De Waele Boudewijn, Vanmierlo Bert, Van Nieuwenhove Yves, Delvaux Georges
Department of Surgery, VUB University Hospital, Brussels, Belgium.
Pancreas. 2006 May;32(4):343-5. doi: 10.1097/01.mpa.0000220857.55378.7b.
Body overweight and obesity have been associated with an increased morbidity in acute pancreatitis, but conflicting results were reported in the literature with regard to the type and frequency of complications. We investigated the occurrence of complications in different classes of overweight in a homogeneous group of patients with gallstone pancreatitis.
Data were collected prospectively from 250 patients with biliary pancreatitis to allow calculation of the Blamey (Glasgow) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores. According to their body mass index (BMI), the patients were allocated to different categories of body overweight. The outcome for each category was measured by the components of the Atlanta criteria. Secondary end points of the study were the length of hospital stay, the length of stay at the intensive care unit, and the number of abdominal operations.
When compared with normal-weight patients (BMI 18.5-24.9), all categories with BMI > or =25 had an increased risk of developing the "severe" form of acute pancreatitis [odds ratio (OR): 3.55, 95% confidence interval (CI): 1.50-8.40]. Patients with class I obesity (BMI 30-34.9) developed significantly more organ failure and local complications (OR: 3.469, 95% CI: 1.15-10.43). Patients with class II and III obesity (BMI 35-49.9) had, in addition to more organ failure and local complications, also more metabolic complications (OR: 7.33, 95% CI: 1.62-33.24) than did their normal-weight counterparts. They needed also more frequently intensive care and had a longer total hospital stay.
In acute biliary pancreatitis, body overweight and obesity represent a risk of more "severe" disease and the number and type of complications increase in categories of increasing BMI.
体重超重和肥胖与急性胰腺炎发病率增加有关，但文献报道在并发症类型和发生率方面存在相互矛盾的结果。我们在一组同质的胆石性胰腺炎患者中，研究了不同超重类别中并发症的发生情况。
前瞻性收集250例胆源性胰腺炎患者的数据，以计算布莱梅（格拉斯哥）评分和急性生理与慢性健康状况评估（APACHE II）评分。根据体重指数（BMI），将患者分为不同的超重类别。通过亚特兰大标准的各项指标衡量每个类别的结局。该研究的次要终点为住院时间、重症监护病房停留时间和腹部手术次数。
与体重正常的患者（BMI 18.5 - 24.9）相比，BMI≥25的所有类别发生“重症”急性胰腺炎的风险均增加[比值比（OR）：3.55，95%置信区间（CI）：1.50 - 8.40]。I类肥胖患者（BMI 30 - 34.9）发生器官衰竭和局部并发症的情况明显更多（OR：3.469，95% CI：1.15 - 10.43）。II类和III类肥胖患者（BMI 35 - 49.9）除了器官衰竭和局部并发症更多外，代谢并发症也比体重正常的患者更多（OR：7.33，95% CI：1.62 - 33.24）。他们也更频繁地需要重症监护，且总住院时间更长。
在急性胆源性胰腺炎中，体重超重和肥胖是病情更“严重”的风险因素，且随着BMI类别的增加，并发症的数量和类型也会增加。
