中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 5
May  2024
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(5): 1009-1015

Clinical features of acute pancreatitis in pregnancy and related risk factors

DOI: 10.12449/JCH240522

  • Department of Critical Care Medicine，Affiliated Hospital of Zunyi Medical University，Zunyi，Guizhou 563003，China

Research funding:

Guizhou Provincial Health Commission Scientific Research Fund Project (gzwk2022-015)

More Information
  • Corresponding author: FU Xiaoyun， zyyxyfxy@163.com （ORCID： 0009-0000-8967-0518）
  • Received Date: 2023-08-13
  • Accepted Date: 2023-09-19
  • Published Date: 2024-05-25
    Abstract
  •   Objective  To investigate the clinical features and maternal and fetal outcomes of acute pancreatitis in pregnancy （APIP） and the risk factors for disease aggravation， and to establish a predictive model.  Methods  A retrospective analysis was performed for 52 APIP patients who were admitted to Affiliated Hospital of Zunyi Medical University from January 2017 to December 2022， and according to disease severity， they were divided into mild acute pancreatitis （MAP） group with 32 patients， moderate-severe acute pancreatitis （MSAP） group with 8 patients， and severe acute pancreatitis （SAP） group with 12 patients. The logistic regression analysis was performed for the clinical data of each group，and the receiver operating characteristic （ROC） curves were plotted to assess the value of risk factors in predicting the severity of APIP. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups，and the least significant difference t-test was used for further comparision between two groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups，and the Wilcoxon rank-sum test was used for further comparision between two groups； the chi-square test was used for comparison of categorical data between groups.  Results  Of all patients in terms of etiology， 26 （50%） had hyperlipidemic pancreatitis， 20 （38.4%） had biliary pancreatitis， and 6 （11.5%） had idiopathic pancreatitis. In terms of gestational week， 1 patient （1.9%） was in early pregnancy， 25 （48.1%） were in mid-pregnancy， and 26 （50.0%） were in late pregnancy. A total of 10 patients （19.2%） had acute respiratory distress syndrome （ARDS）， among whom 9 （90%） required respiratory support. There were significant differences between the patients with different severities of APIP in aspartate aminotransferase， alanine aminotransferase， blood urea nitrogen， blood glucose， C-reactive protein （CRP）， international normalized ratio （INR）， pneumonia， ARDS， sepsis， hepatic insufficiency， and coagulation dysfunction （all P<0.05）. The univariate analysis showed that the severity of APIP was associated with blood glucose， blood urea nitrogen， CRP， and pneumonia （all P<0.05）， and pneumonia was a risk factor for the aggravation of APIP （odds ratio=18.938， 95% confidence interval： 1.020 ‍— ‍351.747， P=0.048）. CRP， blood glucose， blood urea nitrogen， and INR used in combination had a larger area under the ROC curve than each index used alone （0.954 vs 0.778/0.796/0.721/0.801）.  Conclusion  Pneumonia is a risk factor for the aggravation of APIP， and the combination of CRP， blood glucose， blood urea nitrogen， and INR can be used to predict the severity of APIP.

     

    • FullText(HTML)
  • loading
    • References(29)
  • [1]
    DATE RS, KAUSHAL M, RAMESH A. A review of the management of gallstone disease and its complications in pregnancy[J]. Am J Surg, 2008, 196( 4): 599- 608. DOI: 10.1016/j.amjsurg.2008.01.015.
    [2]
    HUANG CL, LIU J, LU YY, et al. Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: A retrospective study[J]. J Clin Apher, 2016, 31( 6): 571- 578. DOI: 10.1002/jca.21453.
    [3]
    BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis: 2012: Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62( 1): 102- 111. DOI: 10.1136/gutjnl-2012-302779.
    [4]
    WEI P, ZHAO XL, HOU WH, et al. Clinical characteristics and maternal and fetal outcomes of 166 patients with acute pancreatitis in pregnancy[J]. Chin J Pract Gynecol Obstet, 2022, 38( 7): 756- 759. DOI: 10.19538/j.fk2022070119.

    魏鹏, 赵先兰, 侯文汇, 等. 妊娠合并急性胰腺炎166例临床特征及母儿结局分析[J]. 中国实用妇科与产科杂志, 2022, 38( 7): 756- 759. DOI: 10.19538/j.fk2022070119.
    [5]
    DUCARME G, MAIRE F, CHATEL P, et al. Acute pancreatitis during pregnancy: A review[J]. J Perinatol, 2014, 34( 2): 87- 94. DOI: 10.1038/jp.2013.161.
    [6]
    TSUANG W, NAVANEETHAN U, RUIZ L, et al. Hypertriglyceridemic pancreatitis: Presentation and management[J]. Am J Gastroenterol, 2009, 104( 4): 984- 991. DOI: 10.1038/ajg.2009.27.
    [7]
    JIANG X, YAN YF, ZHONG R, et al. Clinical features of biliary acute pancreatitis versus hypertriglyceridemic acute pancreatitis[J]. J Clin Hepatol, 2020, 36( 9): 2050- 2055. DOI: 10.3969/j.issn.1001-5256.2020.09.028.

    蒋鑫, 严永峰, 钟瑞, 等. 胆源性急性胰腺炎与高甘油三酯血症性急性胰腺炎临床特点对比分析[J]. 临床肝胆病杂志, 2020, 36( 9): 2050- 2055. DOI: 10.3969/j.issn.1001-5256.2020.09.028.
    [8]
    ONG Y, SHELAT VG. Ranson score to stratify severity in acute pancreatitis remains valid-old is gold[J]. Expert Rev Gastroenterol Hepatol, 2021, 15( 8): 865- 877. DOI: 10.1080/17474124.2021.1924058.
    [9]
    Chinese Society for Emergency Medicine, Beijing-Tianjin-Hebei Alliance of Emergency Treatment and First Aid, Emergency Medicine Branch, Beijing Medical Association, et al. Expert consensus on emergency diagnosis and treatment of acute pancreatitis[J]. J Clin Hepatol, 2021, 37( 5): 1034- 1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012.

    中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识[J]. 临床肝胆病杂志, 2021, 37( 5): 1034- 1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012.
    [10]
    PITCHUMONI CS, YEGNESWARAN B. Acute pancreatitis in pregnancy[J]. World J Gastroenterol, 2009, 15( 45): 5641. DOI: 10.3748/wjg.15.5641.
    [11]
    GARG PK, SINGH VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156( 7): 2008- 2023. DOI: 10.1053/j.gastro.2018.12.041.
    [12]
    SZATMARY P, GRAMMATIKOPOULOS T, CAI WH, et al. Acute pancreatitis: Diagnosis and treatment[J]. Drugs, 2022, 82( 12): 1251- 1276. DOI: 10.1007/s40265-022-01766-4.
    [13]
    TANG SJ, RODRIGUEZ-FRIAS E, SINGH S, et al. Acute pancreatitis during pregnancy[J]. Clin Gastroenterol Hepatol, 2010, 8( 1): 85- 90. DOI: 10.1016/j.cgh.2009.08.035.
    [14]
    KMN V, SHEELA CN, BANKA S, et al. Maternal and perinatal outcome of acute pancreatitis during pregnancy: A 5 year experience at a tertiary care centre[J]. Int J Reprod Contracept Obstet Gynecol, 2016: 4041- 4045. DOI: 10.18203/2320-1770.ijrcog20163886.
    [15]
    GENG YX, LI WQ, SUN LQ, et al. Severe acute pancreatitis during pregnancy: Eleven years experience from a surgical intensive care unit[J]. Dig Dis Sci, 2011, 56( 12): 3672- 3677. DOI: 10.1007/s10620-011-1809-5.
    [16]
    PAPADAKIS EP, SARIGIANNI M, MIKHAILIDIS DP, et al. Acute pancreatitis in pregnancy: An overview[J]. Eur J Obstet Gynecol Reprod Biol, 2011, 159( 2): 261- 266. DOI: 10.1016/j.ejogrb.2011.07.037.
    [17]
    ZHANG TT, WANG GX, CAO Z, et al. Acute pancreatitis in pregnancy: A 10-year, multi-center, retrospective study in Beijing[J]. BMC Pregnancy Childbirth, 2022, 22( 1): 414. DOI: 10.1186/s12884-022-04742-8.
    [18]
    YANG ZY, GUO GY, LI H. Predicting fetal loss in severe acute pancreatitis during pregnancy: A 5-year single-tertiary-center retrospective analysis[J]. Postgrad Med, 2020, 132( 5): 473- 478. DOI: 10.1080/00325481.2020.1752010.
    [19]
    RAUSCHERT S, GÁZQUEZ A, UHL O, et al. Phospholipids in lipoproteins: Compositional differences across VLDL, LDL, and HDL in pregnant women[J]. Lipids Health Dis, 2019, 18( 1): 20. DOI: 10.1186/s12944-019-0957-z.
    [20]
    RUSSI G. Severe dyslipidemia in pregnancy: The role of therapeutic apheresis[J]. Transfus Apher Sci, 2015, 53( 3): 283- 287. DOI: 10.1016/j.transci.2015.11.008.
    [21]
    PENG R, ZHANG XM, ZHANG L, et al. CT findings of acute pancreatitis with pneumonia and its clinical correlation analysis[J]. Radiol Pract, 2020, 35( 1): 68- 73. DOI: 10.13609/j.cnki.1000-0313.2020.01.013.

    彭容, 张小明, 张凌, 等. 急性胰腺炎伴肺炎的CT表现及其与临床相关性分析[J]. 放射学实践, 2020, 35( 1): 68- 73. DOI: 10.13609/j.cnki.1000-0313.2020.01.013.
    [22]
    SHEN HN, CHANG YH, CHEN HF, et al. Increased risk of severe acute pancreatitis in patients with diabetes[J]. Diabet Med, 2012, 29( 11): 1419- 1424. DOI: 10.1111/j.1464-5491.2012.03680.x.
    [23]
    URUSHIHARA H, TAKETSUNA M, LIU Y, et al. Increased risk of acute pancreatitis in patients with type 2 diabetes: An observational study using a Japanese hospital database[J]. PLoS One, 2012, 7( 12): e53224. DOI: 10.1371/journal.pone.0053224.
    [24]
    SCHÜTTE K, MALFERTHEINER P. Markers for predicting severity and progression of acute pancreatitis[J]. Best Pract Res Clin Gastroenterol, 2008, 22( 1): 75- 90. DOI: 10.1016/j.bpg.2007.10.013.
    [25]
    ZHOU HJ, MEI X, HE XH, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study[J]. Medicine(Baltimore), 2019, 98( 16): e15275. DOI: 10.1097/MD.0000000000015275.
    [26]
    KONG WH, HE YY, BAO HR, et al. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: A meta-analysis[J]. Dis Markers, 2020, 2020: 9731854. DOI: 10.1155/2020/9731854.
    [27]
    LIU DL, WEN LL, WANG ZD, et al. The mechanism of lung and intestinal injury in acute pancreatitis: A review[J]. Front Med(Lausanne), 2022, 9: 904078. DOI: 10.3389/fmed.2022.904078.
    [28]
    GE JH. Risk factors for development of acute respiratory distress syndrome in septic patients[J]. Zhejiang Med J, 2017, 39( 20): 1789- 1792. DOI: 10.12056/j.issn.1006-2785.2017.39.20.2017-1141.

    葛建辉. 脓毒症患者并发ARDS的早期危险因素分析[J]. 浙江医学, 2017, 39( 20): 1789- 1792. DOI: 10.12056/j.issn.1006-2785.2017.39.20.2017-1141.
    [29]
    CASQUEIRO J, CASQUEIRO J, ALVES C. Infections in patients with diabetes mellitus: A review of pathogenesis[J]. Indian J Endocrinol Metab, 2012, 16( Suppl1): S27- S36. DOI: 10.4103/2230-8210.94253.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(5)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (109) PDF downloads(15) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return