妊娠期高甘油三酯血症性急性胰腺炎的临床特征及重症进展的预测因素分析

背景与目的：妊娠合并急性胰腺炎（APIP）是妊娠期中少见且严重的并发症，APIP的严重进展可导致母体和胎儿死亡。近年来高甘油三酯血症（HTG）逐渐成为APIP的主要病因。目前关于HTG引起的APIP的临床特征和病情预后因素研究的报道较少。因此，本研究探讨妊娠期高甘油三酯血症性急性胰腺炎（HTG-APIP）的临床特征以及重症进展的预测因素。方法：回顾性分析2018年1月—2020年12月湖北省妇幼保健院成人重症医学科和华中科技大学同济医学院附属同济医院胆胰外科39例APIP患者临床资料。根据甘油三酯的浓度将患者分为HTG-APIP组（17例）和非HTG-APIP组（22例），比较两组患者的一般资料、病情严重程度等以及各种实验室指标；比较HTG-APIP患者中轻症（MAP）与重症（SAP）患者相关实验室指标的差异，分析HTG-APIP重症进展的危险因素，并用ROC曲线评价其预测效能。结果：HTG-APIP组与非HTG-APIP组比较，前者除了血甘油三酯高和血钙偏低之外（均P<0.05），其余指标均无明显差异（均P>0.05）。在HTG-APIP患者中，MAP 8例，SAP 9例...

Clinical features of hypertriglyceridemia acute pancreatitis in pregnancy and predictive factors for severe progression

Background and Aims Acute pancreatitis in pregnancy (APIP) is a rare but serious complication during pregnancy, and severe progression of APIP can lead to maternal and fetal death. In recent years, hypertriglyceridemia (HTG) has emerged as a primary cause of APIP. Reports on the clinical characteristics and prognosis factors of APIP caused by HTG are scarce. Therefore, this study was performed to investigate the clinical features of hypertriglyceridemia-induced acute pancreatitis in pregnancy (HTG-APIP) and predictive factors for severe progression.Methods The clinical data from 39 APIP patients treated in the Department of Critical Care Medicine, Hubei Maternal and Child Health Care Hospital and Department of Biliary and Pancreatic Surgery of Wuhan Maternal and Child Health Hospital and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to December 2020 was retrospectively analyzed. Patients were categorized into the HTG-APIP group (17 cases) and the non-HTG-APIP group (22 cases) based on triglyceride concentrations. General characteristics, disease severity, and various laboratory parameters were compared between the two groups. Differences in laboratory parameters between mild (MAP) and severe (SAP) cases among the HTG-APIP patients were also analyzed, and risk factors for severe progression of HTG-APIP were assessed using Logistic regression analysis, with the predictive efficacy evaluated using ROC curve.Results Compared with the non-HTG-APIP group, the HTG-APIP group showed significantly higher blood triglyceride level and lower blood calcium level (both P<0.05). In contrast, all other variables showed no significant differences (all P>0.05). Among HTG-APIP patients, there were 8 MAP cases and 9 SAP cases. The SAP group exhibited a significantly higher neutrophil-to-lymphocyte ratio (NLR) compared to the MAP group (P<0.05). Logistic regression analysis revealed NLR as an independent risk factor for severe progression of HTG-APIP (OR=1.120, 95% CI=1.004-1.250, P=0.042), and the area under the ROC curve for predicting severe HTG-APIP was 0.847, with a sensitivity of 75.0%, and a specificity of 88.9%.Conclusions There were no significant differences in the clinical features between HTG-APIP and non-HTG-APIP; elevated NLR can be used to predict the severe progression of HTG-APIP.