Analysis of the etiology and clinical characteristics of acute pancreatitis in Xuzhou area
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摘要: 目的 探讨徐州地区急性胰腺炎(acute pancreatitis, AP)的病因和临床特征, 为今后AP的诊治和预防提供一定的临床参考依据。方法 回顾性分析徐州医科大学附属医院、徐州市第一人民医院、徐州市中医院2018年1月-2022年12月期间收治的AP患者3125例, 其中男1932例, 女1193例; 年龄16~95岁, 平均(48.03±18.05)岁。详细调查患者的一般资料、实验室检查(白细胞计数、中性粒细胞计数、超敏C反应蛋白、血钙、血钾、总胆固醇、甘油三酯、碳酸氢根等), 按病因分成8组: 胆源性AP组、酒精性AP组、高脂血症性AP组、胆源性合并酒精性AP组、胆源性合并高脂血症性AP组、高脂血症性合并酒精性AP组、特发性AP组、其他类型AP组。分析AP不同病因患者的性别、年龄、病史资料、严重程度和实验室检查结果。结果 3125例AP患者按年龄分组: 青年组1258例, 中年组1319例, 老年组548例。依据病情严重程度分为轻症急性胰腺炎(MAP)271例、中度重症急性胰腺炎(MSAP)1888例、重症急性胰腺炎(SAP)966例。其中胆源性(1245例, 39.84%)、酒精性(464例, 14.85%)、高脂血症性(407例, 13.02%)位居病因前3位。胆源性胰腺炎在男性和女性患者中均为最常见病因, 酒精性为男性患者中为第二常见病因, 高脂血症性为女性患者中第二常见病因。另外, 男女患者的不同病因构成进行比较, 差异有统计学意义(χ2=325.41, P < 0.05)。中、老年组以胆源性胰腺炎为主, 青年组以胆源性、酒精性、高脂血症性和特发性胰腺炎为主, 年龄在不同病因导致的AP中差异有统计学意义(χ2=289.95, P < 0.05)。胆源性胰腺炎、酒精性胰腺炎、高脂血症性胰腺炎、胆源性合并酒精性胰腺炎、高脂血症合并酒精性胰腺炎在MAP、MSAP、SAP中占比差异明显。其中胆源性胰腺炎在MSAP和SAP中的比例高于MAP, 酒精性胰腺炎和高脂血症性胰腺炎在MAP和SAP中的比例均高于MSAP, 特发性胰腺炎在MAP和MSAP中的比例高于SAP, 差异均有统计学意义(χ2=152.47, P < 0.05)。MAP、MSAP和SAP组中糖尿病史、高血压病史、冠心病史、吸烟史、饮酒史等占比均差异有统计学意义(P < 0.05), MAP、MSAP和SAP三组之间的白细胞计数、中性粒细胞计数、超敏C反应蛋白、血钙、血钾、总胆固醇、碳酸氢根等指标均差异有统计学意义(P < 0.05)。与MSAP组比较, MAP组中白细胞计数、血钾、甘油三酯指标均差异有统计学意义(P < 0.05)。结论 在徐州地区, 胆源性、酒精性和高脂血症是导致AP的常见病因。男性更容易出现胆源性和酒精性胰腺炎, 女性更容易出现胆源性和高脂血症性胰腺炎。中老年人及合并高血压、糖尿病、冠心病病史患者, 以及有吸烟、饮酒史患者更容易出现重症。另外早期实验室检查结果对于AP病情严重程度的预测具有很好的参照依据。Abstract: Objective To explore the etiology and clinical characteristics of acute pancreatitis(AP) in Xuzhou area, and provide a certain clinical reference basis for the diagnosis, treatment, and prevention of AP in the future.Methods Three thousand one hundred and twenty five patients with acute pancreatitis(AP) admitted to the Affiliated Hospital of Xuzhou Medical University, the First People's Hospital of Xuzhou City, and the Xuzhou Hospital of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively analyzed. The general information and laboratory tests(white blood cell count, neutrophil count, hypersensitive C-reactive protein, blood calcium, blood potassium, total cholesterol, triglycerides, bicarbonate, etc.) of the patients were investigated in detail. Patients were divided into 8 groups according to etiology (biliary AP, alcoholic AP, hyperlipidemic AP, biliary combined with alcoholic AP, biliary combined with hyperlipidemic AP, hyperlipidemic combined with alcoholic AP, idiopathic AP, and other types of AP). Terms of the gender, age, medical history, severity, and laboratory test results of patients with different causes of AP were analyzed.Results There were 1932 males and 1193 females with AP, aged(48.03±18.05) years old. There were 1258 cases in the youth group, 1319 cases in the middle-aged group, and 548 cases in the elderly group. There were 271 cases of mild acute pancreatitis(MAP), 1888 cases of moderately severe acute pancreatitis(MSAP), and 966 cases of severe acute pancreatitis(SAP). Among them, biliary(1245 cases, 39.84%), alcoholic(464 cases, 14.85%), and hyperlipidemic(407 cases, 13.02%) ranked among the top three causes of the disease. Biliary pancreatitis was the most common cause in both male and female patients, alcohol was the second most common cause in male patients, and hyperlipidemia was the second most common cause in female patients. In addition, there were significant differences in the composition of different etiologies between male and female patients, with statistical significance(χ2=325.41, P < 0.05). The middle-aged and elderly groups were mainly characterized by biliary pancreatitis, while the young group was mainly characterized by biliary, alcoholic, hyperlipidemic, and idiopathic pancreatitis. Age has statistical significance in acute pancreatitis caused by different causes(χ2=289.95, P < 0.05). There was a significant difference in the proportion of MAP, MSAP, and SAP among patients with biliary pancreatitis, alcoholic pancreatitis, hyperlipidemic pancreatitis, hyperlipidemic pancreatitis, and alcoholic pancreatitis. Among them, the proportion of biliary pancreatitis in MSAP and SAP was higher than that in MAP, while the proportion of alcoholic pancreatitis and hyperlipidemic pancreatitis in MAP and SAP was higher than that in MSAP. The proportion of idiopathic pancreatitis in MAP and MSAP was higher than that in SAP, and the difference was statistically significant(χ2=152.47, P < 0.05). The proportions of diabetes history, hypertension history, coronary heart disease history, smoking history and drinking history in MAP, MSAP and SAP groups were statistically different(P < 0.05), and the indexes of white blood cell count, neutrophil count, hypersensitive C-reactive protein, blood calcium, blood potassium, total cholesterol, bicarbonate, etc. between MAP, MSAP and SAP groups were statistically different(P < 0.05). Compared with the MSAP group, there were statistically significant differences in white blood cell count, blood potassium, and triglyceride indicators in the MAP group(P < 0.05).Conclusion In Xuzhou area, biliary, alcoholic, and hyperlipidemia were common causes of AP. Men were more likely to develop biliary and alcoholic pancreatitis, while women were more likely to develop biliary and hyperlipidemic pancreatitis. Middle aged and elderly people, patients with hypertension, diabetes, coronary heart disease history, and patients with smoking and drinking history were more likely to have severe disease. In addition, early laboratory examination results have a good reference basis for predicting the severity of AP's condition.
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Key words:
- acute pancreatitis /
- etiology /
- clinical characteristics /
- severity
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表 1 不同性别AP患者的病因构成
例(%) 病因 男性 女性 合计 胆源性 772(35.06) 473(51.25) 1 245(39.84) 酒精性 452(20.53) 12(1.30) 464(14.85) 高脂血症性 189(8.58) 218(23.62) 407(13.02) 胆源性合并酒精性 272(12.35) 3(0.33) 275(8.80) 胆源性合并高脂血症性 81(3.68) 61(6.61) 142(4.54) 高脂血症性合并酒精性 236(10.72) 5(0.54) 241(7.71) 特发性 149(6.77) 123(13.33) 272(8.70) 其他 51(2.31) 28(3.03) 79(2.53) 合计 2 202(100.00) 923(100.00) 3 125(100.00) 
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表 2 不同年龄AP患者的病因构成
例(%) 病因 青年组(≤44岁) 中年组(>44~59岁) 老年组(>59岁) 合计 胆源性 341(27.39) 509(40.88) 395(31.73) 1 245(100.00) 酒精性 236(50.86) 213(45.91) 15(3.23) 464(100.00) 高脂血症性 172(42.26) 184(45.21) 51(12.53) 407(100.00) 胆源性合并酒精性 131(47.64) 105(38.18) 39(14.18) 275(100.00) 胆源性合并高脂血症性 52(36.62) 71(50.00) 19(13.38) 142(100.00) 高脂血症性合并酒精性 105(43.57) 128(53.11) 8(3.32) 241(100.00) 特发性 182(66.91) 74(27.21) 16(5.88) 272(100.00) 其他 39(49.37) 35(44.30) 5(6.33) 79(100.00) 合计 1 258(40.26) 1 319(42.21) 548(17.54) 3 125(100.00)
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表 3 不同病情严重程度AP病因构成
例(%) 病因 MAP MSAP SAP 合计 胆源性 145(53.51) 852(45.13) 248(25.67) 1 245(100.00) 酒精性 25(9.23) 248(13.14) 191(19.77) 464(100.00) 高脂血症性 69(25.46) 187(9.90) 151(15.63) 407(100.00) 胆源性合并酒精性 6(2.21) 159(8.42) 110(11.39) 275(100.00) 胆源性合并高脂血症性 5(1.85) 71(3.76) 66(6.83) 142(100.00) 高脂血症性合并酒精性 8(2.95) 128(6.78) 105(10.87) 241(100.00) 特发性 9(3.32) 185(9.80) 78(8.07) 272(100.00) 其他 4(1.48) 58(3.07) 17(1.76) 79(100.00) 合计 271(8.67) 1 888(60.42) 966(30.91) 3 125(100.00)
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表 4 不同严重程度AP病史资料及实验室结果比较
指标 MAP MSAP SAP χ2/F P 性别/例 5.12 0.12 男 194 1156 582 女 77 732 384 年龄/岁 48.21±21.15 47.59±17.59 45.98±19.72 0.25 0.84 住院天数/d 6.75±3.28 8.72±4.15 7.41±3.19 1.08 0.29 高血压/例(%) 15(5.54) 685(36.28) 512(53.00) 35.59 < 0.01 糖尿病/例(%) 12(4.43) 1052(55.72) 481(49.79) 57.82 < 0.01 冠心病/例(%) 5(1.85) 528(27.97) 318(32.92) 45.97 < 0.01 吸烟史/例(%) 25(9.23) 971(51.43) 548(56.73) 92.16 < 0.01 饮酒史/例(%) 51(18.82) 1251(66.26) 452(46.79) 105.37 < 0.01 白细胞计数/(×109/L) 8.15±2.13 12.34±4.24 13.15±5.24 25.31 < 0.01 中性粒细胞计数/(×109/L) 8.57±3.21 12.56±5.49 15.21±4.79 14.15 < 0.01 超敏C反应蛋白/(mg/L) 25.38±17.94 62.81±50.14 150.14±101.05 28.98 < 0.01 血钙/(mmol/L) 2.29±0.76 2.01±0.35 1.71±0.28 30.92 < 0.01 血钾/(mmol/L) 4.01±0.78 3.64±0.37 3.15±0.31 9.55 0.01 碳酸氢根/(mmol/L) 23.51±3.42 22.83±3.82 20.88±4.26 7.85 0.02 总胆固醇/(mmol/L) 5.76±1.32 5.65±1.28 9.38±5.45 10.23 < 0.01 甘油三酯/(mmol/L) 7.41±6.41 8.95±6.98 15.21±11.32 2.52 0.41
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