SAP病程中后期继发急性胆囊炎的风险因素分析

目的 探讨重症急性胰腺炎（SAP）中后期继发急性胆囊炎（AC）的风险因素及临床意义. 方法 收集本院2010年1月～2013年6月经确诊的42例SAP继发急性胆囊炎病例（SAP-AC）为观察组和210例SAP病例作为对照组,记录分析各项临床资料,采用单因素分析及多因素非条件Logistic回归法筛选各风险因素. 结果 单因素Logistic回归分析显示胆道结石、高血脂、APACHEⅡ评分、局部并发症、全身并发症、生长抑素时间、全肠外营养（TPN）持续时间、激素使用等13个变量影响AC的发生;多因素Logistic回归分析显示激素使用（OR=5.395）胆道结石（OR=2.963）、生长抑素时间（OR=1.404） APACHEⅡ评分（OR=1.361）、TPN持续时间（OR=1.034）、为继发AC的显著风险因素. 结论 激素使用、胆道结石、生长抑素时间、APACHEⅡ评分、TPN持续时间均为SAP中后期继发AC显著风险因素.

Risk Factors Analysis of Severe Acute Pancreatitis Complicatedwith Acute Cholecystitis in Middle and Later Stage

Objective To explore the risk factors and clinical significance of severe acute pancreatitis （SAP） com- plicated with acute cholecystitis（AC） in middle and later stage. Methods With case-control study method,we collected clinical data of 42 cases of SAP complicated with AC patients and 210 cases of SAP patients from Jan 2010 - Jun 2013 ,then used single factor non-conditional Logistic Regression method and muhiple factors Logistic Regression method to screen the risk factors of SAP-AC. Results Single factors Logistic Regression result showed that biliary lithiasis, Balthazar＇CT score,APACHE Ⅱ score,local and systemic complication, somatostatin time,TPN lasting time, glucocorticosteroid applica- tion, etc, significanetly affected SAP-AC. And multiple factors Logistic Regression result showed that glucocorticosteroid ap- plication （OR = 5. 395 ） biliary lithiasis （ OR = 2. 963）, somatostatin time （ OR = 1. 404） APACHE Ⅱ score （ OR = 1. 361 ）, and TPN lasting time （ OR = 1. 034） significanctly affected SAP-AC. Conclusion This study showed that glu- cocorticosteroid application,biliary lithiasis, somatostatin time, APACHE Ⅱ score and TPN lasting time were significanct risk factors of SAP-AC in middle and later stage,and paying more attention to its predictive value will reduce its mortality and morbidity of SAP-AC.