急性胰腺炎合并代谢综合征的临床特征及预后影响因素分析

目的探讨合并代谢综合征(MS)的急性胰腺炎(AP)患者临床特征及预后影响因素。方法回顾性分析2013年1月-2019年1月西南医科大学附属医院收治的590例AP患者的临床资料,根据有无MS分为MS组(n=178)和非MS组(n=412),比较两组患者的基本临床特征;根据AP严重程度分为轻型急性胰腺炎(MAP)(n=317)、中度重型急性胰腺炎(MSAP)(n=171)、重型急性胰腺炎(SAP)(n=102),比较3组患者的MS成分指标。符合正态分布的计量资料两组间比较采用t检验,多组间比较采用单因素方差分析;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。进一步两两比较均采用Bonferroni校正法。计数资料组间比较采用χ^2检验,单向有序分类资料采用趋势χ^2检验,双向有序分类资料采用Goodman-Kruskal Gamma分析。有序logistic回归分析评估BMI与AP严重程度的关系;二分类logistic回归分析MS与AP严重程度的关系。结果MS合并AP最常见的病因为高脂性(48.3%)和胆源性(24.7%),SAP更易合并MS(χ^2=141.519,P<0.001),AP合并MS患者有着更高的临床系统评分、更多的局部和全身并发症、住院时间更长、ICU入住率与病死率更高(P值均<0.05)。随着MS成分(超重、高血压、糖尿病、血脂紊乱)增加,AP严重程度随之增加(G=0.540,P<0.001)。不同AP严重程度组间比较,BMI(F=9.291,P<0.001)、HDL-C(χ^2=40.351,P<0.001)差异均有统计学意义;SAP较MAP、MSAP患者有着更高的BMI、更低的HDL-C(P值均<0.05)。有序logistic回归分析显示,BMI是AP病情发展的独立危险因素比值比(OR)=1.091,95%可信区间(95%CI):1.041~1.143,P<0.001]。根据AP严重程度建立二元logistic回归模型,设立MAP组对比非MAP组为模型1,SAP组对比非SAP组为模型2。结果显示,模型1中MS患者发生非MAP是MAP的5.867倍(OR=5.867,95%CI:3.072~11.207,P<0.001);模型2中MS患者发生SAP是非SAP的7.214倍(OR=7.214,95%CI:3.018~17.244,P<0.001)。模型1和2均显示HDL-C为AP病情发展的保护因素(OR=0.593,95%CI:0.387~0.910,P=0.017;OR=0.314,95%CI:0.160~0.614,P=0.001)。结论AP入院时合并MS提示患者预后较差,其中BMI和HDL-C水平与患者病情发展密切相关。

Clinical features of acute pancreatitis with metabolic syndrome and influencing factors for prognosis

Objective To investigate the clinical features of acute pancreatitis(AP)with metabolic syndrome(MS)and the influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical data of 590 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to January 2019,and according the presence or absence of MS,they were divided into MS group with 178 patients and non-MS group with 412 patients and basic clinical features were compared between the two groups.According to the severity of AP,they were divided into mild acute pancreatitis(MAP)group with 317 patients,moderate-severe acute pancreatitis(MSAP)group with 171 patients,and severe acute pancreatitis(SAP)group with 102 patients,and the component indicators of MS were compared between the three groups.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;Bonferroni correction was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between groups;the trend chi-square test was used for comparison of one-way ordinal categorical data,and the Goodman-Kruskal Gamma analysis was used for two-way ordinal categorical data.An ordinal logistic regression analysis was used to investigate the correlation between body mass index(BMI)and severity of AP,and a binary logistic regression analysis was used to investigate the correlation between MS and severity of AP.Results The most common causes of MS with AP were hyperlipidemia(48.3%)and biliary disease(24.7%).The patients with SAP were more likely to have MS(χ^2=141.519,P<0.001),and the patients with AP and MS tended to have a significantly higher clinical system score,significantly more local and systemic complications,significantly longer hospital stays,a significantly higher ICU admission rate,and a significantly higher mortality rate(all P<0.05).The severity of AP increased with the increase in MS components(overweight,hypertension,diabetes,and dyslipidemia),(G=0.540,P<0.001).There were significant differences between the MAP,MSAP,and SAP groups in BMI(F=9.291,P<0.001)and high-density lipoprotein cholesterol(HDL-C)(χ^2=40.351,P<0.001),and the SAP group had significantly higher BMI and significantly lower HDL-C than the MAP group and the MSAP group(all P<0.05).The ordinal logistic regression analysis showed that BMI was an independent risk factor for the progression of AP(odds ratioOR]=1.091,95%confidence intervalCI]:1.041-1.143,P<0.001).Binary logistic regression models were established based on the severity of AP,with MAP group versus non-MAP group as model 1 and SAP group versus non-SAP group as model 2.The results showed that in model 1,the incidence rate of non-MAP was 5.867 times that of MAP in patients with MS(OR=5.867,95%CI:3.072-11.207,P<0.001),and in model 2,the incidence rate of SAP was 7.214 times that of non-SAP(OR=7.214,95%CI:3.018-17.244,P<0.001).Both model 1 and model 2 showed that HDL-C was a protective factor against the progression of AP(model 1:OR=0.593,95%CI:0.387-0.910,P=0.017;model 2:OR=0.314,95%CI:0.160-0.614,P=0.001).Conclusion AP with MS on admission may suggest poor prognosis,and BMI and HDL-C are closely associated with disease progression.