急性中毒合并高淀粉酶血症的临床分析

Clinical analysis of hyperamylasemia in patients with acute poisoning

摘要:

分析急性中毒患者血淀粉酶的变化及与预后的关系，并探讨血淀粉酶升高的机制。方法回顾性分析2014 年3 月-2016 年3 月该院ICU收治的急性中毒患者的临床资料，观察其血清淀粉酶及同工酶变化。根据血清淀粉酶水平将患者分为淀粉酶正常组、轻度升高组和明显升高组，比较3 组患者的APACHEⅡ评分、PSS 评分及死亡率。结果共纳入急性中毒患者189 例，132 例患者合并血淀粉酶升高，其中胰淀粉酶升高76 例。与淀粉酶正常组比较，淀粉酶轻度升高组、淀粉酶明显升高组患者的APACHEⅡ评分、PSS 评分及死亡率升高，差异有统计学意义（p <0.05）；淀粉酶明显升高组患者的APACHEⅡ评分、PSS 评分及死亡率高于淀粉酶轻度升高组，差异有统计学意义（p <0.05）。结论中毒患者常常合并血淀粉酶升高；血清淀粉酶可以作为判断急性中毒患者病情危重程度和预后的指标。中毒患者合并血淀粉酶升高的机制复杂，对胰腺炎的诊断需谨慎。

Abstract:

To study the relationship between serum amylase level and prognosis, and explore the mechanism of hyperamylasemia in the patients with acute poisoning. Methods The clinical data of the patients with acute poisoning in Tongji Hospital from March 2014 to March 2016 were retrospectively analyzed. The changes of serum amylase and the isozyme were observed. The patients were divided into three groups according to the serum level of amylase: normal amylase group, moderate amylase level group and high amylase level group. The APACHEII sore, PSS sore and mortality were compared between the three groups. Results A total of 189 patients with acute poisoning were included, including 132 cases with hyperamylasemia and 76 cases with increased pancreatic amylase. Compared with the normal amylase group, the APACHEII sore, PSS sore and mortality were obviously increased in the other two groups, and the differences were statistical significant (p < 0.05). The APACHEII sore, PSS sore and mortality in the high amylase level group were significantly higher than those in the moderate amylase level group (p < 0.05). Conclusions Hyperamylasemia often appears in the patients with acute poisoning. Serum amylase can be used as an indicator of the critical condition and prognosis of the patients with acute poisoning. The mechanism of hyperamylasemia in the patients of acute poisoning is complicated, and the diagnosis of acute pancreatitis should be cautious.