急性复发性胰腺炎并发急性肾损伤的影响因素分析

王健; 郁毅刚; 林庆斌; 吴燕生

doi:10.13201/j.issn.1009-5918.2023.12.04

急性复发性胰腺炎并发急性肾损伤的影响因素分析

- 第九〇九医院(厦门大学附属东南医院)急诊科(福建漳州，363000)
基金项目:
军队后勤科研重大项目(No：BLB18J006)

详细信息

通讯作者: 吴燕生，E-mail：wuyansheng175@163.com

中图分类号: R657.5

收稿日期: 2023-07-11

刊出日期: 2023-12-10

Analysis of influencing factors of acute kidney injury in acute recurrent pancreatitis

- Department of Emergency, the 909th Hospital, Dongnan Hospital of Xiamen University, Zhangzhou, Fujian, 363000, China

More Information

Corresponding author: WU Yansheng, E-mail: wuyansheng175@163.com

Received Date: 11 July 2023

Publish Date: 10 December 2023

摘要

摘要: 目的探讨急性复发性胰腺炎(acute recurrent pancreatitis，ARP)并发急性肾损伤(acute kidney injury，AKI)的影响因素。方法回顾性分析2019年1月—2022年12月第九〇九医院急诊科收治的76例ARP患者临床资料，根据是否并发AKI分为AKI组(29例)和非AKI组(47例)，采用单因素和logistic多因素分析ARP并发AKI的危险因素。结果 AKI组全身炎症反应综合征、腹腔间隔室综合征、辅助通气、中重度AP发生率高于非AKI组，差异有统计学意义(P < 0.05)；AKI组急性生理与慢性健康评估Ⅱ评分(acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ)、C-反应蛋白(C-reactive protein，CRP)、降钙素原(procalcitonin，PCT)高于非AKI组，差异有统计学意义(P < 0.05)；AKI组AP发作间隔时小于非AKI组，差异有统计学意义(P < 0.05)。APACHE Ⅱ评分(OR=12.503，95%CI：3.705~17.431)、AP分级(OR=9.177，95%CI：3.512~18.834)、CRP(OR=9.909，95%CI：1.228~18.440)、PCT(OR=8.876，95%CI：2.661~11.246)是ARP患者发生AKI的独立危险因素(P < 0.05)。结论 ARP患者中AKI发生较高，APACHE Ⅱ评分≥15分、中重症AP、CRP≥42 mmol/L、PCT≥3.35 ng/mL是ARP患者发生AKI的危险因素，早期识别相关危险因素，及早干预，有助于降低AKI发生率。
- 急性复发性胰腺炎 /
- 急性肾损伤 /
- 并发症
Abstract: Objective To investigate the influencing factors of acute kidney injury(AKI) in acute recurrent pancreatitis(ARP).Methods The clinical data of 76 ARP patients admitted to the 909th Hospital from January 2019 to December 2022 were retrospectively analyzed. All patients were divided into AKI group(n=29) and non-AKI group(n=47) according to whether they had concurrent AKI. Single factor and logistic multiple factor were used to analyze the risk factors of ARP concurrent AKI.Results The incidence of systemic inflammatory response syndrome, abdominal compartment syndrome, assisted ventilation and moderate to severe AP in AKI group were higher than there in non-AKI group, there were significantly different in two groups(P < 0.05). The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, C-reactive protein(CRP) and procalcitonin(PCT) in AKI group were higher than those in non-AKI group, there were significantly different in two groups(P < 0.05). The interval between AP episodes in AKI group was shorter than that in non-AKI group, there were significantly different in two groups(P < 0.05). APACHE Ⅱ score(OR=12.503, 95%CI: 3.705-17.431), AP score(OR=9.177, 95%CI: 3.512-18.834), CRP(OR=9.909, 95%CI: 1.228-18.440) and PCT(OR=8.876, 95%CI: 2.661-11.246) were independent risk factors for AKI in ARP patients(P < 0.05).Conclusion The incidence of AKI is high in ARP patients. APACHE Ⅱ score ≥15, intermediate and severe AP, CRP≥42 mmol/L, and PCT≥3.35 ng/mL are risk factors for AKI in ARP patients. Early identification of related risk factors and early intervention can help reduce the incidence of AKI.
- acute recurrent pancreatitis /
- acute kidney injury /
- complications

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表 1 两组患者一般资料对比例，X±S

一般资料	AKI组(29例)	非AKI组(47例)	t/χ²	P
年龄/岁	49.20±5.83	49.06±5.39	0.109	0.914
性别			0.335	0.563
男	18	26
女	11	21
糖尿病			0.085	0.771
有	7	10
无	22	37
高血压			0.005	0.942
有	7	11
无	22	36
吸烟			1.101	0.294
有	10	11
无	19	36
酗酒			0.004	0.951
有	6	10
无	23	37
病因			< 0.001	1.000
胆源性	27	43
酒精性	2	4

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表 2 两组患者临床指标对比 X±S，M(Q₁，Q₃)

临床指标	AKI组(29例)	非AKI组(47例)	t/χ²/Z	P
AP发作次数/次	2.55±0.68	2.27±0.53	1.837	0.072
AP发作间隔时间/月	9.31±4.67	11.61±3.76	-2.362	0.021
APACHE Ⅱ评分/分	19.62±2.80	10.12±1.90	17.555	< 0.001
胰周积液/例			0.003	0.955
有	14	23
无	15	24
SIRS/例			5.731	0.020
有	15	12
无	14	35
IAH/例			0.884	0.347
有	13	16
无	16	31
ACS/例			7.209	0.007
有	14	9
无	15	38
辅助通气/例			5.750	0.016
有	13	9
无	16	38
AP分级/例			8.808	0.003
中重度	15	9
轻度	14	38
白细胞/(×10⁹/L)	17.23±1.97	17.08±2.07	0.295	0.769
甘油三酯/(mmol/L)	4.16±0.72	4.07±0.62	0.579	0.564
淀粉酶/(U/L)	637(537.5，777)	735(634，845)	-1.797	0.072
Cr/(μmol/L)	97(85，123.5)	86(78，112)	-1.765	0.078
CRP/(mmol/L)	46(42，52.5)	36(27，46)	-3.253	0.001
PCT/(ng/mL)	4.67±0.88	2.71±0.79	10.014	< 0.001
尿素氮/(μmol/L)	9.00±1.16	7.21±0.90	7.506	< 0.001

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表 3 AKI发生的多因素分析

因素	赋值	β	SE	Wald	OR	95%CI	P
AP发作间隔时间/月	0=>10，1=≤10	0.776	1.509	0.265	2.173	0.113~4.892	0.607
APACHE Ⅱ评分/分	0= < 15，1=≥15	7.322	3.067	5.697	12.503	3.705~17.431	0.017
SIRS	0=无，1=有	2.547	2.248	1.284	2.078	0.111~6.414	0.257
ACS	0=无，1=有	3.470	1.956	3.148	12.138	0.695~25.431	0.076
辅助通气	0=无，1=有	1.157	1.847	0.393	5.314	0.998~11.727	0.531
AP分级	0=轻度，1=中重度	5.856	3.329	3.094	9.177	3.512~18.834	0.009
CRP/(mmol/L)	0= < 42，1=≥42	4.381	2.106	4.327	9.909	1.228~18.440	0.038
PCT/(ng/mL)	0= < 3.35，1=≥3.35	4.417	1.754	6.339	8.876	2.661~11.246	0.012

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