyponatraemia in acute pancreatitis with hyperlipaemia[J]. Lancet,1979,1(8109):211.

[18] WANG Y,ATTAR BM,ABU OMAR Y,et al. Pseudohyponatremia in hypertriglyceridemia-induced acute pancreatitis:A tool for diagnosis rather than merely a laboratory error?[J]. Pancreas,2019,48(1):126-130.

[19] LANGELAAN ML,KAMP L,ZANDIJK E,et al. Prevalence of pseudonatremia in a clinical laboratory-role of the water content[J]. Clin Chem Lab Med,2017,55(4):546-553.

[20] HANSEN S,MADSEN CM,VARBO A,et al. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis:A study of more than 115000 individuals from the general population[J].Clin Chem,2019,65(2):321-332.

[21] PASCUAL I,SANAHUJA A,GARCA N,et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis:Cohort analysis of 1457 patients[J]. Pancreatology,2019,19(5):623-629.

[22] WU Q,FU M,ZHENG K,et al. Elevated triglycerides level in hospital stay as a risk factor of mortality in patients with severe acute pancreatitis[J]. PLo S One,2018,13(11):e0207875.

[23] ZAFRIR B,SALIBA W,JUBRAN A,et al. Severe hypertriglyceridemia-related pancreatitis:Characteristics and predictors of recurrence[J]. Pancreas,2019,48(2):182-186.

[24] KISS L,FR G,MTRAI P,et al. The effect of serum triglyceride concentration on the outcome of acute pancreatitis:systematic review and meta-analysis[J]. Sci Rep,2018,8(1):14096.

[25] SHENG ZX,XIE DH,SUN L,et al. The relationship of inflammatory factors with glucose metabolism and insulin resistance in type 2 diabetes mellitus[J]. Chin J Diabetes,2010,18(4):253-254.(in Chinese)盛志新，谢丹红，孙辽，等．2型糖尿病患者血浆炎症因子水平与糖代谢及胰岛素抵抗的关系[J]．中国糖尿病杂志，2010,18(4):253-254.

[26] WEI YQ. Research progress in the relationship between chronic inflammation and insulin resistance[J]. J Clin Pathol Res,2019,39(3):640-645.(in Chinese)魏伊秋．慢性炎症与胰岛素抵抗机制关系的研究进展[J]．临床与病理杂志，2019,39(3):640-645.

[27] BAIG S,SHABEER M,PARVARESH RIZI E,et al. Heredity of type 2 diabetes confers increased susceptibility to oxidative stress and inflammation[J]. BMJ Open Diabetes Res Care,2020,8(1):e000945.

[28] PENDHARKAR SA,SINGH RG,CHAND SK,et al. Pro-inflammatory cytokines after an episode of acute pancreatitis:Associations with fasting gut hormone profile[J]. Inflamm Res,2018,67(4):339-350.

[29] JINNO N,HORI Y,NAITOH I,et al. Predictive factors for the mortality of acute pancreatitis on admission[J]. PLo S One,2019,14(8):e0221468.

施引文献

资源附件(0)

访问统计