摘要
背景急性肺损伤是重症急性胰腺炎病程中除胰腺外最易发生的器官损伤,主要表现为呼吸功能不全伴呼吸急促、发绀、肺顺应性降低等,其具体发病机制尚不完全清楚。虽然经过保护性治疗,重症急性胰腺炎并发急性肺损伤患者的生活质量仍受到不利影响。目的系统评价重症急性胰腺炎并发急性肺损伤的危险因素。方法计算机检索中国知网、万方数据知识服务平台、维普网(VIP)、PubMed、Web of Science、EBSCO数据库中有关重症急性胰腺炎并发急性肺损伤危险因素的相关研究,检索时限为建库至2023年10月。由2位研究者独立筛选文献、提取资料、评价文献质量以及证据等级,采用RevMan 5.3软件进行Meta分析并使用Stata 17.0中的Begg's检验进行发表偏倚分析。结果共纳入10篇文献,均为病例对照研究,包括1053例重症急性胰腺炎患者。Meta分析结果显示,年龄增大(SMD=0.58,95%CI=0.03~1.14,P=0.04)、空腹血糖升高(SMD=0.45,95%CI=0.27~0.64,P<0.00001)、呼吸频率增加(>30次/min)(OR=6.18,95%CI=3.20~11.94,P<0.00001)、合并发热(OR=12.92,95%CI=4.41~37.84,P<0.00001)、合并胸腔积液(OR=7.19,95%CI=3.25~15.91,P<0.00001)、白蛋白降低(SMD=-0.77,95%CI=-0.98~-0.56,P<0.00001)、合并肥胖(OR=3.11,95%CI=1.94~4.98,P<0.00001)、钙离子降低(SMD=-0.63,95%CI=-0.85~-0.42,P<0.00001)、合并酸中毒(OR=2.15,95%CI=1.03~4.49,P=0.04)、C反应蛋白升高(SMD=0.79,95%CI=0.56~1.03,P<0.00001)、血红蛋白降低(SMD=-0.77,95%CI=-1.10~-0.43,P<0.00001)、血清淀粉酶升高(SMD=0.21,95%CI=0.01~0.42,P=0.04)、尿淀粉酶升高(SMD=0.40,95%CI=0.03~0.77,P=0.03)、Ranson评分增加(SMD=0.87,95%CI=0.66~1.08,P<0.00001)、急性生理与慢性健康状况评分(APACHEⅡ评分)增加(SMD=0.77,95%CI=0.58~0.96,P<0.00001)、CT严重指数评分升高(SMD=0.39,95%CI=0.19~0.59,P<0.00001)、BISAP升高(SMD=0.62,95%CI=0.37~0.88,P<0.00001)、高脂血症性急性胰腺炎(OR=1.68,95%CI=1.05~2.67,P=0.03)、合并全身炎症反应综合征(SIRS)(OR=9.57,95%CI=4.03~22.72,P<0.00001)、器官损伤数目增加(≥2个)(OR=6.94,95%CI=3.34~12.59,P<0.00001)、合并感染(OR=4.59,95%CI=2.42~8.71,P<0.00001)为重症急性胰腺炎并发急性肺损伤的危险因素。发表偏倚分析结果显示,进行分析的14项因素(年龄、肥胖、空腹血糖、白蛋白、钙离子、C反应蛋白、血清淀粉酶、呼吸频率、Ranson评分、APACHEⅡ评分、CT严重指数评分、BISAP、高脂血症性、胸腔积液)未见明显发表偏倚(P>0.05)。GRADE证据评价结果显示,共有11项危险因素(年龄、呼吸频率、胸腔积液、肥胖、血红蛋白、血清淀粉酶、尿淀粉酶、Ranson评分、BISAP、高脂血症性急性胰腺炎、器官损伤数目)为中等质量,10项(空腹血糖、发热、白蛋白、钙离子、酸中毒、C反应蛋白、APACHEⅡ评分、CT严重指数评分、SIRS、感染)为低质量。结论年龄增大,血糖、C反应蛋白、血清淀粉酶、尿淀粉酶升高,白蛋白、血红蛋白、钙离子浓度降低,呼吸频率增加(>30次/min),Ranson评分、APACHEⅡ评分、CT严重指数评分、BISAP评分高,高脂血症性急性胰腺炎,合并发热、酸中毒、肥胖、胸腔积液、SIRS、器官受累(≥2个)、感染是SAP患者并发ALI的危险因素。未来需要进一步开展高水平研究,对上述研究成果加以论证。
Background Acute lung injury represents the most probable organ injury in the context of severe acute pancreatitis,with the exception of the pancreas,which is primarily distinguished by respiratory insufficiency,manifested as shortness of breath,cyanosis,and diminished lung compliance.Nevertheless,the precise pathogenesis remains incompletely elucidated.Despite the administration of protective measures,the quality of life of patients with severe acute pancreatitis complicated by acute lung injury remains adversely affected.Objective To systematically evaluate the risk factors of severe acute pancreatitis complicated with acute lung injury.Methods Computer searches were conducted on CNKI,Wanfang database,VIP,PubMed,Web of Science and EBSCO databases to search relevant studies on the risk factors of severe acute pancreatitis complicated with lung injury from the establishment of the database to October 2023.Two researchers independently screened literature,extracted data,evaluated literature quality and evidence level,and conducted meta-analysis using RevMan 5.3 software.Begg's test in Stata17.0 was used for publication bias analysis.Results A total of 10 studies were included,all of which were case-control studies,including 1053 patients with severe acute pancreatitis.The results of meta-analysis showed that increased age(SMD=0.58,95%CI=0.03-1.14,P=0.04),elevated fasting blood glucose(SMD=0.45,95%CI=0.27-0.64,P<0.00001),and an elevated respiratory rate(>30 breaths/min)(OR=6.18,95%CI=3.20-11.94,P<0.00001),the occurrence of fever(OR=12.92,95%CI=4.41-37.84,P<0.00001),the occurrence of pleural effusion(OR=7.19,95%CI=3.25-15.91,P<0.00001),decreased albumin(SMD=-0.77,95%CI=-0.98 to-0.56,P<0.00001),combined with obesity(OR=3.11,95%CI=1.94-4.98,P<0.00001),decreased calcium ion(SMD=-0.63,95%CI=-0.85 to-0.42,P<0.00001),combined with acidosis(OR=2.15,95%CI=1.03-4.49,P=0.04),elevated C-reactive protein(SMD=0.79,95%CI=0.56-1.03,P<0.00001),decreased hemoglobin(SMD=-0.77,95%CI=-1.10 to-0.43,P<0.00001),elevated blood amylase(SMD=0.21,95%CI=0.01-0.42,P=0.04),increased urinary amylase(SMD=0.40,95%CI=0.03-0.77,P=0.03),elevated Ranson score(SMD=0.87,95%CI=0.66-1.08,P<0.00001),a rise in APACHEⅡscore(SMD=0.77,95%CI=0.58-0.96,P<0.00001),increased CT severity index score(SMD=0.39,95%CI=0.19-0.59,P<0.00001),elevated BISAP(SMD=0.62,95%CI=0.37-0.88,P<0.00001),severe acute pancreatitis with hyperlipidemia(OR=1.68,95%CI=1.05-2.67,P=0.03),combined with SIRS(OR=9.57,95%CI=4.03-22.72,P<0.00001),number of organ injury(≥2)(OR=6.94,95%CI=3.34-12.59,P<0.00001),the occurrence of infection(OR=4.59,95%CI=2.42-8.71,P<0.00001)were risk factors for severe acute pancreatitis complicated with acute lung injury.The results of the publication bias analysis demonstrated that no significant publication bias was observed for the 14 factors(age,obesity,glucose,albumin,calcium ions,C-reactive protein,serum amylase,respiratory rate,Ranson score,APACHEⅡscore,CT severity index score,BISAP,hyperlipidemicity and pleural effusion)for which the analyses were conducted(P>0.05).The GRADE evidence evaluation demonstrated that a total of 11 risk factors(age,respiratory rate,pleural effusion,obesity,hemoglobin,serum amylase,urinary amylase,Ranson score,BISAP,hyperlipidemicity and organ damage)exhibited moderate quality,while 10(fasting blood glucose,fever,albumin,calcium ions,acidosis,C-reactive protein,APACHEⅡscore,CT severity Index score,SIRS and infection)demonstrated low quality.Conclusion Age increase,fasting blood glucose,amylase,C-reactive protein,urinary amylase increase,albumin,hemoglobin,calcium ion concentration decrease,respiratory rate(>30 breaths/min),Ranson score,APACHEⅡscore,CT severity index score,BISAP score high,SAP subtype-hyperlipidemia,fever,acidosis,obesity,pleural effusion,SIRS,organ involvement(≥2)and infection were the risk factors for ALI in SAP patients.In the future,it is necessary to carry out further high-level research to prove the above research results.
作者
郭盛滕
张芬芬
万迪
于冬梅
王庆华
GUO Shengteng;ZHANG Fenfen;WAN Di;YU Dongmei;WANG Qinghua(School of Nursing(School of Gerontology),Binzhou Medical University,Binzhou 256603,China;Operating Room,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China)
出处
《中国全科医学》
北大核心
2025年第20期2546-2554,共9页
Chinese General Practice
基金
山东省自然科学基金资助项目(ZR2022MH117)。
