Clinical Features Of 432 Cases Of Acute Pancreatitis

Objective:The clinical data of patients with acute pancreatitis（AP）of different etiology and severity were compared to analyze the clinical characteristics of AP,so as to provide reference for the clinical diagnosis and treatment of AP,facilitate the early identification of the etiology of acute pancreatitis,take corresponding treatment measures and improve the prognosis of patients.Methods:Using retrospective study method,collected in January 2017-January 2020 in people’s hospital of 432 AP patients hospitalized with general data and laboratory results,severity,length of hospital stay,complications and prognosis,features of different etiology and clinical features of different severity of AP,using Excel and SPSS22.0 software to analyze data record and perfect the relevant charts.Results:1.Clinical features of AP with different etiologies:（1）Among the 432 AP patients,123 had gallbladder origin,109 had hyperlipidemia,77 had dietary-related,66 had idiopathic,and 57 had alcoholism.（2）Compared with biliary diseases,hyperlipidemia,alcohol,diet-related and idiopathic diseases were more common in males,with a lower average age of onset,and a higher proportion of fatty liver.The proportion of hyperlipidemia with diabetes was higher than that in biliary diseases,diet-related and idiopathic diseases（P<0.05）.（3）For gallstone AP,the level of serum amylase（AMY）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TBIL）,direct bilirubin（DBIL）,alkaline phosphatase（ALP）and gamma glutamyl transpeptidase（GGT）were higher than the other four groups.Neutrophils/lymphocyte ratio（NLR）was higher than that of hyperlipidemia,lymphocyte（LY）was lower than the hyperlipidemia and idiopathic.For hyperlipidemia AP,the level of hemoglobin（HGB）,triglycerides（TG）,total cholesterol（CHOL）,low density lipoprotein cholesterol（LDL-C）,albumin（propagated）were higher than the other four groups.High density lipoprotein cholesterol（HDL-C）had the lowest levels among the groups.Red blood cells deposited（HCT）,uric acid（UA）levels were higher than gallstone,diet correlation and idiopathic.For alcoholic AP,the levels of creatinine（Cr）,UA and C-reactive protein（CRP）were higher than those in biliary AP,Cr and DBIL were higher than those in hyperlipidemia,and GGT was higher than it in idiopathic AP.The above differences were statistically significant（P<0.05）.The levels of white blood cell（WBC）,neutrophils（NEUT）,red blood cell distribution width（RDW）,platelet distribution width（PDW）,urea（BUN）and Ca²⁺in the 5 groups were not statistically significant（P>0.05）.（4）Alcoholic patients had the highest proportion of acute peripancreatic fluid accumulation（APFC）.The proportion of renal failure in alcoholic patients and hyperlipidemia patients was higher than that in biliary patients,the differences were statistically significant（P<0.05）.There was no significant difference in the incidence of pleural effusion,peritoneal effusion,acute necrotic accumulation（ANC）,systemic inflammatory response syndrome（SIRS）,acute respiratory distress syndrome（ARDS）,circulatory failure,sepsis,pancreatic encephalopathy and peritoneal infection among the 5 groups（P>0.05）.（5）The incidence of moderate severe acute pancreatitis（MSAP）and severe acute pancreatitis（SAP）in the patients of hyperlipidemia,alcohol and diet were higher than those of biliary.The 1-year recurrence rate of hyperlipidemia was the highest among the 5 groups（P<0.05）.There was no statistical significance in the length of stay and mortality among the 5 groups（P>0.05）.2.Clinical features of AP with different severity:（1）Among the 432 AP patients,there were 222 cases of mild acute pancreatitis（MAP）,189 cases of MSAP,21 cases of SAP.（2）Of all the patients counted,there were 8 patients died,which all of them were from the SAP group,accounting for 1.9%and 38.1%of all AP patients and SAP patients,respectively.What’s more,the hospitalization time of SAP and MSAP was higher than that of MAP（P<0.05）.However,there were no statistical significance in onset age and 1-year recurrence rate among the three groups（P>0.05）.（3）The levels of RDW,PDW,AST,DBIL,BUN,CRP,Cr and prothrombin time（PT）in SAP were highest among the 3 groups;the levels of HGB,HCT,CHOL,HDL-C,ALB and Ca²⁺were the lowest in SAP group.In MAP group,the levels of WBC,NEUT and NLR were the lowest among the 3groups,and the levels of ALP and GGT were higher than the other groups（P<0.05）.Besides,There were no significant differences of LY,AMY,LDL-C,TBIL and UA levels in the three groups（P>0.05）.（4）The incidence of peritoneal effusion,ANC,SIRS,ARDS,renal failure,circulatory failure,sepsis,pancreatic encephalopathy and peritoneal infection in SAP were highest among the 3groups.The incidence of APFC in MSAP was higher than the other groups（P<0.05）.3.Effect of surgical intervention on recurrence rate of biliary AP:Among 123patients with biliary AP,69 patients received surgical intervention,there was one patient（1.4%）relapsed within 1 year among the patients received surgical intervention.54 patients received conservative treatment,7 patients（13%）had recurrence within 1year.The one-year recurrence rate of patients receiving surgical intervention was lower than conservative treatment,the difference was statistically significant（P<0.05）.Conclusion:1.The most common cause of AP in this region was bile origin,followed by hyperlipidemia,diet-related,idiopathic and alcoholic.2.The level of AMY in hyperlipidemia,alcohol,diet-related and idiopathic was almost not more than 3 times of the upper limit of normal value.3.Alcoholic and hyperlipidemic AP were more likely to happen the complications of acute renal failure.What’s more,alcoholic AP was easier to merge APFC contrast with the other groups.4.The total mortality of AP showed a downward trend in this study than before,however,the mortality of SAP was still remained high.5.The 1-year recurrence rate of hyperlipidemia AP was the higher than the other groups.What’s more,it was particularly important to regularly apply lipid-lowering drugs and monitor the changes of blood lipid outside the hospital.