妊娠合并急性胰腺炎是一种少见但潜在严重的疾病,甚至可能危及母婴生命。因此及时诊断和有效治疗对改善母婴预后十分重要。胆结石疾病与高甘油三酯血症是妊娠合并急性胰腺炎的常见病因。其中并发症风险最大的是由高甘油三酯血症引起的急性胰腺炎。此种类型胰腺炎的治疗重难点在妊娠期高脂血症的管理。目前国内外尚无指南。本文报道了一例妊娠合并急性胰腺炎的患者,并探讨了其诊断和治疗策略。本案例患者在使用双重血浆置换、非诺贝特、omega-3脂肪酸等降脂药物及其他治疗后病情得到显著改善,顺利分娩一活婴,为该疾病的诊治和妊娠期高脂血症的管理提供了很好的参考意义。Acute pancreatitis during pregnancy is a rare but potentially serious disease that may even endanger the life of the mother and child. Therefore, timely diagnosis and effective treatment are very important to improve maternal and infant prognosis. Gallstone disease and hypertriglyceridemia are common causes of acute pancreatitis during pregnancy. The highest risk of complications is acute pancreatitis caused by hypertriglyceridemia. The treatment of this type of pancreatitis is difficult in the management of hyperlipidemia during pregnancy. At present, there are no guidelines at home or abroad. This article reports a case of pregnancy complicated with acute pancreatitis, and discusses its diagnosis and treatment strategy. In this case, the patient’s condition was significantly improved after the use of lipid-lowering drugs such as double plasma exchange, fenofibrate, omega-3 fatty acids and other treatments, and a live baby was delivered successfully, which provided a good reference for the diagnosis and treatment of this disease and the management of hyperlipidemia during pregnancy.
目的:分析妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)患者的类型、临床特征及预后危险因素,探讨APIP的预防及治疗管理。方法:回顾性分析2012年4月—2022年3月绵阳市中心医院收治的96例APIP患者,包括APIP的病因、严重程度、实验室指标、并发症、治疗及预后等。结果:根据疾病严重程度分组,轻症APIP(mild APIP,MAPIP)49例(51.04%),中重症APIP(moderate severe APIP,MSAPIP)27例(28.12%),重症APIP(severe APIP,SAPIP)20例(20.83%)。疾病越重,患者的超敏C反应蛋白越高,血钙及白蛋白水平越低,差异有统计学意义(均P<0.05)。组间血淀粉酶、血脂肪酶、血糖指标的差异均无统计学意义(P>0.05)。APIP的主要病因为高脂血症(45/96,46.87%),胆源性APIP 28例(29.17%),特发性APIP 23例(23.96%)。合并有糖尿病的患者高脂血症性APIP发生率更高。高脂血症性APIP更容易出现局部或全身并发症,发展为MSAPIP和SAPIP,差异有统计学意义(P<0.001)。APIP患者的病情越重,胎儿丢失率越高,差异有统计学意义(P<0.05),高脂血症性APIP更易出现胎儿丢失,差异有统计学意义(P<0.001)。结论:APIP在妊娠晚期发生率高,高脂血症是首要病因,并且高脂血症性APIP更易重症化。胎儿丢失率与APIP的严重程度密切相关。APIP的早期诊断、严重程度的评估及治疗方法的选择对于母婴预后非常重要。
