摘要
目的本研究旨在探究糖皮质激素对急性重症胰腺炎(SAP)患者预后及炎症指标的影响。方法回顾性收集2020年1月至2023年1月在陕西中医药大学第二附属医院普外肝胆一科诊治的SAP患者临床资料。根据SAP患者是否使用糖皮质激素(GC)分为GC组和非GC(NGC)组。比较两组一般资料、炎症指标[中性粒细胞-淋巴细胞比值(NLR)、单核细胞-淋巴细胞比值(MLR)、血小板-淋巴细胞比值(PLR)、全身炎症指数(SII)和C-反应蛋白-白蛋白比值(CAR)]、临床事件[连续肾脏替代治疗(CRRT)、血管活性药物、ICU住院时间、总住院时间和存活情况]和并发症发生情况(器官衰竭、电解质紊乱、消化道出血和感染)的差异。Kaplan-Meier曲线分析GC与SAP患者死亡的关系;采用Logistic回归探讨使用GC与死亡和器官衰竭的关系。结果研究共纳入84例SAP患者,GC组40例和NGC组44例。治疗后,GC组SAP患者NLR、MLR、PLR、SII和CAR明显低于NGC组(P<0.05)。GC组和NGC组在CRRT治疗、血管活性药物使用、手术、ICU住院时间、总住院时间、电解质紊乱、消化道出血、胰腺假性囊肿、脓肿形成、胰性脑病和感染并发症上差异无统计学意义(P>0.05);而GC组患者死亡率和器官衰竭发生率明显低于NGC组(P<0.05)。多因素回归结果表明,使用GC是SAP患者死亡[OR=0.243,95%CI(0.062,0.948),P=0.042]和器官衰竭[OR=0.401,95%CI(0.165,0.976),P=0.044]的独立保护因素。结论GC可降低SAP患者死亡率和器官衰竭发生率,且不增加额外并发症的发生率,具有较高的安全性。
Objective To investigate the effect of glucocorticoids on the prognosis and inflammatory markers of patients with acute severe pancreatitis(SAP).Methods A retrospective collection was performed for SAP patients diagnosed and treated in the Department of General Hepatobiliary Surgery,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2020 to January 2023.SAP patients were divided into GC group and non-GC(NGC)group according to whether they used glucocorticoids(GC)or not.The two groups were compared with general data,inflammatory markers[neutrophil-lymphocyte ratio(NLR),monocyte-lymphocyte ratio(MLR),platelet lymphocyte ratio(PLR),systemic inflammatory index(SII)and C-reactive protein albumin ratio(CAR)],clinical events[continuous renal replacement therapy(CRRT),vasoactive drugs,ICU stay,total length of stay and survival)],and complications(organ failure,electrolyte imbalances,gastrointestinal bleeding and infection).Kaplan-Meier curve analysis of the relationship between GC and death in SAP patients.Logistic regression was used to explore the relationship between GC and death and organ failure.Results A total of 84 patients with SAP,40 in the GC group and 44 in the NGC group were included in the study.After treatment,NLR,MLR,PLR,SII and CAR in the GC group were significantly lower than those in the NGC group(P<0.05).There were no statistically significant differences between the GC and NGC groups in CRRT treatment,vasoactive drug use,surgery,ICU stay,total length of stay,electrolyte imbalance,gastrointestinal bleeding,pancreatic pseudocyst,abscess formation,pancreatic encephalopathy,and infectious complications(P>0.05);The mortality rate and organ failure incidence of patients in the GC group were significantly lower than those in the NGC group(P<0.05).The results of multivariate regression showed that the use of GC was an independent protective factor for death[OR=0.243,95%CI(0.062,0.948),P=0.042]and organ failure[OR=0.401,95%CI(0.165,0.976),P=0.044]in SAP patients.Conclusion GC can reduce the mortality rate and organ failure rate of SAP patients without increasing the incidence of additional complications,and has a high safety profile.
作者
何海涛
周泽
魏志力
雷芳
师婉
Hai-Tao HE;Ze ZHOU;Zhi-Li WEI;Fang LEI;Wan SHI(Department of General External Hepatobiliary,The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi Province,China;Department of Clinical laboratory,Xi'an Fengcheng Hospital,Xi'an 710016,China)
出处
《中国药师》
CAS
2023年第12期435-441,共7页
China Pharmacist
基金
咸阳市重点研发计划项目(L2022ZDYFSF013)。
关键词
急性重症胰腺炎
糖皮质激素
预后
炎症指标
Sever acute pancreatitis
Glucocorticoids
Prognosis
Inflammatory indicators
