经内镜逆行胰胆管造影术后急性胰腺炎与高淀粉酶血症对比观察

目的 比较经内镜逆行胰胆管造影术(ERCP)后急性胰腺炎(PEP)与高淀粉酶血症(PEHA)患者的临床特点及影响因素,为预防病情进展提供依据。 方法 选取武汉大学人民医院2017年1月-2019年8月住院行ERCP的患者117例,所有患者术前均预防性使用双氯芬酸钠栓塞肛。术后发生PEHA组77例,PEP组40例,比较2组患者临床特点及影响因素。符合正态分布的计量资料2组间比较采用t检验;不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验;采用多因素logistic回归分析PEP的独立影响因素。结果 术前ALP(Z=-2.518,P=0.012)、GGT(Z=-2.313,P=0.021)、TBil(Z=-2.978,P=0.003)、DBil(Z=-3.069,P=0.002)水平及术中是否行导丝进入胰管检查(χ2=4.176,P=0.041)在两组之间差异显著。进一步logistic回归分析结果显示,导丝进入胰管次数≥3次优势比(OR)=2.469,95%可信区间(95%CI): 1.199~5.188,P=0.047]、ALP<125 U/L(OR=5.499,95%CI: 1.452~18.830,P=0.012)、TBil<22 μmol/L(OR=4.249,95%CI: 1.023~17.648,P=0.046)是影响PEP发生的独立危险因素。结论 即使预防性使用双氯芬酸钠栓剂,术前ALP、TBil水平正常及术中导丝多次进入胰管的患者更易发生PEP,需引起手术医师警惕。根据病情,术前及术后采取早期干预措施可能减少PEHA向PEP进展,减少中重度PEP的发生,改善预后。

A comparative analysis of acute pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography

Objective To investigate the clinical features of patients with acute pancreatitis versus hyperamylasemia after endoscopic retrograde cholangiopancreatography (ERCP) and related influencing factors, and to provide a basis for preventing disease progression. MethodsA retrospective analysis was performed for the clinical data of 117 patients who underwent ERCP in Renmin Hospital of Wuhan University from January 2017 to August 2019, and all patients were given the preventive use of diclofenac sodium suppository before surgery. After surgery, 77 patients developed hyperamylasemia and 40 developed acute pancreatitis, and the two groups were compared in terms of clinical features and influencing factors. The 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 was used for comparison of categorical data between two groups;a multivariate logistic regression analysis was used to investigate the independent risk factors for post-ERCP pancreatitis (PEP). Results There were significant differences between the two groups in preoperative levels of alkaline phosphatase (ALP) (Z=-2.518, P=0.012), gamma-glutamyl transpeptidase (Z=-2.313, P=0.021), total bilirubin (TBil) (Z=-2.978, P=0.003), and direct bilirubin (Z=-3.069, P=0.002) and presence or absence of guide wire insertion into the pancreatic duct during surgery (χ2=4.176, P=0.041). Further logistic regression analysis showed that the number of times of guide wire insertion into the pancreatic duct ≥3 (odds ratio OR]=2.469, 95% confidence interval CI]: 1.199-5.188, P=0.047), ALP<125 U/L (OR=5.499, 95% CI: 1.452-18.830, P=0.012), and TBil <22 umol/L (OR=4.249, 95% CI: 1.023-17.648, P=0.046) were independent risk factors for PEP. Conclusion Although patients are given the preventive use of diclofenac sodium suppository before surgery, the patients with normal levels of ALP and TBil before surgery and repeated guide wire insertion into the pancreatic duct during surgery are more likely to develop PEP, which should be taken seriously by surgeons. Early intervention measures before and after surgery based on patients’ conditions can reduce the progression of post-ERCP hyperamylasemia to PEP, reduce the development of moderate-to-severe PEP, and improve patients’ prognosis.