李洪玉

[摘要] 目的 研究急性胰腺炎（AP）合并肝损伤的临床特征及对预后的影响。 方法 对187例急性胰腺炎患者的临床资料进行分析和比较，了解肝损伤的发生率以及肝损伤的程度对病情产生的影响。 结果 187例急性胰腺炎患者中合并肝损伤者112例，其中重症急性胰腺炎（SAP）65例，轻症急性胰腺炎（MAP）47例；胆源性急性胰腺炎（BAP）79例，非胆源性急性胰腺炎（NBAP）33例。SAP较MAP肝损伤发生率高（分别为100%和38.5%）；BAP比NBAP肝损伤发生率高（分别为74.5%和40.7%）。SAP患者肝脏功能受到的损伤程度较MAP更为严重，差异有统计学意义（P<0.01）。SAP合并肝损伤患者较MAP合并肝损伤患者在腹痛缓解、血淀粉酶复常及肝功能恢复正常的时间方面均明显延长（P<0.01）。 结论 急性胰腺炎合并肝损伤发生率高，其肝损伤程度与急性胰腺炎病情严重程度有关，掌握肝损伤的临床特点对临床治疗具有重要意义。

[关键词] 急性胰腺炎；肝损伤；肝功能；预后

[中图分类号] R576；R575 [文献标识码] B [文章编号] 1673-9701（2015）34-0037-03

Clinical analysis of acute pancreatitis with liver injury

LI Hongyu

Department of Gastroenterology， the Second Hospital of Fushun City in Liaoning Province，Fushun 113001，China

[Abstract] Objective To study the clinical features of acute pancreatitis（AP） with liver injury and its impact on prognosis. Methods 187 cases of patients with acute pancreatitis were analyzed and compared，to understand the incidence of liver injury and the influence of the degree of liver injury. Results In the 187 cases of AP patients， 112 cases were with liver injury， including 65 severe acute pancreatitis （SAP） and 47 cases of mild acute pancreatitis （MAP）. In the 79 cases of biliary acute pancreatitis（BAP） and 33 cases of non-biliary acute pancreatitis （NBAP）. The incidence of liver injury in the SAP group （100%） was higher than that in the MAP group （38.5%）； and the incidence of liver injury in the BAP group （74.5%） was higher than the NBAP group （40.7%）. From the statistical data，the degree of liver injury in the SAP group was severer than that in the MAP group，which was significant different（P<0.01）. The abdominal pain relief time， time to normalization of serum amylase and liver function returned to normal were longer in SAP patients complicated with liver injury than those in the MAP patients complicated with liver injury（P<0.01）. Conclusion AP complicated with liver injury has a high incidence rate. The degree of liver injury is associated with severity of AP. So to master the clinical characteristics of liver injury is of great significance for clinical treatment.

[Key words] Acute pancreatitis； Liver injury； Liver function； Prognosis

急性胰腺炎（acute pancreatitis，AP）是多种病因导致胰酶在胰腺内被激活后引起胰腺组织自身消化、水肿、出血甚至坏死的炎症反应。临床以急性上腹痛、恶心、呕吐、发热和血胰酶增高等为特点。是临床常见急腹症之一，该病发展迅速，临床症状明显，极易并败血症，甚至造成死亡[1]。还可并发多种脏器功能衰竭。其中，肝损伤最为常见[2]，可直接影响患者的预后及临床治疗效果。本研究对我院近两年多收治的112例AP合并肝损伤患者的临床资料进行整理和分析，以探究急性胰腺炎与肝损伤发生的相关性，并为临床治疗提供帮助。

1 资料与方法

1.1 一般资料

选取我院2013年1月～2015年4月收治的共计187例AP患者的相关资料，其中男100例，女87例，年龄（60.1±19.3）岁。其中重症急性胰腺炎（severe acute pancreatitis，SAP）65例，全部合并肝损伤（100%）；轻症急性胰腺炎（mild acute pancreatitis，MAP）122例，合并肝损伤47例（38.5%）。其中胆源性急性胰腺炎（biliary acute pancreatitis，BAP）106例，合并肝损伤79例（74.5%），非胆源性急性胰腺炎（non-biliary acute pancreatitis，NBAP）81例，合并肝损伤33例（40.7%）。……