妊娠合并高甘油三酯血症性急性胰腺炎的临床特征及预后分析

陈雨晴; 李佩玲; 张璐; 徐欢; 彭燕; 汤小伟

doi:10.3969/j.issn.1001-5256.2021.05.036

妊娠合并高甘油三酯血症性急性胰腺炎的临床特征及预后分析

DOI: 10.3969/j.issn.1001-5256.2021.05.036

西南医科大学附属医院消化内科，四川泸州 646000

基金项目:

西南医科大学附属医院博士科研启动基金资助项目 (16229);

泸州市人民政府西南医科大学科技战略合作项目 (2019LZXNYDJ24);

西南医科大学青年基金 (0903-00031099)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：陈雨晴负责课题设计，资料分析，撰写论文；李佩玲、张璐、徐欢参与收集数据，修改论文；彭燕、汤小伟负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
陈雨晴(1995—)，女，主要从事胰腺疾病基础及临床研究

通信作者:
汤小伟，583437126@qq.com

中图分类号: R576
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出版历程
- 收稿日期: 2020-10-22
- 录用日期: 2020-11-27
- 出版日期: 2021-05-20

Clinical and prognostic features of hypertriglyceridemic pancreatitis during pregnancy

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

摘要

摘要: 目的分析妊娠合并高甘油三酯血症性急性胰腺炎(HTGP)的临床特征及预后情况。方法选取2013年1月—2020年6月西南医科大学附属医院收治的77例妊娠合并急性胰腺炎患者为研究对象。根据病因(是否为HTGP)分为高脂组(n=38)和非高脂组(n=39)。分析对比组间临床特征，包括年龄、孕期、实验室指标、并发症及预后指标。符合正态分布的计量资料两组间比较采用独立样本t检验，不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验；计数资料两组间比较用χ²检验或Fisher精确检验，等级资料两组间比较用Mann-Whitney U检验；根据孕期分为早期组(n=4)、中期组(n=14)和晚期组(n=59)，比较不同孕期血脂水平，组间和组内两两比较采用Kruskal-Wallis H检验。结果高脂组平均年龄大于非高脂组(t=-3.000，P=0.004); 高脂组伴发糖尿病的比例高于非高脂组(χ²=8.867，P=0.003)；高脂组孕妇与非高脂组相比发病主要集中在孕晚期(P < 0.001)；高脂组血钠水平明显低于非高脂组(Z=-6.328，P < 0.001)；对于急性胰周液体积聚及全身炎症反应综合征，高脂组的发生率分别为76.3%、81.6%，均高于非高脂组33.3%、41.0%(χ²值分别为14.342、13.310，P值均 < 0.001)。两组住院天数、ICU入住率、住院费用比较均有统计学差异(Z=-2.077、χ²=11.537、Z=-3.525，P值均 < 0.05)。孕晚期TC、TG水平明显高于中期，差异均有统计学意义(P值均 < 0.05)。结论与非高脂组相比，高脂组发病更集中在孕晚期，并发症的风险更高，住院时间更长，花费更多。
- 胰腺炎 /
- 妊娠 /
- 高脂血症 /
- 预后
Abstract: Objective To investigate the clinical and prognostic features of hypertriglyceridemic pancreatitis (HTGP) during pregnancy. Methods A total of 77 patients with acute pancreatitis in pregnancy who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to June 2020 were enrolled as subjects, and according to the presence or absence of HTGP, they were divided into HTGP group with 38 patients and non-HTGP group with 39 patients. The two groups were compared in terms of the clinical features including age, pregnancy, laboratory markers, complication, and prognostic indices. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups. According to the trimester of pregnancy, the patients were divided into early pregnancy group with 4 patients, middle pregnancy group with 14 patients, and late pregnancy with 59 patients, and blood lipid levels were compared between groups; the Kruskal-Wallis H test was used for comparison between two groups or within each group. Results Compared with the non-HTGP group, the HTGP group had significantly higher mean age (t=-3.000, P=0.004) and proportion of patients with diabetes (χ²=8.867, P=0.003). Compared with the non-HTGP group, the HTGP group had a significantly higher proportion of patients with disease onset in the third trimester (P < 0.001) and a significantly lower serum level of sodium (Z=-6.328, P < 0.001). Compared with the non-HTGP group, the HTGP group had significantly higher incidence rates of acute peripancreatic fluid collection (76.3% vs 33.3%, χ²=14.342, P < 0.001) and systemic inflammatory response syndrome (81.6% vs 41.0%, χ²=13.310, P < 0.001). There were significant differences between the two groups in the length of hospital stay, the rate of admission to the intensive care unit, and hospital costs (Z=-2.077, χ²=11.537, Z=-3.525, all P < 0.05). The levels of total cholesterol and triglyceride in the third trimester were significantly higher than those in middle pregnancy (both P < 0.05). Conclusion Compared with the non-HTGP group, the HTGP group has a higher proportion of patients with disease onset in the third trimester of pregnancy, a higher risk of complications, a longer length of hospital stay, and higher hospital costs.
- Pancreatitis /
- Pregnancy /
- Hyperlipidemias /
- Prognosis

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表 1 两组一般资料比较

项目	非高脂组(n=39)	高脂组(n=38)	统计值	P值
年龄(岁)	26.08±5.29	29.55±4.86	t=-3.000	0.004
糖尿病[例(%)]	1(2.6)	10(26.3)	χ²=8.867	0.003
脂肪肝[例(%)]	6(15.4)	13(34.2)	χ²=3.670	0.068
孕期[例(%)]				< 0.001
早期	3(7.7)	1(2.6)
中期	13(33.3)	1(2.6)
晚期	23(59.0)	36(94.7)
血钙(mmol/L)	2.2±0.2	2.1±0.2	t=1.543	0.127
血钠(mmol/L)	137.5(136.2~139.2)	128.6(125.0~134.1)	Z=-6.328	< 0.001
淀粉酶(U/L)	436.8(94.9~1626.0)	213.6(107.5~501.8)	Z=-1.707	0.088
脂肪酶(U/L)	561.0(36.8~1192.6)	287.5(149.6~1002.8)	Z=-0.357	0.721
白细胞计数(10⁹/L)	12.3(7.8~15.6)	14.7(10.4~18.1)	Z=-1.809	0.071
CRP(mg/L)	34.0(8.3~53.0)	43.7(13.3~80.0)	Z=-1.580	0.114

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表 2 两组病情及并发症比较

项目	非高脂组(n=39)	高脂组(n=38)	统计值	P值
分型[例(%)]			Z=-4.076	< 0.001
MAP	24(61.5)	6(15.8)
MSAP	14(35.9)	28(73.7)
SAP	1(2.6)	4(10.5)
局部并发症[例(%)]
APFC	13(33.3)	29(76.3)	χ²=14.342	< 0.001
ANC	1(2.6)	6(15.8)		0.056
WON	5(12.8)	3(7.9)		0.711
PPC	2(5.1)	4(10.5)		0.431
全身并发症[例(%)]
SIRS	16(41.0)	31(81.6)	χ²=13.310	< 0.001
呼吸衰竭	1(2.6)	6(15.8)		0.056
肾衰竭	1(2.6)	0		＞0.05
循环衰竭	0	1(2.6)		0.494

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表 3 两组住院天数、ICU入住情况、住院总费用比较

项目	非高脂组(n=39)	高脂组(n=38)	统计值	P值
住院时间(d)	11.0(8.0~14.0)	16.0(8.8~22.5)	Z=-2.077	0.038
ICU入住[例(%)]	4(10.3)	17(44.7)	χ²=11.537	0.001
住院总费用(元)	23 782.0(9439.5~33 543.7)	35 554.1(24 849.6~59 647.5)	Z=-3.525	< 0.001

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表 4 不同孕期血脂水平比较

项目	早期(n=4)	中期(n=14)	晚期(n=59)	H值	P值
TC(mmol/L)	0.9(0.7~17.4)	2.5(1.4~2.7)	7.1(3.4~21.0)¹⁾	18.208	< 0.001
TG(mmol/L)	4.7(4.1~6.8)	4.8(4.2~5.5)	7.1(5.1~15.4)¹⁾	9.421	0.009
HDL-C(mmol/L)	1.4(0.9~2.1)	1.5(1.2~1.7)	1.3(0.9~1.7)	1.341	0.511
LDL-C(mmol/L)	2.1(0.8~3.1)	2.9(2.2~3.2)	3.8(2.5~5.6)	8.765	0.012
APO-A(g/L)	1.8(1.3~2.2)	1.8(1.6~1.9)	1.6(1.0~2.0)	0.793	0.673
APO-B(g/L)	0.8(0.7~1.0)	1.1(0.7~1.3)	1.0(0.6~2.3)	1.317	0.581
注：与中期比较，1)P<0.05。

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