Clinical Features Of Acute Pancreatitis In Pregnancy And The Correlation Analysis Of PNI,SII And NHDL

ObjectiveAPIP(acute pancreatitis in pregnancy)is a common acute abdominal condition that occurs in women during pregnancy and the puerperium,with a rapid onset and a poor prognosis for both mother and baby.Recent meta-analyses have shown that the incidence of this disease is increasing annually,and studies have shown that the hyperlipidaemic APIP is significantly higher in Chinese women than in foreign countries and is more likely to lead to severe pancreatitis and higher infant mortality.This study retrospectively analyzed the clinical data of 62 patients discharged from the Third Affiliated Hospital of Guangzhou Medical University with HIS case system diagnosis of acute pancreatitis in pregnancy(or acute pancreatitis in pregnancy)in order to understand the epidemiological characteristics of APIP to identify the factors leading to the development of APIP into severe disease and to explore the value of the role of PNI,SII,and NHDL in APIP.Date and methodsSixty-two patients discharged from the Third Affiliated Hospital of Guangzhou Medical University with a diagnosis of APIP meeting the exclusion criteria from January 2012 to December 31,2022,were collected through the HIS case system.Their general data,clinical symptoms,laboratory test data,maternal and infant conditions,and PNI,SII,NHDL,and BISAP scores were calculated for regression analysis.APIP was divided into mild and severe acute pancreatitis groups according to the presence or absence of organ failure,the general data,clinical symptom characteristics,and the value of the role of PNI,SII,and NHDL in APIP were compared between the groups.The subjects were divided into three groups according to the etiology,the clinical characteristics of each group were analyzed,and the role of PNI,SII,and NHDL was assessed.Analysis was performed using SPSS 27.0statistical software,and P < 0.05 was considered statistically different.Results1.62 patients with APIP in this study had a mean age of 30.24±5.42 years and a mean gestational week of 31(27,34)weeks.There were 27 cases in mild cases and 35 cases in the severe group.The two groups had no differences in age,age stratification,number of pregnancies,and mode of prior delivery.There were no statistical differences in laboratory tests for blood amylase,urinary amylase,blood albumin,total bilirubin,creatinine,urea,platelet count,lymphocyte count,and PLT(P > 0.05).Body temperature,pulse rate,respiratory rate,and BMI were all higher in the severe group than in the mild group.In terms of etiological composition,the distribution was similar between the two groups in the mild disease group;BAP patients(37.04%)and HLAP patients(37.04%),while 27 cases of HLAP patients(77,14%)were significantly higher in the severe disease group than in BAP patients(5.71%).Haemo-depleting therapy was administered more frequently in the severe group(88.57%)than in the mild group(29.63%),mainly by plasma exchange(25.72%)and plasma exchange combined with CVVH(31.43%),and often within 24 hours of admission(85.71% in the severe group vs.25.93% in the mild group).The number of days spent in the ICU was significantly longer in the severe group than in the mild group.Non-high density lipoprotein(NHDL),triglycerides(TG),total cholesterol,and white blood cell count were significantly higher in the severe group than in the mild group.At the same time,PNI,LDL,and HDL were lower than in the mild group.CT scan of the whole abdomen was often performed at 48 hours of admission in the severe group,while MRI was the mainstay in the mild group.The rate of pancreatic necrosis was significantly higher in the severe group(25.71%)than in the mild group(3.70%)Preterm birth occurred in 23 babies in the severe group(65.71%),which was higher than in the mild group(37.04%);the severe group resulted in four stillbirths,while the mild group did not.Surgery was often required within 24 hours of admission in the severe group(62.90%),whereas,in the mild group,the pregnancy was predominantly continued(66.70%).PNI was 34.60±4.77 in the severe group,lower than 37.42±5.62 in the mild group,while SII was higher than in the mild group.2.NHDL,TG,TC,white blood cell count,CPRP,PCT,SII,and BISAP scores were significantly higher in the hyperlipidaemic group than in the other two groups.Thirteen cases of SAP(35.1%)in the hyperlipidemic group were significantly higher than those in the biliary origin and other etiology groups.There were 10 cases of pancreatic necrosis in the hyperlipidaemic group,whereas no necrosis was seen in the remaining two groups.The hyperlipidaemic group was frequently admitted for haemo-depleting therapy(91.9%)and often within 24 hours of admission(86.5%),mainly by plasma exchange(37.8%)and plasma exchange combined with CVVH(27.0%).At the same time,fewer patients with biliary origin and other causes were treated with haemo-depleting therapy,8.3%,and 30.8%,respectively.Hyperlipidaemic APIP requires longer days of ICU stay.Thirty cases(81.1%)in the hyperlipidaemic group were treated by cesarean section,of which 62.2% were performed within 24 hours of admission,all higher than in the other two groups.There were 24 cases of preterm labor(62.9%),4 cases(10.8%)of stillbirth,and 2 cases(5.4%)of induced labor in the hyperlipidaemic group,higher than in the other two groups.3.Correlation analysis suggested that PNI and LDL were negatively correlated with the severity of the disease.BMI,NHDL,BISAP score,SII,CRP,days of ICU admission,white blood cell count,time of cesarean section,history of gallstones,time of initiation of haemo-depletion,mode of haemo-depletion,SIRS,TG,and TC were positively correlated with the severity of the disease.Conclusion1.The incidence of pancreatitis due to hyperlipidemia is significantly higher.It can easily lead to pancreatic necrosis,making the condition more severe and often requiring early cesarean section and blood purification therapy.2.Increased TG and Chol and decreased HDL and LDL often indicate a more severe APIP condition.;Patients with APIP who develop organ failure(including transient)often have a more severe inflammatory response,which can easily lead to preterm labor and stillbirth,requiring longer ICU stays.3.PNI,SII,and NHDL correlate with the severity of the condition.SII and NHDL are significantly higher in patients with hyperlipidaemic APIP.