摘要
目的探讨妊娠合并急性胰腺炎(APIP)病情进展的影响因素。方法回顾性收集福建医科大学附属第二医院2007年7月至2022年6月收治49例APIP患者的临床资料,根据病情严重程度分为轻症组(n=23)和重症组(n=26),比较两组病因、临床特点、并发症、试验室指标及母婴结局等方面的差异,将差异有统计学意义的指标纳入二元Logistic回归分析,探讨可能影响APIP病情严重程度的独立因素,并绘制受试者工作特征曲线(ROC曲线),评价相关试验室指标对病情进展的预测能力。结果APIP病因依次为高甘油三酯血症性、胆源性、特发性。重症组的高甘油三酯血症性病因占比、并发症、死胎/流产发生率以及ICU住院时间、总住院时间均高于轻症组,继续待产率低于轻症组,重症组的中性粒细胞淋巴细胞比率(NLR)、C-反应蛋白(CRP)、降钙素原(PCT)、甘油三酯(TG)、总胆固醇(TC)、载脂蛋白B(Apo-B)、载脂蛋白B/A1(Apo-B/A1)、血糖(GLU)、乳酸脱氢酶(LDH)、血浆纤维蛋白原(FIB)和D-二聚体(D-D)高于轻症组,重症组的淋巴细胞计数(LC)、载脂蛋白A1(Apo-A1)、血钙(Ca)水平低于轻症组(P<0.05);二元Logistic回归分析发现,TG、Ca和Apo-A1是APIP患者病情进展的独立影响因素(OR>1,P<0.05),结合这3个因素的预测模型显示,ROC曲线下面积为0.957。结论APIP多发于妊娠晚期,病因多为高甘油三酯血症,血TG、Ca和Apo-A1水平是病情进展的危险因素,3者可作为APIP病情重症化的预测指标。
Objective To investigate the pancreatitis progression in acute pancreatitis in pregnancy(APIP).Methods Clinical data of 49 patients with APIP admitted to the Second Affiliated Hospital of Fujian Medical University from July 2007 to June 2022 were retrospectively collected.They were divided into mild group(n=23)and severe group(n=26)according to the severity of the disease.Differences in etiology,clinical features,complications,laboratory indicators and maternal and infant outcomes were compared between the two groups.Indicators with statistical significance were included in binary Logistic regression analysis to explore independent factors that may affect the severity of APIP.Receiver operating characteristic curve(ROC curve)was plotted to evaluate its ability to predict disease progression.Results The causes of APIP were hypertriglyceridemia,biliary and idiopathic.The proportion of causes of hypertriglyceridemia,complications,incidence of stillbirth/abortion,length of stay in ICU and total length of stay in ICU in the severe group were higher than those in the mild group,while the rate of continued labor was lower than that in the mild group.Neutrophil lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),triglyceride(TG),total cholesterol(TC),polipoprotein B(Apo-B),apolipoprotein B/A1(Apo-B/A1),blood glucose(GLU),lactate dehydrogenase(LDH),fibrinogen(FIB)and plasma D-dimer(D-D)in the severe group were higher than those in mild patients,and lymphocyte count(LC),apolipoprotein A-1(Apo-A1)and blood calcium(Ca)in the severe group were lower than those in the mild group(P<0.05).Further binary logistic regression analysis showed that TG,Ca and Apo-A1 were independent influencing factors for disease progression in APIP patients(OR>1,P<0.05).The predictive model combined with these three factors showed that the area under ROC curve was 0.957.Conclusions APIP occurs more frequently in the third trimester of pregnancy,and the most common cause is hypertriglyceridemia.Serum TG,Ca and Apo-A1 levels are risk fact
作者
陈成文
罗春花
杨聪汉
孙旭日
CHEN Chengwen;LUO Chunhua;YANG Conghan;SUN Xuri(Department of Critical Care Medicine,The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China;Department of Emergency,The Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350003,China)
出处
《中国医药指南》
2024年第24期19-23,共5页
Guide of China Medicine
基金
福建省自然科学基金项目(NO.2020J01237)。
关键词
妊娠
急性胰腺炎
高甘油三酯血症
预测
Pregnancy
Acute pancreatitis
Hypertriglyceridemia
Predictive
