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目的:探讨急性胰腺炎(Acute pancreatitis,AP)严重程度与糖代谢异常的相关性及其预后。方法:选择2006年7月至2013年6月我院消化科收治入院的急性胰腺炎患者158例,按疾病严重程度分为轻症急性胰腺炎(MAP)组68例和重症急性胰腺炎(SAP)组90例;检测两组患者糖代谢指标空腹静脉血糖(FPG)、负荷2 h静脉血糖(PPG)及评定两组患者急性生理及慢性健康评分Ⅱ(APACHEⅡ),对两组的糖代谢指标和APACHEⅡ评分进行相关性分析,并观察两组患者的预后。结果:SAP组患者FPG、PPG、胰岛素水平(FINS)、胰岛素抵抗指数(IRI)明显高于MAP组,胰岛素敏感指数(ISI)低于MAP(P<0.01);急性胰腺炎(AP)患者的APACHEⅡ评分与FPG、PPG、FINS、IRI呈正相关(P<0.05,P<0.01),与ISI呈负相关(P<0.05);SAP组的假性囊肿、感染、脓肿、坏死、急性肺损伤或急性呼吸窘迫综合征(ARDS)、死亡发生率明显高于MAP组(P<0.05,P<0.01)。结论:AP的严重程度与糖代谢异常存在密切的关系,两者相互影响,因此,在治疗AP时,应积极控制胰腺炎症,防止和减少胰腺坏死,将血糖降至正常范围,以降低并发症和死亡的发生率。
Objective: To investigate the correlation between the severity of acute pancreatitis (AP) and abnormal glucose metabolism and its prognosis. Methods: A total of 158 acute pancreatitis admitted to our department of gastroenterology from July 2006 to June 2013 were divided into 68 cases of severe acute pancreatitis (MAP) and severe acute pancreatitis (SAP) according to the disease severity ) Group (n = 90). Fasting venous blood glucose (FPG), 2-hour intravenous glucose (PPG), and acute physiology and chronic health score Ⅱ (APACHEⅡ) were measured in both groups. And APACHE Ⅱ score correlation analysis, and observed the prognosis of two groups of patients. Results: The levels of FPG, PPG, FINS and IRI in SAP group were significantly higher than those in MAP group and the ISI was lower than that in MAP group (P <0.01). The levels of FPG, PPG, insulin, insulin resistance index APACHEⅡscore was positively correlated with FPG, PPG, FINS and IRI (P <0.05, P <0.01), but negatively correlated with ISI (P <0.05) Acute respiratory distress syndrome (ARDS), the incidence of death was significantly higher than the MAP group (P <0.05, P <0.01). Conclusion: There is a close relationship between the severity of AP and the abnormal glucose metabolism. Therefore, AP should actively control pancreatic inflammation, prevent and reduce pancreatic necrosis, reduce blood glucose to normal range and reduce complications And the incidence of death.