胰腺疾病糖代谢紊乱的临床病例研究

发布时间：2018-09-19 20:53

【摘要】：目的:回顾分析胰腺疾病(急性胰腺炎、慢性胰腺炎、胰腺癌)的临床病例资料,研究它们糖代谢紊乱及临床特点,进一步指导临床治疗。方法:收集2012年1月-2014年12月在皖南医学院第一附属医院收住的胰腺疾病患者,其中76例轻度急性胰腺炎(mild acute pancreatitis,MAP),46例中度重症急性胰腺炎(moderately severe acute pancreatitis,MSAP),27例重症急性胰腺炎(severe acute pancreatitis,SAP),28例慢性胰腺炎(chronic pancreatitis,CP),157例胰腺癌(pancreatic carcinoma,PC),总结各组一般情况、临床表现、血糖变化等资料。结果:76例MAP患者,平均年龄53.2岁,伴有胆囊结石或胆总管结石或二者兼有者约占65.8%;腹痛患者100%;伴恶心呕吐患者约占82.9%;伴腰背部放射痛患者约占40.8%,入院空腹血糖平均为7.87mmol/L,住院期间血糖平均为7.25mmol/L,出院前血糖平均为6.29mmol/L,入院查白细胞平均为11.0*1012/L;低钙血症患者约占13.2%;无低蛋白血症患者,没有发生局部并发症和全身并发症;46例MSAP患者,平均年龄51.4岁,伴有胆囊结石或胆总管结石或二者兼有者约占58.7%;腹痛患者占100%;伴恶心呕吐患者约占91.3%;伴腰背部放射痛患者约占43.5%,其血糖观察指标分别是9.58mmol/L、7.69mmol/L、7.14mmol/L,入院查白细胞平均为13.5*1012/L;低钙血症患者约占13.0%;低蛋白血症患者约占47.8%,并发假性囊肿者约为13.0%;伴胸腹水者约为84.8%;没有并发胰腺脓肿患者;并发急性肺损伤(acute lung injury,ALl)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)者约占2.2%;并发急性肾衰竭(acute renal failure,ARF)者约占2.2%;27例SAP患者,平均年龄51.1岁,伴有胆囊结石或胆总管结石或二者兼有者约占44.4%;腹痛患者占100%;伴恶心呕吐患者约占96.3%;伴腰背部放射痛患者约占59.3%,其血糖观察指标分别是11.8mmol/L、9.63mmol/L、8.98mmol/L,入院查白细胞平均为15.5*1012/L;低钙血症患者约占29.6%;低蛋白血症患者约占88.9%,并发假性囊肿者约为63.0%;伴胸腹水者约为96.3%;并发胰腺脓肿者约占7.4%;并发ALl/ARDS者约占29.6%;并发ARF者约占14.8%。28例CP患者,平均年龄为61.1岁,饮酒病史者约占39.3%,有胆系疾病病史者约占39.3%,有AP病史者占25%,腹痛患者约占78.6%;腹泻患者约占17.9%,消瘦患者约占10.7%;纳差患者约占10.7%;餐后上腹饱胀患者约占3.6%,空腹血糖高于6.1mmol/L者约占39.3%,有糖尿病病史患者6例。157例PC患者,好发于老年患者,平均发病年龄为64.1岁,腹痛患者82%,消瘦患者87.2%,黄疸患者占36.9%,大量腹水患者3%;腹泻患者6%,有糖尿病病史患者其空腹血糖平均为9.12mmol/L,无糖尿病病史患者其空腹血糖平均为6.00mmol/L,糖尿病病史3年以内者有16例,3年以上或病史年限不详的为14例,发现有转移的患者占80.9%,未发现转移的患者占19.1%;胰头癌患者占64.3%,胰体尾癌患者占35.7%。结论:1,AP时,血糖异常升高,在一定程度上可以反映病情严重程度;2,胆囊结石或胆总管结石是AP最主要的病因;腹痛是最常见的临床表现;SAP时常常出现全身并发症;3,随着病程进展,CP后期可出现糖耐量异常和糖尿病;4,腹痛是CP最突出的症状,也可出现腹泻、纳差、消瘦等临床表现;5,新发糖尿病有助于PC的早期诊断;6,PC好发于老年患者,可有腹痛、腹泻、消瘦、黄疸等表现,且转移较早。
[Abstract]:Objective: to retrospectively analyze the clinical data of pancreatic diseases (acute pancreatitis, chronic pancreatitis, pancreatic cancer), study their glucose metabolism disorders and clinical characteristics, and further guide clinical treatment. methods: 76 patients with pancreatic diseases admitted to the First Affiliated Hospital of Southern Anhui Medical College from January 2012 to December 2014 were collected. Mild acute pancreatitis (MAP), 46 moderately severe acute pancreatitis (MSAP), 27 severe acute pancreatitis (SAP), 28 chronic pancreatitis (CP), and 157 pancreatic carcinoma (PC). The general conditions, clinical manifestations, blood glucose levels of each group were summarized. Results: The average age of 76 patients with MAP was 53.2 years old, with cholecystolithiasis or choledocholithiasis or both accounting for 65.8%; abdominal pain 100%; nausea and vomiting 82.9%; low back radiation pain 40.8%; admission fasting blood glucose 7.87 mmol/L, average blood glucose 7.25 mmol/L during hospitalization, before discharge The average blood glucose was 6.29 mmol/L, and the average leukocyte count was 11.0*1012/L on admission; 13.2% of the patients with hypocalcemia; no hypoalbuminemia, no local complications and systemic complications; 46 patients with MSAP, with an average age of 51.4 years, with cholecystolithiasis or choledocholithiasis or both accounted for 58.7%; 100% with abdominal pain; and 100% with nausea; Vomiting accounted for 91.3%; low back radiation pain accounted for 43.5%; blood glucose was 9.58 mmol/L, 7.69mmol/L, 7.14 mmol/L, and the average white blood cell was 13.5*1012/L; hypocalcemia accounted for 13.0%; hypoalbuminemia accounted for 47.8%; pseudocyst accounted for 13.0%; hydrothorax and ascites accounted for 84.8%; no and no leukocyte. Pancreatic abscess; acute lung injury (ALl) / acute respiratory distress syndrome (ARDS) accounted for 2.2%; acute renal failure (ARF) accounted for 2.2%; 27 SAP patients, average age 51.1 years, with gallstones or common bile duct stones or both About 44.4%; abdominal pain accounted for 100%; nausea and vomiting accounted for 96.3%; low back radiation pain accounted for 59.3%; the blood glucose indexes were 11.8 mmol/L, 9.63 mmol/L, 8.98 mmol/L, and the average leukocyte count was 15.5*1012/L; hypocalcemia accounted for 29.6%; hypoalbuminemia accounted for 88.9%; and pseudocyst accounted for 63.9%. Among the 28 CP patients, the average age was 61.1 years old, the drinking history was 39.3%, the history of biliary diseases was 39.3%, the AP history was 25%, the abdominal pain was 78.6%, the diarrhea patients was 17.9%, and the emaciation patients were about 17.9%. 10.7%; 10.7%; 10.7%; 3.6% of the patients with postprandial fullness, 39.3% of the patients with fasting blood glucose higher than 6.1 mmol/L, and 6.157 patients with diabetes mellitus were PC patients. The average age of onset was 64.1 years old, 82% of the patients with abdominal pain, 87.2% of the patients with emaciation, 36.9% of the patients with jaundice, 3% of the patients with massive ascites, and 6% of the patients with diarrhea. The average fasting blood glucose was 9.12 mmol/L in patients with diabetes history, 6.00 mmol/L in patients without diabetes history, 16 patients with diabetes history less than 3 years, 14 patients with more than 3 years or unknown disease history, 80.9% patients with metastasis, 19.1% patients without metastasis, 64.3% patients with pancreatic head cancer and 64.3% patients with pancreatic body and tail cancer. Conclusion: 1. The abnormal increase of blood glucose during AP can reflect the severity of the disease to a certain extent; 2. Gallstone or choledocholithiasis is the main cause of AP; Abdominal pain is the most common clinical manifestation; Systemic complications often occur during SAP; 3. With the progress of the disease, abnormal glucose tolerance and diabetes mellitus may occur in the later stage of CP; 4. Abdominal pain is the most common cause of AP. The most prominent symptoms of CP can also appear diarrhea, poor appetite, emaciation and other clinical manifestations; 5, new-onset diabetes contributes to the early diagnosis of PC; 6, PC occurs in elderly patients, can have abdominal pain, diarrhea, emaciation, jaundice and other manifestations, and metastasis early.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R576

【相似文献】