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目的:探讨妊娠期急性胰腺炎(APIP)患者的临床特征及胎儿死亡的危险因素。方法:回顾性分析2013年1月至2020年6月间西南医科大学附属医院收治的90例APIP患者临床资料。根据病情严重程度将患者分为MAP组(41例)、MSAP组(33例)、SAP组(16例)，根据有无胎儿死亡分为胎儿死亡组(13例)和胎儿存活组(77例)，比较各组患者临床特征及各项生物化学指标。将组间比较差异有统计学意义的变量进行二元logistic回归分析，探究胎儿死亡的独立危险因素，绘制受试者工作特征曲线，评价其诊断效能。结果:90例APIP的主要病因是高三酰甘油血症(42/90，46.7%)。血LDH、CRP、血糖、D-二聚体、白蛋白、载脂蛋白A1(ApoA1)水平及新生儿1、5 min Apgar评分在不同严重程度APIP患者间差异均有统计学意义(n P值均<0.05)。90例孕产妇无死亡，胎儿死亡13例(14.4%)。随着APIP患者病情严重程度的增加，胎儿死亡率增加。APIP合并高血压(n OR＝14.742，95%n CI 1.157～187.890，n P＝0.038)、酮症酸中毒(n OR＝19.587，95%n CI 1.789～214.469，n P＝0.015)及CRP水平(n OR＝1.013，95%n CI 1.001～1.025，n P＝0.031)是胎儿死亡的危险因素，ApoA1水平(n OR＝0.118，95%n CI 0.021～0.664，n P＝0.015)是胎儿死亡的保护因素。ApoA1预测胎儿死亡的灵敏度为84.6%，特异度为79.2%，CRP预测胎儿死亡的灵敏度为76.9%，特异度为84.4%，两指标联合预测胎儿死亡的灵敏度为100%，特异度为67.5%。n 结论:APIP的病情严重程度与胎儿死亡密切相关，高血压、酮症酸中毒、CRP水平是胎儿死亡的危险因素，需特别重视。“,”Objective:To explore the clinical features of acute pancreatitis in pregnancy (APIP) and the risk factors for fetal death.Methods:The clinical data of 90 patients with APIP in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed from January 2013 to June 2020. Based on the severity, the patients were classified into MAP groups (n n=41), MSAP groups (n n=33), SAP group (n n=16). According to the presence of fetal deaths, the patients were divided into fetal death group (n n=13) and fetal survival group (n n=77). The clinical characteristics and indicators of patients in each group were compared. Binary logistic regression analysis was performed on the variables with differences between groups to explore independent risk factors for fetal death. The receiver operating characteristic curves of laboratory indicators were drawn to evaluate their diagnostic efficacy.n Results:Hyperlipidemia was the main cause in 90 APIP cases (42/90, 46.7%). The levels of LDH, CRP, blood glucose, D2 polymer, albumin and ApoA1, the 1-min and 5-min Apgar scores of neonates were statistically significant among MAP group, MSAP group and SAP group (all n P<0.05). There were no maternal deaths in 90 cases and 13 fetal deaths (14.4%). Fetal mortality increased with the severity of APIP. APIP combined with hypertension (n OR=14.742, 95%n CI 1.157-187.890, n P=0.038), ketoacidosis (n OR=19.587, 95%n CI 1.789-214.469, n P=0.015) and CRP level (n OR=1.013, 95%n CI 1.001-1.025, n P=0.031) were risk factors for fetal death. ApoA1 level (n OR=0.118, 95%n CI 0.021-0.664, n P=0.015) was a protective factor for fetal death. The sensitivity and specificity of ApoA1 for predicting fetal death were 84.6% and 79.2%, the sensitivity and specificity of CRP for predicting fetal death were 76.9% and 84.4%, and the sensitivity and specificity of the combination of the two indicators for predicting fetal death were 100% and 67.5%.n Conclusions:The severity of APIP was closely related to fetal death. Hypertension, ketoacidosis and blood level CRP were independent risk factors for fetal death, which should be paid special attention.