关键词: 胰腺炎, 胸腔积液, 影响因素分析, 回归分析, Logistic模型

Abstract: Background　Severe acute pancreatitis （SAP） has a rapid progression and high mortality，and early prediction and correct assessment of the severity of acute pancreatitis （AP） are important. At present，the scoring system commonly used in clinical practice is cumbersome and cannot be applied to early evaluation. Studies have shown that pleural effusion（PE） can be a good early predictor of SAP. However，there are few studies on the risk factors of AP complicated with PE. Objective　To explore influencing factors of  AP complicated by PE，so as to have a better understanding of risk factors at an early stage，reduce the probability of developing into SAP and improve prognosis.Methods　Retrospective analysis was performed on 326 AP inpatients with complete medical records and chest imaging findings in the Department of Gastroenterology of First Affiliated Hospital of Kunming Medical University from January 2013 to December 2017.The patients were divided into PE group and non-PE group according to whether having concurrent PE.The group was further divided into two subgroups according to the length of hospital stay：the subgroup whose hospitalization time was no more than 7 days（including 7 days） and the subgroup whose hospitalization time was longer than 7 days.Discharge diagnosis，complications（hyperlipidemia，hyperglycemia，abdominal effusion，pulmonary infection，liver and kidney injury，pancreatic pseudocyst，and complicated with two or more diseases），hospitalization time，hospitalization expenses，general information〔age，body mass index，gender，etiology，previous history of pancreatitis，smoking history （>2 cigarettes/d，duration >1 year），history of drinking（average daily intake of alcohol >60 g and duration > 5 years）〕 were compared.Laboratory test indicators within 48 h after admission〔worst values：white blood cell count（WBC），neutrophil percentage （NEU），serum albumin （ALB），serum calcium （Ca），fibrinogen （FIB），blood glucose （GLU），C-reactive protein （CRP），amylase （AMY），lipase（LIP）〕，and other data，including 48 h Ranson score，modified CT severe index（MCTSI） score，bedside index for severity in acute pancreatitis（BISAP） score were also compared between PE group and non-PE group.Then multivariate Logistic analysis was used to analyze the influencing factors of AP complicated with PE.Laboratory test indicators and other data between two subgroups were compared.Results　Of 326 AP patients，137 were in PE group and 189 in non-PE group.There was statistically significant differences in discharge diagnosis，complications，hospitalization time，hospitalization expenses，gender，history of pancreatitis，WBC，NEU，ALB，Ca，FIB，CRP，AMY，LIP，48 h Ranson score，MCTSI score and BISAP score between PE group and non-PE group（P<0.05）．Multivariate Logistic analysis showed that no history of pancreatitis，CRP，MCTSI score and BISAP score were influencing factors of AP complicated with PE（P<0.05）．In PE group，ALB and Ca of the subgroup whose hospitalization time was longer than 7 d were lower than those of the subgroup whose hospitalization time was less than or equal to 7 d，and its GLU and 48h Ranson scores were higher than those of the subgroup whose hospitalization time less than or equal to 7 d（P<0.05）．In non-PE group，the CRP and MCTSI scores of the subgroup whose hospitalization time was longer than 7 d were higher than those of subgroup whose hospitalization time less than or equal to 7 d（P<0.05）．Conclusion　History of pancreatitis，ALB，FIB，CRP，MCTSI score，and BISAP score are factors influencing AP complicated with PE.

Key words: Pancreatitis, Pleural effusion, Root cause analysis, Regression analysis, Logistic models