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妊娠合并急性胰腺炎的临床特征与预后分析
Clinical features and prognosis of acute pancreatitis in pregnancy
文章发布日期:2018年12月17日  来源:  作者:袁景,孟飞,汤小伟,等  点击次数:251次  下载次数:47次

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【摘要】:目的提高对妊娠合并急性胰腺炎(APIP)的认知,探讨APIP预防及治疗措施。方法选取西南医科大学附属医院2013年1月-2017年12月收治的APIP患者65例为研究对象。其中轻症急性胰腺炎(MAP)32例,中度重症急性胰腺炎(MSAP)21例,重症急性胰腺炎(SAP)12例,对比3组患者实验室检查结果、影像学检查结果、产妇年龄、妊娠并发症、BMI、病因、孕期、产妇及胎儿结局。符合正态分布且方差齐的计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料多组间比较采用 Kruskal-Wallis H检验,进一步两两比较采用Dunn-Bonferroni检验。计数资料组间比较采用 χ2 检验。结果 36例(55.38%)患者血淀粉酶高于正常值上限3倍,41例(63.08%)患者血脂肪酶高于正常值上限3倍。其中SAP组的超敏C反应蛋白、TG、血糖明显高于MAP组和MSAP组(P值均<0.05),血钙明显低于MAP组和MSAP组(P值均<0.05)。65例患者均行腹部彩超检查,正确诊断51例(78.46%);28例患者行CT检查,正确诊断28例(100%)。妊娠期糖尿病患者更容易发生MSAP和SAP,差异有统计学意义(χ2=7.809, P=0.020)。MSAP组和SAP组患者的BMI明显高于MAP组,差异均有统计学意义(P值均<005)。APIP的主要病因为高脂血症(26例,40.00%),且高脂血症性胰腺炎更易发展为MSAP(50.00%)和SAP(34.62%)(χ2=20.520,P<0.001)。APIP患者病情越重,胎死宫内率越高,新生儿5 min Apgar评分越低(χ2值分别为25.381、14.821,P值均<0.05)。结论高脂血症是APIP的主要病因及影响预后的因素,应加强孕妇血脂监控,控制孕妇BMI,以降低APIP发生率并减轻APIP严重程度。
【Abstract】:ObjectiveTo investigate the preventive and treatment measures for acute pancreatitis in pregnancy (APIP), and to improve the awareness of this disease. MethodsA total of 65 patients with APIP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to December 2017 were enrolled as subjects. Among these patients, 32 had mild acute pancreatitis (MAP), 21 had moderate-severe acute pancreatitis (MSAP), and 12 had severe acute pancreatitis (SAP). The three groups were compared in terms of laboratory results, maternal age, pregnancy complications, body mass index (BMI), etiology, pregnancy, and maternal and fetal outcomes. An analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsOf all patients, 36 (55.38%) had a blood amylase level three times higher than normal, and 41 (63.08%) had a serum lipase level three times higher than normal. The SAP group had significantly higher high-sensitivity C-reactive protein, triglyceride, and blood glucose and a significantly lower blood calcium level than the MAP and MSAP groups (all P<0.05). All 65 patients underwent abdominal color Doppler ultrasound, among whom 51 (78.46%) had a correct diagnosis; 28 patients underwent computed tomography and all of them had a correct diagnosis (100%). The patients with gestational diabetes mellitus tended to develop MSAP and SAP (χ2=7.809, P=0.020). The MSAP and SAP groups had a significantly higher BMI than the MAP group (P<0.05). Of all patients, 26 (40.00%) had hyperlipidemia as the etiology of APIP, among whom 50.00% developed MSAP and 34.62% developed SAP (χ2=20.520, P<0.001). With the increase in the severity of APIP, the rate of intrauterine death increased, and the 5-minute Apgar score of neonates decreased (χ2=25.381 and 14.821, both P<0.05). ConclusionHyperlipidemia is the main cause of APIP and a major influencing factor for prognosis. The monitoring of blood lipids and BMI should be strengthened in pregnant women, in order to reduce the incidence rate and severity of APIP.
【关键字】:胰腺炎; 妊娠; 高脂血症; 临床特点; 预后
【Key words】:pancreatitis; pregnancy; hyperlipemias; clinical features; prognosis
【引证本文】:YUAN J, MENG F, TANG XW, et al. Clinical features and prognosis of acute pancreatitis in pregnancy[J]. J Clin Hepatol, 2019, 35(1): 138-142. (in Chinese)
袁景, 孟飞, 汤小伟, 等. 妊娠合并急性胰腺炎的临床特征与预后分析[J]. 临床肝胆病杂志, 2019, 35(1): 138-142.

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