妊娠期急性胰腺炎临床分析

doi:10.3877/cma.j.issn.1673-5250.2018.03.012

中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (03) : 324 -330. doi: 10.3877/cma.j.issn.1673-5250.2018.03.012

所属专题：文献；

论著

妊娠期急性胰腺炎临床分析

张丹¹, 赵成志², 张琼¹, 蔡春华¹, 李涛¹, 陆静¹, 张健³^,^†(

)

^1. 610031　成都市第三人民医院/西南交通大学附属医院妇产科
^2. 400013　重庆市妇幼保健院妇产科
^3. 610031　成都市第三人民医院/西南交通大学附属医院麻醉科

收稿日期:2018-01-09 修回日期:2018-05-11 出版日期:2018-06-01
通信作者: 张健

Clinical analysis of acute pancreatitis in pregnancy

Dan Zhang¹, Chengzhi Zhao², Qiong Zhang¹, Chunhua Cai¹, Tao Li¹, Jing Lu¹, Jian Zhang³^,^†()

^1. Department of Obstetrics and Gynecology, Third People′s Hospital of Chengdu / Affiliated Hospital of Southwest Jiaotong University, Chengdu 610031, Sichuan Province, China
^2. Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing 400013, China
^3. Department of Anaesthesiology, Third People′s Hospital of Chengdu / Affiliated Hospital of Southwest Jiaotong University, Chengdu 610031, Sichuan Province, China

Received:2018-01-09 Revised:2018-05-11 Published:2018-06-01
Corresponding author: Jian Zhang
About author:
Corresponding author: Zhang Jian, Email: anesthesiology@zju.edu.cn

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引用本文：

张丹, 赵成志, 张琼, 蔡春华, 李涛, 陆静, 张健. 妊娠期急性胰腺炎临床分析[J]. 中华妇幼临床医学杂志(电子版), 2018, 14(03): 324-330.

Dan Zhang, Chengzhi Zhao, Qiong Zhang, Chunhua Cai, Tao Li, Jing Lu, Jian Zhang. Clinical analysis of acute pancreatitis in pregnancy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(03): 324-330.

目的

探讨妊娠期急性胰腺炎(APIP)的临床特点及其对母胎的影响。

方法

选择2010年1月1日至2016年12月31日于成都市第三人民医院收治的32例APIP孕产妇为研究对象，纳入APIP组。选择同期于本院就诊并且无产科合并症的96例正常孕产妇纳入对照组。采用回顾性分析法，收集2组孕产妇的一般临床资料、实验室检查结果、妊娠结局、新生儿结局，以及APIP组孕产妇的临床特征，并且进行统计学分析。采用成组t检验，对2组孕产妇的年龄、人体质量指数(BMI)及所分娩新生儿出生体重进行比较。采用χ²检验，对2组孕产妇的产妇类型、BMI分级构成比及自然分娩率、剖宫产术分娩率进行比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》。

结果

①2组孕产妇年龄、产妇类型构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。②APIP组孕产妇的BMI为(29.2±2.0)kg/m²，显著高于对照组的(22.3±1.2)kg/m²，并且差异有统计学意义(t＝18.328，P<0.001)。APIP组孕产妇体重正常所占比例为6.2%(2/32)，显著低于对照组的47.9%(46/96)，并且差异有统计学意义(χ²＝17.778，P<0.001)，APIP组Ⅱ度肥胖者所占比例为71.9%(23/32)，明显高于对照组的29.2%(28/96)，差异有统计学意义(χ²＝74.381，P<0.001)。③APIP组32例孕产妇中，胆源性急性胰腺炎为17例(53.1%，17/32)，高脂血症性急性胰腺炎为9例(28.1%，9/32)，暴食暴饮所致急性胰腺炎为3例(9.4%，3/32)，其他病因所致急性胰腺炎为3例(9.4%，3/32)。④APIP组32例孕产妇中，31例(96.9%，31/32)孕产妇以上腹痛或剑突下疼痛为首发症状。32例APIP孕产妇的实验室检查结果显示，其血清降钙素原值为0.08～9.06 ng/mL。合并症情况：合并妊娠期糖尿病(GDM)者为10例(31.3%，10/32)，合并重度子痫前期者为5例(15.6%，5/32)，合并妊娠期肝内胆汁淤积症(ICP)者为4例(12.6%，4/32)。⑤APIP组孕产妇自然分娩率为3.1%(1/32)，显著低于对照组的75.0%(72/96)，并且差异有统计学意义(χ²＝50.594，P<0.001)。APIP组孕产妇急诊剖宫产术分娩率为75.0%(24/32)，早产率为62.5%(20/96)，分别显著高于对照组的3.1(3/32)和8.3%(8/96)，2组比较，差异亦均有统计学意义(χ²＝74.491、41.204，P<0.001)。⑥APIP组孕产妇所分娩新生儿的出生体重为(2 940.0±335.9)g，显著低于对照组的(3 450.2±154.7)g，并且差异有统计学意义(t＝－11.677，P<0.001)。

结论

APIP孕妇中同时合并GDM者较多，早产率高。对于上腹疼痛的孕产妇，应警惕APIP的发生，晚孕期一旦确诊，临床应对其及时进行剖宫产术终止妊娠，可积极改善母儿预后。

关键词: 妊娠, 胰腺炎, 妊娠并发症, 妊娠结局, 病因, 孕妇

Objective

To explore clinical characteristics and influences of acute pancreatitis in pregnancy (APIP).

Methods

A total of 32 pregnant women with APIP from January 1, 2010 to December 31, 2016 in Third People′s Hospital of Chengdu were selected as study subjects and enrolled into APIP group. Meanwhile, another 93 normal pregnant women were selected as control group. The general clinical data, laboratory test results, pregnancy outcomes, newborn outcomes, and clinical characteristics of APIP group were retrospectively analyzed. Independent-samples t test was used to compare the age, body mass index (BMI), and newborn weight between two groups. Chi-square test was used to compare the constituent ratios of types of puerperae and BMI grades, incidence rates of natural labor and cesarean section between two groups. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

Results

① There were no significant differences between two groups in the aspects of age and the constituent ratios of primipara and pluripara (P>0.05). ② The BMI in APIP group was (29.2±2.0) kg/m^2, which was significant higher than that in control group (22.3±1.2) kg/m^2, and the difference was statistically significant (t=18.328, P<0.001). The proportion of normal body weight in APIP group was 6.2% (2/32), which was significant lower than that in control group 47.9%(46/96), and the difference was statistically significant (χ²=17.778, P<0.001). The proportions of grade Ⅱ obesity in APIP group was 71.9% (23/32), which was higher than that of control group [29.2% (28/96)], and the difference also was statistically significant (χ²=74.381, P<0.001). ③Among 32 pregnant women of APIP group, 17 cases (53.1%, 17/32) were gallstone acute pancreatitis, 9 cases (28.1%, 9/32) were hyperlipidemia acute pancreatitis, 3 cases (9.4%, 3/32) were acute pancreatitis caused by binge eating, and 3 cases (9.4%, 3/32) were acute pancreatitis caused by other reasons. ④ Among 32 pregnant women of APIP group, the first symptom of 31 cases (96.9%, 31/32) was upper abdominal pain or subxiphoid pain. The laboratory test results showed that their serum procalcitonin levels ranged from 0.08 ng/mL to 9.06 ng/mL. Besides, 10 cases (31.3%, 10/32) were combined with gestational diabetes mellitus (GDM), 5 cases (15.6%, 5/32) were combined with severe pre-eclampsia, 4 cases (12.6%, 4/32) were combined with intrahepatic cholestasis of pregnancy (ICP). ⑤ The incidence rate of natural labor in APIP group was 3.1% (1/32), which was lower than 75.0% (72/96) in control group, and the difference was statistically significant (χ²=50.594, P<0.001). The incidence rates of emergency cesarean section and preterm birth in APIP group were 75.0% (24/32) and 62.5% (20/96), respectively, which were higher than those of control group [3.1% (3/32) and 8.3% (8/96), respectively], and both the differences were statistically significant (χ²=74.491, 41.204; P<0.001). ⑥ The birth weights of newborns in APIP group was (2 940.0±335.9) g, which was lower than that in control group [(3 450.2±154.7) g], and the difference was statistically significant (t=-11.677, P<0.001).

Conclusions

GDM is the most common complications of APIP, and the incidence rate of premature birth in APIP is high. It is necessary to aware the occurence of APIP in pregnant women with upper abdominal pain. Timely cesarean section can actively improve the maternal and fetal prognosis of APIP.

Key words: Pregnancy, Pancreatitis, Pregnancy complications, Pregnancy outcome, Etiology, Pregnant women

表1 2组孕产妇一般临床资料比较

组别	例数	年龄(岁，±s)	产妇类型[例数(%)]
组别	例数	年龄(岁，±s)	初产妇	经产妇
APIP组	32	29.2±4.8	21(65.6)	11(34.4)
对照组	96	28.6±3.2	64(66.7)	32(33.3)
检验值	?	t＝－0.084	χ²＝0.012
P值	?	0.379	0.914

表1 2组孕产妇一般临床资料比较

组别	例数	年龄(岁，±s)	产妇类型[例数(%)]
组别	例数	年龄(岁，±s)	初产妇	经产妇
APIP组	32	29.2±4.8	21(65.6)	11(34.4)
对照组	96	28.6±3.2	64(66.7)	32(33.3)
检验值	?	t＝－0.084	χ²＝0.012
P值	?	0.379	0.914

表2 2组孕产妇人体质量指数及其分级比较

组别	例数	BMI(kg/m²，±s)	BMI分级[例数(%)]
组别	例数	BMI(kg/m²，±s)	体重正常	肥胖前期	Ⅰ度肥胖	Ⅱ度肥胖
APIP组	32	29.2±2.0	2(6.2)	2(6.3)	5(15.6)	23(71.9)
对照组	96	22.3±1.2	46(47.9)	2(2.0)	20(20.8)	28(29.2)
检验值	?	t＝18.328	χ²＝17.778	χ²＝0.344	χ²＝0.414	χ²＝74.381
P值	?	<0.001	<0.001	0.556	0.520	<0.001

表2 2组孕产妇人体质量指数及其分级比较

组别	例数	BMI(kg/m²，±s)	BMI分级[例数(%)]
组别	例数	BMI(kg/m²，±s)	体重正常	肥胖前期	Ⅰ度肥胖	Ⅱ度肥胖
APIP组	32	29.2±2.0	2(6.2)	2(6.3)	5(15.6)	23(71.9)
对照组	96	22.3±1.2	46(47.9)	2(2.0)	20(20.8)	28(29.2)
检验值	?	t＝18.328	χ²＝17.778	χ²＝0.344	χ²＝0.414	χ²＝74.381
P值	?	<0.001	<0.001	0.556	0.520	<0.001

表3 2组孕产妇妊娠结局比较[例数(%)]

组别	例数	自然分娩	急诊剖宫产术分娩	择期剖宫产术分娩	死胎引产	早产
APIP组	32	1(3.1)	24(75.0)	6(18.8)	1(3.1)	20(62.5)
对照组	96	72(75.0)	3(3.1)	21(21.9)	0(0)	8(8.3)
χ²值	?	50.594	74.491	0.141	—	41.204
P值	?	<0.001	<0.001	0.707	0.250	<0.001

表3 2组孕产妇妊娠结局比较[例数(%)]

组别	例数	自然分娩	急诊剖宫产术分娩	择期剖宫产术分娩	死胎引产	早产
APIP组	32	1(3.1)	24(75.0)	6(18.8)	1(3.1)	20(62.5)
对照组	96	72(75.0)	3(3.1)	21(21.9)	0(0)	8(8.3)
χ²值	?	50.594	74.491	0.141	—	41.204
P值	?	<0.001	<0.001	0.707	0.250	<0.001

表4 2组孕产妇所分娩新生儿一般情况比较

组别	例数	出生体重(g，±s)	窒息[例数(%)]		死亡[例数(%)]
组别	例数	出生体重(g，±s)	轻度窒息	重度窒息	死亡[例数(%)]
APIP组	29	2 940.0±335.9	3(10.3)	1(3.4)	1(3.4)
对照组	96	3 450.2±154.7	3(3.1)	0(0)	0(0)
检验值	?	t＝—11.677	χ²＝0.933 ^a	—	—
P值	?	<0.001	0.334	0.250	0.250

表4 2组孕产妇所分娩新生儿一般情况比较

组别	例数	出生体重(g，±s)	窒息[例数(%)]		死亡[例数(%)]
组别	例数	出生体重(g，±s)	轻度窒息	重度窒息	死亡[例数(%)]
APIP组	29	2 940.0±335.9	3(10.3)	1(3.4)	1(3.4)
对照组	96	3 450.2±154.7	3(3.1)	0(0)	0(0)
检验值	?	t＝—11.677	χ²＝0.933 ^a	—	—
P值	?	<0.001	0.334	0.250	0.250

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Clinical analysis of acute pancreatitis in pregnancy

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Clinical analysis of acute pancreatitis in pregnancy