本文選題：急性胰腺炎 + 胰島功能　； 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過定期檢測急性胰腺炎后患者的糖代謝指標,分析急性胰腺炎后遠期胰島內(nèi)分泌功能的變化情況及與之相關(guān)的危險因素。方法:選取2015年2月到2016年4月在山西醫(yī)科大學附屬第二醫(yī)院進行住院治療并臨床痊愈出院且到我院門診復查的52名急性胰腺炎(AP)患者,男性28名(53.8%),女性24名(46.2%),平均病程8月,同時選取40名健康人作為對照組男性25名(62.5%)女性15名(37.5%)。胰腺內(nèi)分泌功能檢查通過測定:空腹血清葡萄糖及餐后1小時、2小時血清葡萄糖水平和糖化血紅蛋白,上述測定指標分別于患者出院后3、6、9個月后測得。同時搜集患者發(fā)病前后可能影響血糖代謝的相關(guān)臨床資料。結(jié)果:52名AP患者中,平均隨訪年齡(48.4+16.7)歲,其中按疾病的嚴重程度分類:急性水腫性胰腺炎(MAP)30例(57.7%),急性重癥胰腺炎(S AP)22例(42.3%);按病因分類,其中膽源性胰腺炎33例(63.5%),酒精性胰腺炎10例(19.3%),高脂血癥性胰腺炎9例(17.2%)。9個月后隨訪發(fā)現(xiàn)DM8例,10例糖耐量異常,8例空腹血糖受損,40名健康對照組血糖代謝均在正常范圍。AP組患者在空腹血糖、餐后1,2小時血糖測定值與對照組相比均明顯升高,有統(tǒng)計學意義(p0.05);而糖化血紅蛋白AP組與對照組相比沒有明顯差異,無統(tǒng)計學意義。SAP組患者發(fā)生血糖代謝異常的人數(shù)比例(77.27%)與MAP組(23.23%)相比明顯增高,且具有統(tǒng)計學意義(p0.05);在病因方面高脂血癥性胰腺炎患者發(fā)生血糖代謝異常(87%)較膽源性胰腺炎(22%)、酒精性胰腺炎(30%)更容易發(fā)生血糖代謝的紊亂(P0.05);MAP組患者隨著隨訪間期的延長,血糖代謝異常的患者比例由第三個月時的33%下降到第九個月后的23%,胰島的內(nèi)分泌功能有逐漸緩解的趨勢;S AP組患者隨著隨訪時間的進展,胰島功能未見緩解趨勢。在本研究中,導致胰腺內(nèi)分泌功能發(fā)生異常的各相關(guān)危險因素中:肥胖、長期飲酒(發(fā)病后并未戒酒)及高脂血癥等與患者遠期胰島內(nèi)分泌功能異常有關(guān)。結(jié)論:1急性胰腺炎后患者確實存在遠期胰島功能不全的情況,不同病因和不同嚴重程度對后期胰島功能的影響差別明顯。2急性水腫型胰腺炎在短期內(nèi)影響胰島功能,隨著恢復期的延長,胰島功能可逐漸恢復。急性重癥胰腺炎對胰島功能的損害是持久性的,其大部分患者可能轉(zhuǎn)為糖尿病。3高脂血癥性胰腺炎對遠期胰島功能的損害較其他類型胰腺炎更加嚴重。膽源性胰腺炎和酒精性胰腺炎發(fā)生胰島功能損害的程度較輕。4急性胰腺炎后胰島功能損傷是胰腺炎后最嚴重的慢性并發(fā)癥,發(fā)病后有飲酒史、肥胖、高脂血癥的患者較其他患者更容易出現(xiàn)遠期胰島功能的不全,臨床上針對不同病因及不同嚴重程度的患者進行個體化治療對保存胰島功能具有重要意義。
[Abstract]:Objective: to analyze the changes of endocrine function of pancreatic islets after acute pancreatitis (AP) and its related risk factors by regularly detecting glucose metabolism in patients with acute pancreatitis. Methods: from February 2015 to April 2016, 52 patients with acute pancreatitis (AP) who were hospitalized in the second affiliated Hospital of Shanxi Medical University and were discharged from the clinic and re-examined in our outpatient department, 28 males and 24 females, with an average course of 8 months, were selected. At the same time, 40 healthy persons were selected as control group. Pancreatic endocrine function was measured by fasting serum glucose and serum glucose and glycosylated hemoglobin at 1 hour and 2 hours postprandial. The above indexes were measured after 3 days and 9 months after discharge respectively. At the same time, collect the related clinical data of blood glucose metabolism before and after onset. Results the mean follow-up age of 52 AP patients was 48.4.16. 7 years old. According to the severity of the disease, there were 30 cases of acute edematous pancreatitis with MAPP and 57.7% with acute severe pancreatitis and 42.3% with S AP)22. 33 cases of gallstone pancreatitis, 10 cases of alcoholic pancreatitis and 9 cases of hyperlipidemic pancreatitis were found to have normal glucose metabolism in 10 cases with impaired glucose tolerance and 8 cases with impaired fasting blood glucose in the control group, 9 cases with hyperlipidemic pancreatitis and 9 cases with hyperlipidemic pancreatitis. 9 months later, 10 patients with abnormal glucose tolerance and 8 patients with impaired fasting blood glucose were found to have normal glucose metabolism. Range. AP group patients with fasting blood glucose, Compared with the control group, the blood glucose measurement value of 1h / 2 h after meal was significantly higher than that of the control group (P 0.05), but there was no significant difference between the AP group and the control group in glycosylated hemoglobin (glycosylated hemoglobin). The proportion of patients with abnormal blood glucose metabolism in SAP group (77.27%) was significantly higher than that in MAP group (23.23%). In the etiology of hyperlipidemic pancreatitis, abnormal blood glucose metabolism occurred in 87% of the patients with hyperlipidemic pancreatitis, compared with gallstone pancreatitis (22%) and alcoholic pancreatitis (30%). The patients in map group were more likely to develop the disorder of blood glucose metabolism with the prolongation of follow-up period. The percentage of patients with abnormal blood glucose metabolism decreased from 33% at the third month to 23 months after the ninth month. The endocrine function of the islets gradually alleviated. In this study, obesity, long-term drinking (no abstinence after onset) and hyperlipidemia were associated with long-term islet endocrine dysfunction. Conclusion there is a long term islet insufficiency in patients with acute pancreatitis, and the effects of different etiology and severity on islet function are different. 2. Acute edematous pancreatitis affects pancreatic islet function in a short period of time. With the extension of recovery period, islet function can be gradually restored. The damage to pancreatic islet function caused by severe acute pancreatitis is persistent. Most of the patients may turn to diabetes mellitus and hyperlipidemia pancreatitis has more serious damage to long-term islet function than other types of pancreatitis. The degree of islet function damage after acute pancreatitis is the most serious chronic complication after acute pancreatitis. Patients with hyperlipidemia are more prone to long-term islet insufficiency than other patients. Individualized treatment for patients with different etiology and severity is of great significance to preserve islet function.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R576

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