Cappell M S, Marks M
Department of Medicine, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019.
Am J Med. 1995 Mar;98(3):243-8. doi: 10.1016/S0002-9343(99)80370-2.
To analyze whether pancreatitis presents differently in HIV-seropositive patients compared to the general population, and to evaluate the accuracy of classic predictors of pancreatitis severity in patients with HIV infection.
A multiyear, multicenter, retrospective study of 44 consecutive patients with acute pancreatitis and HIV and 44 consecutive control patients with acute pancreatitis without HIV.
Of 939 hospitalized patients with HIV, 44 (4.7%) had acute pancreatitis, 27 of whom had AIDS. Pancreatitis presented with similar clinical findings in HIV patients and controls except that HIV patients had greater anemia, hypoalbuminemia, and leukopenia (Student's t-test P < 0.0001, < 0.0002, < 0.0001, respectively), and a higher incidence of fever, diarrhea, and hepatomegaly. These differences probably stem from HIV-related immunosuppression and malnourishment rather than pancreatitis. Patients with HIV had a higher frequency of medication-associated pancreatitis due to pancreatoxic medications used in HIV patients (18 versus 2 cases; odds ratio [OR] 14.54; Student's t-test P < 0.0001). They had a lower frequency of gallstone pancreatitis (2 versus 22 cases; OR 0.05; P < 0.0001). Patients with HIV had a higher frequency of a severe hospital course, defined as prolonged hospitalization or death in hospital (22 versus 12 cases; chi-square P < 0.05). The presence of AIDS or leukopenia in patients with HIV was strongly associated with a severe hospital course. The Ranson and modified Glasgow scales were poor predictors of disease severity in HIV patients (eg, Ranson scale sensitivity 41%; positive predictive value 53%; negative predictive value 52%). These scales' lack of markers of immunosuppression impeded their performance. The APACHE II scale, which contains markers of immunosuppression, was a moderately robust predictor of disease severity in HIV patients (sensitivity 73%; specificity 68%; positive predictive value 70%; negative predictive value 71%). All three scales predicted the disease severity in control patients well.
Pancreatitis presents similarly in HIV patients as in the general population with the following significant differences: a high frequency of medication-associated pancreatitis, a low frequency of gallstone pancreatitis, a high frequency of HIV-related causes (most commonly from HIV-related drugs), additional symptoms and signs due to underlying immunosuppression, and a more severe hospital course. The APACHE II system can be used to predict whether a patient with HIV and pancreatitis is at risk for prolonged hospitalization or death in hospital.
分析与普通人群相比，HIV血清阳性患者的胰腺炎表现是否不同，并评估HIV感染患者中胰腺炎严重程度经典预测指标的准确性。
对44例连续性急性胰腺炎合并HIV患者和44例连续性无HIV的急性胰腺炎对照患者进行多年、多中心的回顾性研究。
在939例住院的HIV患者中，44例（4.7%）发生急性胰腺炎，其中27例患有艾滋病。HIV患者和对照患者的胰腺炎临床表现相似，只是HIV患者贫血、低白蛋白血症和白细胞减少更严重（Student t检验P值分别<0.0001、<0.0002、<0.0001），发热、腹泻和肝肿大的发生率更高。这些差异可能源于HIV相关的免疫抑制和营养不良，而非胰腺炎。HIV患者因使用HIV患者的胰腺毒性药物导致药物相关性胰腺炎的频率更高（18例对2例；优势比[OR]14.54；Student t检验P<0.0001）。他们胆石性胰腺炎的频率较低（2例对22例；OR 0.05；P<0.0001）。HIV患者严重住院病程（定义为住院时间延长或住院死亡）的频率更高（22例对12例；卡方检验P<0.05）。HIV患者中艾滋病或白细胞减少的存在与严重住院病程密切相关。Ranson和改良Glasgow评分对HIV患者疾病严重程度的预测较差（例如，Ranson评分敏感性41%；阳性预测值53%；阴性预测值52%）。这些评分缺乏免疫抑制标志物阻碍了其性能表现。包含免疫抑制标志物的APACHE II评分是HIV患者疾病严重程度的中度可靠预测指标（敏感性73%；特异性68%；阳性预测值70%；阴性预测值71%）。所有这三种评分对对照患者的疾病严重程度预测良好。
HIV患者的胰腺炎表现与普通人群相似，但存在以下显著差异：药物相关性胰腺炎频率高、胆石性胰腺炎频率低、HIV相关病因（最常见于HIV相关药物）频率高、潜在免疫抑制导致的额外症状和体征以及更严重的住院病程。APACHE II系统可用于预测HIV合并胰腺炎患者是否有住院时间延长或住院死亡的风险。
