2023 年第 8 期 第 18 卷

不同严重程度妊娠合并急性胰腺炎患者的临床特征及母婴预后分析

Clinical characteristics and maternal and infant prognosis analysis of acute pancreatitis in pregnancy patients of different severities

作者：徐俊田地陈阳琴李彦媚李叶青齐文杰

英文作者：Xu Jun Tian Di Chen Yangqin Li Yanmei Li Yeqing Qi Wenjie

单位：首都医科大学附属北京友谊医院感染内科，北京100050

英文单位：Department of Infectious Medicine Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：急性胰腺炎；妊娠；母婴结局

英文关键词：Acutepancreatitis;Pregnancy;Maternalandinfantoutcomes

• 摘要：

• 目的 分析不同严重程度妊娠合并急性胰腺炎（APIP）患者的临床特征及与母婴预后的关系。方法 收集2016年1月至2020年12月首都医科大学附属北京友谊医院收治的42例住院APIP患者的临床资料行回顾性分析。根据急性胰腺炎的程度将其分为轻度急性胰腺炎（MAP）组（18例）和重度急性胰腺炎（SAP）组（24例）。分析其临床特点以及母婴结局。结果 SAP组入院时孕周小于、唐氏筛查高危比例高于、孕次多于、腹泻比例高于MAP组［（33.6±4.5）周比（36.0±2.8）周、25.0%（6/24）比0（0/18）、（2.5±1.6）次比（1.7±0.5）次、25.0%（6/24）比0（0/18）］，差异均有统计学意义（均P<0.05）。MAP组与SAP组血白细胞计数、中性粒细胞计数、血小板计数、总胆红素、直接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、血尿素氮、血肌酐、血淀粉酶、降钙素原水平比较差异均有统计学意义（均P＜0.05）。SAP组分娩时孕周小于MAP组［（35.3±3.1）周比（37.5±2.1）周］，差异有统计学意义（t=2.60，P=0.01）。SAP组新生儿体质量、身长、头围、Apgar评分低于/小于MAP组，住院率、病理性黄疸、肺炎、呼吸窘迫发生率及呼吸机辅助呼吸率高于MAP组，差异均有统计学意义（均P＜0.05）。SAP组死亡1例，但2组死亡率差异无统计学意义（P＞0.05）。结论 既往孕次更多、唐氏筛查高危孕产妇发展成SAP的风险更高，SAP可显著缩短孕产妇的分娩孕周，增加新生儿预后不良的风险，并增加新生儿的病死率。

• Objective To analyze the clinical characteristics and maternal and infant prognosis of acute pancreatitis in pregnancy(APIP) patients of different severities. Methods  A retrospective analysis was conducted on the clinical data of 42 hospitalized APIP patients admitted to Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2020. According to the severity of acute pancreatitis, patients were divided into a mild acute pancreatitis(MAP) group(18 cases) and a severe acute pancreatitis(SAP) group(24 cases). The clinical characteristics and maternal and infant outcomes were analyzed. Results The SAP group had a less gestational age, a higher proportion of high-risk individuals for Down′s screening, more pregnancies, and a higher proportion of diarrhea compared to the MAP group at admission［（33.6±4.5）weeks vs （36.0±2.8）weeks, 25.0%（6/24） vs 0（0/18）,（2.5±1.6）times vs （1.7±0.5）times, 25.0%（6/24） vs 0（0/18）］(all P<0.05). There were statistically significant differences in blood leukocyte count, neutrophil count, platelet count, total bilirubin, direct bilirubin, alanine transaminase, aspartate transaminase, alkaline phosphatase, blood urea nitrogen, serum creatinine, blood amylase, and procalcitonin levels between MAP group and SAP group(all P<0.05). The gestational age at delivery in the SAP group was shorter than that in the MAP group［（35.3±3.1）weeks vs （37.5±2.1）weeks］(t=2.60, P=0.01). The body mass, length, head circumference, and Apgar score of newborns in the SAP group were lower/smaller than those in the MAP group; the hospitalization rate, incidences of pathological jaundice, pneumonia, respiratory distress, and the ventilator-assisted breathing rate in the SAP group were higher than those in the MAP group(all P<0.05). One case died in the SAP group, but there was no statistically significant difference in the mortality between the two groups(P>0.05). Conclusions    Women with more previous pregnancies and high risk of Down′s screening are at higher risk of developing SAP. SAP shortens the gestational age of delivery significantly, increases the risk of poor neonatal outcomes, and increases neonatal mortality.