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

doi:10.3877/cma.j.issn.1674-6880.2021.05.008

Abstract

Abstract:

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

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.

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组别	例数	年龄（岁，±s）	孕周（周，±s）	疾病严重程度			局部并发症
组别	例数	年龄（岁，±s）	孕周（周，±s）	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 ± 5^a	26 ± 8	59（89.39）	4（6.06）	3（4.55）	2（3.03）	4（6.06）	1（1.52）
HTGP组	45	30 ± 5^a	32 ± 7^ab	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

组别	例数	年龄（岁，±s）	孕周（周，±s）	疾病严重程度			局部并发症
组别	例数	年龄（岁，±s）	孕周（周，±s）	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 ± 5^a	26 ± 8	59（89.39）	4（6.06）	3（4.55）	2（3.03）	4（6.06）	1（1.52）
HTGP组	45	30 ± 5^a	32 ± 7^ab	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

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 ± 17^a	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 ± 34^ab	312（116，1 002）	228（142，482）	1.8 ± 0.4	9.9 ± 5.4^a	16^c	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

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 ± 17^a	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 ± 34^ab	312（116，1 002）	228（142，482）	1.8 ± 0.4	9.9 ± 5.4^a	16^c	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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