急性胰腺炎合并全身炎症反应综合征的危险因素分析

目的急性胰腺炎(acute pancreatitis,AP)是多种病因导致胰酶在胰腺内激活后引起胰腺组织自身消化、水肿、出血甚至坏死的炎症反应。全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)可从新的角度阐明多器官功能障碍综合征(mutiple organ dysfunction syndrome,MODS)的病理生理及发生发展过程。AP合并SIRS对临床诊治和预后判断有重要影响,但目前研究报道尚少。文中探讨AP合并SIRS的可能危险因素。方法对105例住院急性胰腺炎患者的人口统计学资料、临床表现、实验室检查等指标进行回顾性分析。结果有58例(55.24%)合并SIRS,为病例组;其余47例(44.76%)无SIRS为对照组。病例组与对照组相比,患者年龄偏大、住院天数较长、发病天数较长、病情分型重、体温较高、呼吸频率较快、心率较快、血白细胞总数较高、血中性粒细胞绝对值较高、血清白蛋白水平较低、血清总胆红素较高血淀粉酶较高。非条件Logistic回归分析显示,呼吸次数较快的心率较快、血中性粒细胞计数较高和血清总胆红素水平较高是4个独立的危险因素,比值比(odds ratio,OR)值分别为15.669、4.945、11.764和5.407。结论呼吸次数较快、心率较快、血中性粒细胞计数较高和血清总胆红素水平较高是AP合并SIRS的4个独立危险因素。研究结果为临床判断病情提供辅助依据。

Risk factors of acute pancreatitis complicated with systemic inflammatory response syndrome

Objective Acute pancreatitis(AP) is an inflammatory response with digestion of pancreatic tissue itself,edema,hemorrhage or necrosis,which was caused by the activated trypsin in the pancreas under a variety of factors.Systemic inflammatory response syndrome(SIRS) provides a new perspective on the pathophysiology and development process of multiple organ dysfunction syndrome.AP with SIRS may have greater clinical impacts,but it has been poorly studied.This study is on the risk factors of AP complicating SIRS.Methods The demographic,clinical and laboratorial data and prognosis of 105 AP patients,who were treated in the China-Japan Friendship Hospital during the period of January 1,2008 to January 31,2010,were retrospectively analyzed.Results Of the 105 AP patients,58 cases(55.24%)were positive(case group) and 47 case(44.76%) were negative(control group) for SIRS complication.Compared with the control group,patients in the case group have older age(P=0.078),longer length of hospital stay(P=0.001),longer onset days(P=0.003),heavier type(P<0.001),higher body temperature(P=0.008),faster respiratory rate(P<0.001),faster heart rate(P<0.001),higher WBC count(P<0.001),higher neutrophils count(P<0.001),lower serum albumin level(P=0.004),higher serum total bilirubin level(P=0.027) and higher serum amylase activity/level(P=0.028).In unconditional Logistic analysis,respiratory rate(OR,15.669),heart rate(OR,4.945),neutrophil count(OR,11.764) and serum total bilirubin level(OR,5.407) showed statistical differences.ConclusionFaster breathing,rapid heart rate,higher neutrophil count and higher serum total bilirubin level are four independent risk factors for acute pancreatitis with systemic inflammatory response syndrome.