摘要
目的 探讨肌少症对中老年急性胰腺炎患者严重程度及预后的判断价值.方法 回顾性分析2020年1月至2023年9月安徽省第二人民医院收治的85例中老年急性胰腺炎患者.通过调取患者腹部CT影像资料,计算腰大肌指数(PMI),将PMI男性＜5.24cm2/m2和PMI值女性＜3.85cm2/m2作为肌少症判断标准对患者进行分组.比较两组患者的一般资料、胰腺炎严重程度及临床结局等,采用多因素Logistic回归分析急性胰腺炎患者发生肌少症的相关因素.结果 肌少症组纳入30例患者,其中轻度急性胰腺炎4例(13.33％)、中度6例(20.00％)、重度20例(66.67％),非肌少症组55例患者,轻度急性胰腺炎40例(72.73％)、中度11例(20.00％)、重度4例(7.27％),肌少症组重症胰腺炎比例明显升高,Spearman等级相关分析,腰大肌量与急性胰腺炎严重程度成反比(ρ=-0.647,P＜0.05).肌少症组血红蛋白、白蛋白、前白蛋白、C反应蛋白、血尿素氮、血钙及急性生理学和慢性健康状况评分(APACHE Ⅱ)和序贯器官衰竭评分(SOFA)与非肌少症组比较,差异均有统计学意义(P＜0.05).肌少症组胰腺感染性坏死、肺炎、多器官功能障碍(MODS)、死亡的发生率较非肌少症组高,住院时间更长(P＜0.05).多因素回归分析显示C反应蛋白、血尿素氮、血钙及APACHE Ⅱ评分升高是急性胰腺患者出现肌少症的独立危险因素.结论 肌少症对中老年急性胰腺炎患者的严重程度和预后有一定判断价值.
Abstract
Objective To explore the diagnostic value of sarcopenia for the severity and prognosis of acute pancreatitis in mid-dle-aged and elderly patients.Methods A retrospective analysis was conducted on 85 middle-aged and elderly patients with acute pan-creatitis admitted to the Second People's Hospital of Anhui Province from January 2020 to September 2023.By retrieving abdominal CT imaging data of patients,the lumbar muscle index(PMI)was calculated.Patients were divided into groups based on PMI values of＜5.24cm2/m2 for males and＜3.85cm2/m2 for females.Compare the general information,severity of pancreatitis,and clinical outcomes of two groups of patients,and use multiple logistic regression to analyze the relevant factors for the occurrence of sarcopenia in patients with acute pancreatitis.Results 30 patients were included in the sarcopenia group,including 4 cases of mild acute pancreatitis(13.33％),6 cases of moderate acute pancreatitis(20.00％),and 20 cases of severe acute pancreatitis(66.67％).There were 55 patients in the non sarcopenia group,40 cases of mild acute pancreatitis(72.73％),11 cases of moderate acute pancreatitis(20.00％),and 4 cases of severe acute pancreatitis(7.27％).The proportion of severe pancreatitis in the sarcopenia group was sig-nificantly increased,and Spearman grade correlation analysis showed that the lumbar muscle mass was inversely proportional to the se-verity of acute pancreatitis(ρ=-0.647,P＜0.05).The hemoglobin,albumin,prealbumin,C-reactive protein,blood urea nitro-gen,blood calcium,acute physiology and chronic health score(APACHE Ⅱ),and sequential organ failure score(SOFA)in the sar-copenia group were compared with those in the non sarcopenia group,and the differences were statistically significant(P＜0.05).The incidence of pancreatic infectious necrosis,pneumonia,multiple organ dysfunction(MODS),and death in the sarcopenia group was higher than that in the non sarcopenia group,and the hospitalization time was longer(P＜0.05).Multivariate regression analysis showed that elevated levels of C-reactive protein,blood urea nitrogen,blood calcium,and APACHE Ⅱ score were independent risk fac-tors for sarcopenia in acute pancreatic patients.Conclusion Sarcopenia has certain diagnostic value for the severity and prognosis of middle-aged and elderly patients with acute pancreatitis.
维普
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