急性胰腺炎后远期胰岛功能不全的相关性研究

发布时间：2018-04-21 10:12

本文选题：急性胰腺炎 + 胰岛功能　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:通过定期检测急性胰腺炎后患者的糖代谢指标,分析急性胰腺炎后远期胰岛内分泌功能的变化情况及与之相关的危险因素。方法:选取2015年2月到2016年4月在山西医科大学附属第二医院进行住院治疗并临床痊愈出院且到我院门诊复查的52名急性胰腺炎(AP)患者,男性28名(53.8%),女性24名(46.2%),平均病程8月,同时选取40名健康人作为对照组男性25名(62.5%)女性15名(37.5%)。胰腺内分泌功能检查通过测定:空腹血清葡萄糖及餐后1小时、2小时血清葡萄糖水平和糖化血红蛋白,上述测定指标分别于患者出院后3、6、9个月后测得。同时搜集患者发病前后可能影响血糖代谢的相关临床资料。结果:52名AP患者中,平均随访年龄(48.4+16.7)岁,其中按疾病的严重程度分类:急性水肿性胰腺炎(MAP)30例(57.7%),急性重症胰腺炎(S AP)22例(42.3%);按病因分类,其中胆源性胰腺炎33例(63.5%),酒精性胰腺炎10例(19.3%),高脂血症性胰腺炎9例(17.2%)。9个月后随访发现DM8例,10例糖耐量异常,8例空腹血糖受损,40名健康对照组血糖代谢均在正常范围。AP组患者在空腹血糖、餐后1,2小时血糖测定值与对照组相比均明显升高,有统计学意义(p0.05);而糖化血红蛋白AP组与对照组相比没有明显差异,无统计学意义。SAP组患者发生血糖代谢异常的人数比例(77.27%)与MAP组(23.23%)相比明显增高,且具有统计学意义(p0.05);在病因方面高脂血症性胰腺炎患者发生血糖代谢异常(87%)较胆源性胰腺炎(22%)、酒精性胰腺炎(30%)更容易发生血糖代谢的紊乱(P0.05);MAP组患者随着随访间期的延长,血糖代谢异常的患者比例由第三个月时的33%下降到第九个月后的23%,胰岛的内分泌功能有逐渐缓解的趋势;S AP组患者随着随访时间的进展,胰岛功能未见缓解趋势。在本研究中,导致胰腺内分泌功能发生异常的各相关危险因素中:肥胖、长期饮酒(发病后并未戒酒)及高脂血症等与患者远期胰岛内分泌功能异常有关。结论:1急性胰腺炎后患者确实存在远期胰岛功能不全的情况,不同病因和不同严重程度对后期胰岛功能的影响差别明显。2急性水肿型胰腺炎在短期内影响胰岛功能,随着恢复期的延长,胰岛功能可逐渐恢复。急性重症胰腺炎对胰岛功能的损害是持久性的,其大部分患者可能转为糖尿病。3高脂血症性胰腺炎对远期胰岛功能的损害较其他类型胰腺炎更加严重。胆源性胰腺炎和酒精性胰腺炎发生胰岛功能损害的程度较轻。4急性胰腺炎后胰岛功能损伤是胰腺炎后最严重的慢性并发症,发病后有饮酒史、肥胖、高脂血症的患者较其他患者更容易出现远期胰岛功能的不全,临床上针对不同病因及不同严重程度的患者进行个体化治疗对保存胰岛功能具有重要意义。
[Abstract]:Objective: to analyze the changes of endocrine function of pancreatic islets after acute pancreatitis (AP) and its related risk factors by regularly detecting glucose metabolism in patients with acute pancreatitis. Methods: from February 2015 to April 2016, 52 patients with acute pancreatitis (AP) who were hospitalized in the second affiliated Hospital of Shanxi Medical University and were discharged from the clinic and re-examined in our outpatient department, 28 males and 24 females, with an average course of 8 months, were selected. At the same time, 40 healthy persons were selected as control group. Pancreatic endocrine function was measured by fasting serum glucose and serum glucose and glycosylated hemoglobin at 1 hour and 2 hours postprandial. The above indexes were measured after 3 days and 9 months after discharge respectively. At the same time, collect the related clinical data of blood glucose metabolism before and after onset. Results the mean follow-up age of 52 AP patients was 48.4.16. 7 years old. According to the severity of the disease, there were 30 cases of acute edematous pancreatitis with MAPP and 57.7% with acute severe pancreatitis and 42.3% with S AP)22. 33 cases of gallstone pancreatitis, 10 cases of alcoholic pancreatitis and 9 cases of hyperlipidemic pancreatitis were found to have normal glucose metabolism in 10 cases with impaired glucose tolerance and 8 cases with impaired fasting blood glucose in the control group, 9 cases with hyperlipidemic pancreatitis and 9 cases with hyperlipidemic pancreatitis. 9 months later, 10 patients with abnormal glucose tolerance and 8 patients with impaired fasting blood glucose were found to have normal glucose metabolism. Range. AP group patients with fasting blood glucose, Compared with the control group, the blood glucose measurement value of 1h / 2 h after meal was significantly higher than that of the control group (P 0.05), but there was no significant difference between the AP group and the control group in glycosylated hemoglobin (glycosylated hemoglobin). The proportion of patients with abnormal blood glucose metabolism in SAP group (77.27%) was significantly higher than that in MAP group (23.23%). In the etiology of hyperlipidemic pancreatitis, abnormal blood glucose metabolism occurred in 87% of the patients with hyperlipidemic pancreatitis, compared with gallstone pancreatitis (22%) and alcoholic pancreatitis (30%). The patients in map group were more likely to develop the disorder of blood glucose metabolism with the prolongation of follow-up period. The percentage of patients with abnormal blood glucose metabolism decreased from 33% at the third month to 23 months after the ninth month. The endocrine function of the islets gradually alleviated. In this study, obesity, long-term drinking (no abstinence after onset) and hyperlipidemia were associated with long-term islet endocrine dysfunction. Conclusion there is a long term islet insufficiency in patients with acute pancreatitis, and the effects of different etiology and severity on islet function are different. 2. Acute edematous pancreatitis affects pancreatic islet function in a short period of time. With the extension of recovery period, islet function can be gradually restored. The damage to pancreatic islet function caused by severe acute pancreatitis is persistent. Most of the patients may turn to diabetes mellitus and hyperlipidemia pancreatitis has more serious damage to long-term islet function than other types of pancreatitis. The degree of islet function damage after acute pancreatitis is the most serious chronic complication after acute pancreatitis. Patients with hyperlipidemia are more prone to long-term islet insufficiency than other patients. Individualized treatment for patients with different etiology and severity is of great significance to preserve islet function.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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