Clinical characteristics and prognosis of acute pancreatitis in pregnancy: a 10-year single-center retrospective analysis
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摘要: 目的 分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy，APIP)患者的类型、临床特征及预后危险因素，探讨APIP的预防及治疗管理。方法 回顾性分析2012年4月—2022年3月绵阳市中心医院收治的96例APIP患者，包括APIP的病因、严重程度、实验室指标、并发症、治疗及预后等。结果 根据疾病严重程度分组，轻症APIP(mild APIP，MAPIP)49例(51.04%)，中重症APIP(moderate severe APIP，MSAPIP)27例(28.12%)，重症APIP(severe APIP，SAPIP)20例(20.83%)。疾病越重，患者的超敏C反应蛋白越高，血钙及白蛋白水平越低，差异有统计学意义(均P < 0.05)。组间血淀粉酶、血脂肪酶、血糖指标的差异均无统计学意义(P>0.05)。APIP的主要病因为高脂血症(45/96，46.87%)，胆源性APIP 28例(29.17%)，特发性APIP 23例(23.96%)。合并有糖尿病的患者高脂血症性APIP发生率更高。高脂血症性APIP更容易出现局部或全身并发症，发展为MSAPIP和SAPIP，差异有统计学意义(P < 0.001)。APIP患者的病情越重，胎儿丢失率越高，差异有统计学意义(P < 0.05)，高脂血症性APIP更易出现胎儿丢失，差异有统计学意义(P < 0.001)。结论 APIP在妊娠晚期发生率高，高脂血症是首要病因，并且高脂血症性APIP更易重症化。胎儿丢失率与APIP的严重程度密切相关。APIP的早期诊断、严重程度的评估及治疗方法的选择对于母婴预后非常重要。Abstract: Objective To analyse the types, clinical characteristics and prognostic risk factors of patients with acute pancreatitis in pregnancy(APIP), and to discuss the prevention and therapeutic management of APIP.Methods We retrospectively reviewed 96 APIP cases admitted to Mianyang Central Hospital from April 2012 to March 2022, including APIP types, severity, biochemical parameters, complications, treatment and prognosis.Results In total, 49(51.04%), 27(28.12%), and 20(20.83%) patients had mild APIP(MAPIP), moderate to severe APIP(MSAPIP), and severe APIP(SAPIP), respectively. The more severe the disease, the higher the patient's high-sensitivity C-reactive protein and the lower the blood calcium and albumin levels(all P < 0.05). The differences in blood amylase, blood lipase and blood glucose indicators between groups were not statistically significant(P>0.05). The major cause of APIP in these patients was hyperlipidemia(45/96, 46.87%), 28 cases(29.17%) suffered from biliary APIP, 23 cases(23.96%) suffered from idiopathic APIP. The incidence of hyperlipidaemic APIP was higher in patients with diabetes. Hyperlipidaemic APIP was more likely to develop local or systemic complications, developing MSAPIP and SAPIP(P < 0.001). The more severe the condition of the patient with APIP, the higher the rate of fetal loss(P < 0.05), and hyperlipidaemic APIP was more likely to have fetal loss(P < 0.001).Conclusion APIP has a high incidence in late pregnancy, hyperlipidaemia is the major cause and hyperlipidemic APIP is more likely to be severe. The rate of fetal loss is closely related to the severity of APIP. Early diagnosis, assessment of its severity of APIP and choice of treatment are important for the prognosis of mother and child.
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Key words:
- acute pancreatitis /
- pregnancy /
- hyperlipidaemia /
- fetal loss
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表 1 不同严重程度APIP的临床特征及实验室检查结果比较
项目 MAPIP(49例) MSAPIP(27例) SAPIP(20例) χ2/H/F P 年龄/岁 27.78±4.37 29.89±5.12 31.45±4.64 4.934 0.009 住院时间/d 7.0(5.5~9.0) 15(11.0~19.0) 17(12.0~25.3) 40.911 0.006 发病孕期/例(%) 3.152 0.369 孕早期 4(80.0) 0(0.0) 1(20.0) 孕中期 14(56.0) 7(28.0) 4(16.0) 孕晚期 30(48.4) 19(30.6) 13(21.0) 产褥期 1(25.0) 1(25.0) 2(50.0) 病因/例(%) 30.501 < 0.001 高脂血症性 9(20.0) 20(44.4) 16(35.6) 胆源性 22(78.6) 5(17.9) 1(3.6) 特发性 18(78.3) 2(8.7) 3(13.0) 实验室检查结果 血淀粉酶/(U/L) 437.00 (199.50~727.50) 256.00 (144.00~468.00) 846.50 (447.75~1570.25) 3.259 0.196 血脂肪酶/(U/L) 860.0(200.0~1776.0) 314.0(141.5~644.5) 605.0(311.5~1566.8) 3.141 0.208 白细胞数/(×109/L) 11.77(9.82~15.81) 17.31(14.25~23.44)1) 16.31(12.82~22.83)1) 17.966 < 0.001 嗜中性粒细胞比值/% 85.80(81.20~90.45) 88.70(84.20~91.40) 90.35(87.73~92.78)1) 10.232 0.010 超敏C反应蛋白/(mg/L) 13.62 (3.22~75.18) 147.13 (71.68~257.27)1) 148.89 (122.94~225.99)1)2) 47.314 < 0.001 降钙素原/(ng/mL) 0.12(0.06~0.26) 0.38(0.22~0.69)1) 0.99(0.25~2.34)1) 26.483 < 0.001 甘油三酯/(mmol/L) 3.82(2.36~5.76) 22.32(11.96~42.24)1) 19.66(11.73~47.86)1) 25.287 < 0.001 胆固醇/(mmol/L) 5.63(4.64~7.17) 16.07(8.20~20.82)1) 16.63(12.85~18.46)1) 32.018 < 0.001 血糖/(mmol/L) 5.31(4.47~7.63) 5.88(4.25~10.30) 7.36(5.38~9.14) 4.506 0.250 血钙/(mmol/L) 2.16(2.01~2.27) 1.92(1.72~2.09)1) 1.72(1.37~1.96)1)2) 24.335 < 0.001 白蛋白/(g/L) 34.51±5.96 29.05±5.551) 24.66±5.731)2) 22.398 < 0.001 与MAPIP组比较，1)P < 0.05；与MSAPIP组比较，2)P < 0.05。 
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表 2 不同病因APIP的临床特征及并发症比较
项目 高脂血症性组(45例) 胆源性组(28例) 特发性组(23例) χ2/H/F P 年龄/岁 30.64±4.73 27.46±4.45 28.22±4.77 4.602 0.012 住院时间/d 14.0(10.0~19.0) 8.0(6.0~12.8) 7.0(6.0~12.0) 18.108 < 0.001 糖尿病/例(%) 15(33.3) 1(3.6) 1(4.3) 14.196 0.001 脂肪肝/例(%) 8(17.8) 3(10.7) 5(21.7) 1.180 0.563 并发症/例(%) 急性胰周液体积聚 27(60.0) 4(14.3) 5(21.7) 18.596 < 0.001 急性坏死物积聚 4(8.9) 2(7.1) 1(4.3) 0.466 0.792 胰腺假性囊肿 3(6.7) 1(3.6) 0 1.729 0.421 包裹性坏死 2(4.4) 1(3.6) 0 1.019 0.601 胸腔积液 12(26.7) 1(3.6) 2(8.7) 8.085 0.018 肺部感染 4(8.9) 1(3.6) 0 2.650 0.266 急性呼吸窘迫综合征 8(17.8) 1(3.6) 0 7.229 0.027 休克 7(15.6) 0 1(4.3) 6.096 0.037 急性肾功能不全 3(6.7) 0 1(4.3) 1.824 0.362 多器官功能衰竭 4(8.9) 0 0 4.626 0.115
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表 3 APIP患者胎儿丢失的危险因素分析
例(%) 因素 胎儿存活(73例) 胎儿丢失(15例) χ2/Z P 发病孕期 10.394 0.006 孕早期 2(40.0) 3(60.0) 孕中期 16(72.7) 6(27.3) 孕晚期 55(90.2) 6(9.8) 病因 15.258 < 0.001 高脂血症性 28(66.7) 14(33.3) 胆源性 25(100.0) 0 特发性 20(95.2) 1(4.8) 严重程度 -2.833 0.005 MAPIP 42(91.3) 4(8.7) MSAPIP 20(87.0) 3(13.0) SAPIP 11(57.9) 8(42.1)
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