Funnell I C, Bornman P C, Weakley S P, Terblanche J, Marks I N
Surgical Gastroenterology and Gastrointestinal Clinic, Groote Schuur Hospital, Cape Town, South Africa.
Br J Surg. 1993 Apr;80(4):484-6. doi: 10.1002/bjs.1800800426.
Ninety-nine patients with acute pancreatitis in whom body mass index (BMI = weight (kg)/height2 (m2)) was measured were studied prospectively to determine the importance of obesity as a prognostic factor in this disease. Of 19 obese patients (BMI > or = 30 kg/m2), 12 developed severe pancreatitis; seven had abscesses, of whom five died, and two further patients died. In 80 non-obese patients, the incidence of severe pancreatitis (n = 5), abscess formation (n = 4) and death (n = 4) was significantly less (P = 0.0007). The mean(s.d.) BMI of 17 patients with severe acute pancreatitis was significantly higher than that in 82 patients with mild acute disease (31.2(5.6) versus 23.3(5.6) kg/m2, P < 0.001). As a single prognostic factor, obesity had a sensitivity of 63 per cent and a specificity of 95 per cent for predicting disease severity. When five obese women with gallstone pancreatitis were excluded, the sensitivity of obesity increased to 86 per cent. Severe pancreatitis occurred in all eight obese patients with disease of an alcoholic aetiology. These data suggest that increased fat deposits in the peripancreatic and retroperitoneal spaces in obese patients may increase the risk of peripancreatic fat necrosis, abscess and death. Consideration should be given to including obesity as a prognostic factor in acute pancreatitis.
对99例测定了体重指数（BMI=体重（kg）/身高²（m²））的急性胰腺炎患者进行了前瞻性研究，以确定肥胖作为该疾病预后因素的重要性。19例肥胖患者（BMI≥30kg/m²）中，12例发生了重症胰腺炎；7例出现脓肿，其中5例死亡，另有2例患者死亡。80例非肥胖患者中，重症胰腺炎（n=5）、脓肿形成（n=4）和死亡（n=4）的发生率显著较低（P=0.0007）。17例重症急性胰腺炎患者的平均（标准差）BMI显著高于82例轻症急性胰腺炎患者（31.2（5.6）对23.3（5.6）kg/m²，P<0.001）。作为单一预后因素，肥胖预测疾病严重程度的敏感性为63%，特异性为95%。排除5例肥胖的胆石性胰腺炎女性患者后，肥胖的敏感性增至86%。所有8例酒精性病因疾病的肥胖患者均发生了重症胰腺炎。这些数据表明，肥胖患者胰周和腹膜后间隙脂肪沉积增加可能会增加胰周脂肪坏死、脓肿和死亡的风险。应考虑将肥胖作为急性胰腺炎的一个预后因素。
