肥胖者重症急性胰腺炎发生率的多中心前瞻性对照研究

目的 观察肥胖的急性胰腺炎(AP)患者在基础内科治疗过程中发展为重症急性胰腺炎(SAP)的概率,探讨肥胖对AP病情发展的影响.方法 采用多中心、前瞻性研究,以APACHEⅡ评分评估AP严重程度,共纳入轻症急性胰腺炎(MAP)患者161例,以体重指数25 kg/m2为标准,分为肥胖组(79例)和非肥胖组(82例).在相同的基础内科治疗条件下观察两组患者血C-反应蛋白(CRP)和三酰甘油水平、并发症发生率、SAP的发生率及病死率.结果 肥胖组的CRP水平为(117±109)mg/L,显著高于非肥胖组的(35±36)mg/L(P＜0.01);肥胖组高三酰甘油血症患者的例数是非肥胖组的1倍,但无显著性差异.两组均无局部并发症,但肥胖组各系统并发症发生率(20.3%)显著高于非肥胖组(6.1%,P＜0.01).肥胖组有16例(20.3%)发展为SAP,显著高于非肥胖组(5例,6.1%,P＜0.01).肥胖组有1例(1.3%)病死,非肥胖组无病死.在APACHEⅡ4-7分的MAP患者中,肥胖组的SAP发生率(43.3%)明显高于非肥胖组(18.5%,P＜0.05).结论 肥胖且 APACHEⅡ评分为4-7分的MAP 患者更易进展为SAP,应给予更积极的临床干预措施.

Incidence of severe acute pancreatitis in obese patients: a prospective multicenter controlled study

Objective To observe the incidence of severe acute pancreatitis (SAP) in obese acute pancreatitis (AP) patients with medical treatment, and evaluate the impact of obesity in AP progression.Methods A multicenter prospective controlled study was conducted. APACHE Ⅱ scoring system was used to evaluate the severity of AP. Results 161 patients with mild AP(MAP) were enrolled, according to the cut-off point of 25 kg/m2, these patient were divided into obese group (79 patients) and non-obese group (82patients). The levels of CRP, hypertriacylglycerolemia, complication rate, incidence of SAP and mortality were observed under the circumstance of identical medical treatment. The levels of CRP in obese group and non-obese group were (117±109 ) mg/L and (35±36 ) mg/L(P<0.01). The number of obese patients with hypertriacylglycerolemia was two times as many as that in non-obese patients, but there was no significantly difference. There was no local complication in both groups, but the incidence of systematic complication in obese patients (20.3%) was significantly higher than that in non-obese group (6.1%, P<0.01). 16patients (20.3%) in obese group progressed into SAP, which was significantly higher than that in non-obese group (5 patients, 6.1%, P<0.01). One patient(1.3%) died in obese group, but no one died in non-obese group. In MAP patients with APACHE Ⅱ 4～7 points, the incidence of SAP (43.3%) in obese group was significantly higher than that in non-obese group (18.5%, P<0.05). Conclusions Obese MAP patients with APACHE Ⅱ 4～7 points were prone to develop into SAP. More aggressive interventions are needed.