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肝功能异常对急性胰腺炎病因和病情分级判定的临床意义
Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis
文章发布日期:2017年12月09日  来源:  作者:赵琦,王兵,李振方,等  点击次数:420次  下载次数:84次

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【摘要】:目的 观察急性胰腺炎(AP)伴发肝损伤患者肝功能各项指标与病因及病情的关系,旨在探讨肝功能变化对明确AP病因及预测病情程度的临床意义。方法 回顾性分析聊城市人民医院2011年1月-2016年3月住院的163例AP患者的临床资料,按病因分为胆源性(n=85)、非胆源性(n=78)2组;参照CT影像Balthazar分级标准将其分为轻型胰腺炎(MAP)和重型胰腺炎(SAP),其中MAP患者138例,SAP患者25例。胆源性SAP 18例,胆源性MAP 67例;非胆源性SAP 7例,非胆源性MAP 71例。比较患者肝功能指标ALT、AST、GGT、ALP水平,并观察胆源性、非胆源性AP患者入院时、入院48 h、入院96 h肝功能变化情况。计量资料2组间比较采用t检验;3组间比较采用方差分析,进一步两两比较采用SNK-q检验。计数资料组间比较采用χ2检验。结果 对于MAP患者,胆源性与非胆源性组间ALT、AST、ALP、GGT水平差异均有统计学意义(P值均<0.05);而SAP患者胆源性与非胆源性组间仅ALP和GGT水平差异有统计学意义(P值均<0.05)。胆源性AP所引起的肝损伤,48~96 h的ALT、AST、ALP、GGT水平大幅下降,与入院时比较差异均有统计学意义(P值均<0.05);而非胆源性AP患者不同入院时间肝功能指标比较,差异均无统计学意义(P值均>0.05)。胆源性AP患者ALP、GGT及ALP+GGT水平异常的发生率均高于非胆源性AP组,差异均有统计学意义(P值均<0.05)。对于同一病因引起的胰腺炎,肝功能在SAP与MAP患者之间差异均无统计学意义(P值均>0.05)。结论 AP患者尤其是胆源性AP多合并肝功能异常。对于MAP,肝功能异常越明显,应首先考虑胆源性;对于SAP,ALT、AST对病因的预测价值不大,ALP、GGT则更为敏感, ALP、GGT的升高,提示胆源性AP的可能。连续检测肝功能变化,对于肝功能明显下降,尤其是ALT、AST水平明显下降的患者,胆源性AP的可能性越大。肝功能损伤的程度尤其是转氨酶活性的高低与AP病情程度无关。
【Abstract】:Objective To investigate the association of liver function parameters with etiology and severity in patients with acute pancreatitis (AP) complicated by liver injury, and to clarity the clinical significance of the change in liver function in determining the etiology and severity of AP. Methods A retrospective analysis was performed for the clinical data of 163 AP patients who were hospitalized in Liaocheng People′s Hospital from January 2011 to March 2016, and according to the etiology, these patients were divided into biliary AP group with 85 patients and non-biliary AP group with 78 patients. According to the Balthazar CT grade, the patients were divided into mild acute pancreatitis (MAP) group with 138 patients and severe acute pancreatitis (SAP) group with 25 patients. Of all patients in the biliary AP group, 18 had biliary SAP and 67 had biliary MAP; of all patients in the non-biliary AP group, 7 had non-biliary SAP and 71 had non-biliary MAP. The groups were compared in terms of liver function parameters alanine aminotransferase (ALP), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP), and the change in liver function was observed on admission and at 48 and 96 hours after admission. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between three groups, and the SNK-q test was sued for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. Results In the patients with MAP, there were significant differences in the levels of ALT, AST, ALP, and GGT between the biliary AP group and the non-biliary AP group (all P<0.05); in the patients with SAP, there were only significant differences in the levels of ALP and GGT between the biliary AP group and the non-biliary AP group (both P<0.05). As for liver injury caused by biliary AP, there were significant reductions in the levels of ALT, AST, ALP, and GGT at 48-96 hours after admission (all P<0.05), while in the patients with non-biliary AP, there were no significant changes in these liver function parameters (all P>0.05). Compared with the non-biliary AP group, the biliary AP group had a significantly higher incidence rate of an abnormal level of ALP, GGT, or ALP+GGT (all P<0.05). In the patients with AP caused by the same reason, there was no significant difference in liver function between SAP and MAP patients (all P>0.05). Conclusion Most patients with AP tend to have abnormal liver function, especially those with biliary AP. As for patients with MAP, abnormal liver function often indicates biliary AP; as for patients with SAP, ALT and AST have a low value in predicting etiology, while ALP and GGT are more sensitive, i.e., the increase in ALT and GGT indicates the possibility of biliary AP. When the change in liver function is monitored continuously, the patients with significant reductions in liver function parameters, especially the levels of ALT and AST, tend to have a higher possibility of biliary AP. The degree of liver injury, especially the activities of aminotransferases, is not associated with the severity of AP.
【关键字】:胰腺炎;肝功能试验;转氨酶类
【Key words】:pancreatitis; liver function tests; transaminases
【引证本文】:ZHAO Q, WANG B, LI ZF, et al. Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis[J]. J Clin Hepatol, 2018, 34(1): 152-156. (in Chinese)
赵琦, 王兵, 李振方, 等. 肝功能异常对急性胰腺炎病因和病情分级判定的临床意义[J]. 临床肝胆病杂志, 2018, 34(1): 152-156.

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