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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (05) : 393 -399. doi: 10.3877/cma.j.issn.1674-6880.2021.05.008

论著

妊娠期高甘油三酯性急性胰腺炎临床特征分析：10年单中心回顾性分析
蔡学英1, 陈嘉伊2, 曾龙欢2, 王剑荣1, 朱英1, 胡炜1,†()   
  1. 1. 310006　杭州，浙江大学医学院附属杭州市第一人民医院重症医学科
    2. 310022　杭州，杭州市第一人民医院城北院区重症医学科
  • 收稿日期:2021-04-19 出版日期:2021-10-31
  • 通信作者: 胡炜

Clinical characteristics of patients with hypertriglyceridemia acute pancreatitis during pregnancy: a 10-year single-center retrospective analysis

Xueying Cai1, Jiayi Chen2, Longhuan Zeng2, Jianrong Wang1, Ying Zhu1, Wei Hu1,†()   

  1. 1. Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
    2. Department of Intensive Care Unit, Hangzhou Geriatric Hospital, Hangzhou First People's Hospital Group, Hangzhou 310022, China
  • Received:2021-04-19 Published:2021-10-31
  • Corresponding author: Wei Hu
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蔡学英, 陈嘉伊, 曾龙欢, 王剑荣, 朱英, 胡炜. 妊娠期高甘油三酯性急性胰腺炎临床特征分析：10年单中心回顾性分析[J]. 中华危重症医学杂志(电子版), 2021, 14(05): 393-399.

Xueying Cai, Jiayi Chen, Longhuan Zeng, Jianrong Wang, Ying Zhu, Wei Hu. Clinical characteristics of patients with hypertriglyceridemia acute pancreatitis during pregnancy: a 10-year single-center retrospective analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(05): 393-399.

目的

探讨妊娠期高甘油三酯性急性胰腺炎（HTGP）患者的临床特征。

方法

收集2009年9月1日至2019年8月31日期间浙江大学医学院附属杭州市第一人民医院收治的163例妊娠期急性胰腺炎患者的临床资料，根据不同病因将所有患者分为HTGP组（45例）、胆源性组（66例）及特发性组（52例），同时根据病情严重程度将HTGP患者进一步分为轻症急性胰腺炎（MAP）组（18例）、中度重症急性胰腺炎（MSAP）组（11例）、重症急性胰腺炎（SAP）组（16例）。对不同病因下患者的病情严重程度、局部并发症、合并症进行比较。对各亚组HTGP患者的实验室检查指标、是否接受了血浆置换或血液灌流进行比较。

结果

HTGP组、胆源性组和特发性组间MAP、MSAP、SAP、急性胰周液体积聚（APFC）、胰腺假性囊肿（PPC）、急性坏死物积聚或包裹性坏死及急性呼吸窘迫综合征和循环系统衰竭发生率的比较，差异均有统计学意义（χ2 = 44.457、11.367、28.482、34.340、15.589、9.584、12.272、8.157，P均< 0.05）。且HTGP组的MSAP[24.44%（11/45）、5.77%（3/52）、6.06%（4/66）]、SAP[35.56%（16/45）、3.85%（2/52）、4.55%（3/66）]、APFC[37.78%（17/45）、3.85%（2/52）、3.03%（2/66）]、PPC[24.44%（11/45）、1.92%（1/52）、6.06%（4/66）]和急性呼吸窘迫综合征[20.00%（9/45）、3.85%（2/52）、3.03%（2/66）]的发生率均显著高于特发性组及胆源性组，MAP[40.00%（18/45）、90.38%（47/52）、89.39%（59/66）]的发生率均显著低于特发性组及胆源性组（P均< 0.017）。MAP组、MSAP组和SAP组患者住院时间、血肌酐、血糖水平及接受了血浆置换或血液灌流的比较，差异均有统计学意义（F = 1 349.641、13 578.432、4.916，χ2 = 7.727，P均< 0.05）。且与MAP组患者比较，SAP组患者的住院时间明显延长[（14 ± 9）d vs.（26 ± 17）d，P<0.05]，血糖水平明显升高[（5.9 ± 2.5）mmol/L vs.（9.9 ± 5.4）mmol/L，P<0.05]，接受血浆置换或血液灌流的例数明显较高[11/18 vs.16/16，P<0.017]；SAP组患者的血肌酐水平均显著高于MAP组和MSAP组[（82 ± 34）、（48 ± 18）、（44 ± 24）μmol/L，P均< 0.05]。研究中没有孕产妇死亡，但胎儿病死率达到10.43%（17/163），其中8例为HTGP孕妇。

结论

在HTGP患者中SAP及并发症发生率明显高于胆源性及特发性急性胰腺炎，采用血浆置换或血液灌流快速降低血清甘油三酯水平是HTGP治疗中安全有效的选择。

关键词: 胰腺炎, 妊娠, 高甘油三酯血症, 回顾性研究
Objective

To investigate the clinical characteristics of patients with hypertriglyceridemia acute pancreatitis (HTGP) during pregnancy.

Methods

The clinical data of 163 patients with acute pancreatitis in pregnancy admitted to the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine from September 1, 2009 to August 31, 2019 were collected and retrospectively analyzed. The patients were divided into a HTGP group (45 cases), a biliary pancreatitis group (66 cases) and an idiopathic pancreatitis group (52 cases) according to the etiology. At the same time, HTGP patients were divided into three subgroups according to the severity of the disease: mild acute pancreatitis (MAP) group (18 cases), moderate to severe acute pancreatitis (MSAP) group (11 cases) and severe acute pancreatitis (SAP) group (16 cases). The illness severity, local complications and complications of patients under different etiologies were compared. The laboratory test indexes and whether to receive plasma exchange or hemoperfusion were compared in each subgroup.

Results

The incidence of MAP, MSAP, SAP, acute peripancreatic fluid collection (APFC), pancreatic pseudocysts (PPC), acute necrosis collection or walled-off necrosis, acute respiratory distress syndrome and circulatory failure among the HTGP, biliary pancreatitis and idiopathic pancreatitis groups all showed significant differences (χ2 = 44.457, 11.367, 28.482, 34.340, 15.589, 9.584, 12.272, 8.157; all P < 0.05). The incidence of MSAP [24.44% (11/45), 5.77% (3/52), 6.06% (4/66)], SAP [35.56% (16/45), 3.85% (2/52), 4.55% (3/66)], APFC [37.78% (17/45), 3.85% (2/52), 3.03% (2/66)], PPC [24.44% (11/45), 1.92% (1/52), 6.06% (4/66)] and acute respiratory distress syndrome [20.00% (9/45), 3.85% (2/52), 3.03% (2/66)] was significantly higher in the HTGP group than in the biliary pancreatitis and idiopathic pancreatitis groups, and the incidence of MAP [40.00% (18/45), 90.38% (47/52), 89.39% (59/66)] was significantly lower (all P < 0.017). The length of stay, serum creatinine, blood glucose and received plasma exchange or hemoperfusion among the MAP, MSAP and SAP groups all showed significant differences (F = 1 349.641, 13 578.432, 4.916; χ2 = 7.727; all P < 0.05). Compared with the MAP group, the length of stay was significantly longer [(14 ± 9) d vs. (26 ± 17) d, P < 0.05], and the levels of blood glucose [(5.9 ± 2.5) mmol/L vs. (9.9 ± 5.4) mmol/L, P < 0.05] and the number of received plasma exchange or hemoperfusion [11/18 vs. 16/16, P < 0.017] increased obviously in the SAP group. The serum creatinine in the SAP group was also significantly higher than that in the MAP and MSAP groups [(82 ± 34), (48 ± 18), (44 ± 24) μmol/L; all P < 0.05]. There was no maternal death, but the fetal mortality was 10.43% (17/163), and eight of them were HTGP patients.

Conclusion

The incidence of SAP and complications in the HTGP patients is significantly higher than that in the biliary pancreatitis and idiopathic pancreatitis patients, and plasma exchange or hemoperfusion can rapidly reduce serum triglyceride levels and may be a safe and effective option for HTGP.

Key words: Pancreatitis, Pregnancy, Hypertriglyceridemia, Retrospective studies
表1 各组APIP患者临床特征的比较[例（%）]
组别 例数 年龄（岁，±s） 孕周（周，±s） 疾病严重程度 局部并发症
MAP MSAP SAP APFC PPC ANC或WON
特发性组 52 27 ± 5 25 ± 10 47（90.38） 3（5.77） 2（3.85） 2（3.85） 1（1.92） 2（3.85）
胆源性组 66 30 ± 5a 26 ± 8 59（89.39） 4（6.06） 3（4.55） 2（3.03） 4（6.06） 1（1.52）
HTGP组 45 30 ± 5a 32 ± 7ab 18（40.00）cd 11（24.44）cd 16（35.56）cd 17（37.78）cd 11（24.44）cd 7（15.56）d
F/χ2值   4.533 8.504 44.457 11.367 28.482 34.340 15.589 9.584
P值   0.012 <0.001 <0.001 0.003 <0.001 <0.001 <0.001 0.007
组别 例数 ARDS 循环系统疾病 急性肾功能不全 多器官功能衰竭 高血压 糖尿病 脂肪肝
特发性组 52 2（3.85） 2（3.85） 2（3.85） 2（3.85） 1（1.92） 2（3.85） 9（17.31）
胆源性组 66 2（3.03） 3（4.54） 1（1.52） 2（3.03） 2（3.03） 1（1.52） 6（9.09）
HTGP组 45 9（20.00）cd 8（17.78） 5（11.11） 5（11.11） 2（4.44） 5（11.11） 10（22.22）
F/χ2值   12.272 8.157 5.464 3.760 0.516 5.464 3.781
P值   0.002 0.017 0.065 0.153 0.772 0.065 0.151
表2 各组HTGP患者临床特征及实验室检查结果的比较（±s）
组别 例数 年龄（岁） 孕周（周） 住院时间（d） TG（mmol/L） TG于起病24 h降至安全水平（例） TG于起病48 h降至安全水平（例） TC（mmol/L） WBC（×109/L） CRP（mg/L） Hct（L/L）
MAP组 18 29 ± 5 29 ± 9 14 ± 9 41 ± 35 4 13 22 ± 16 13.8 ± 4.4 100 ± 80 0.32 ± 0.04
MSAP组 11 30 ± 5 32 ± 5 26 ± 12 33 ± 32 2 9 29 ± 16 15.6 ± 2.4 114 ± 103 0.31 ± 0.04
SAP组 16 30 ± 5 34 ± 4 26 ± 17a 52 ± 45 8 16 36 ± 32 16.3 ± 6.3 148 ± 58 0.32 ± 0.07
F/χ2/H值   4.646 156.566 1 349.641 0.746 4.185 5.052 1.750 1.240 1.604 1.627
P值   0.913 0.174 0.036 0.477 0.123 0.080 0.253 0.328 0.317 0.852
组别 例数 ALT（U/L） TB（μmol/L） 血肌酐（μmol/L） 血淀粉酶（U/L） 血脂肪酶（U/L） 血钙（mmol/L） 血糖（mmol/L） 血浆置换或血液灌流（例） 总血浆置换量（mL）
MAP组 18 17 ± 11 15 ± 10 48 ± 18 226（126，818） 625（103，931） 2.0 ± 0.4 5.9 ± 2.5 11 3 143 ± 1 186
MSAP组 11 25 ± 12 14 ± 12 44 ± 24 349（174，1 011） 250（195，760） 2.0 ± 0.3 8.9 ± 5.6 8 3 864 ± 1 321
SAP组 16 27 ± 13 18 ± 16 82 ± 34ab 312（116，1 002） 228（142，482） 1.8 ± 0.4 9.9 ± 5.4a 16c 3 677 ± 1 357
F/χ2/H值   0.876 1.425 13 578.432 1.241 1.258 0.510 4.916 7.727 0.584
P值   0.727 0.775 0.001 0.993 0.710 0.412 0.013 0.022 0.463
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