Роль бактеріального чинника у розвитку гострого панкреатиту та його гнійно-септичних ускладнень

Abstract

Introduction. A feature of acute pancreatitis is the high risk of developing complications (occurring in 50% of patients), the total mortality of which reaches 15%, and in severe cases it varies within 40-70%. The aim of the study was to determine the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications. Materials and methods. The results of treatment of 280 patients with acute pancreatitis were analyzed, which were divided into two groups: the main group (n=187) – patients with severe acute pancreatitis and the comparison group (n=93) – patients with a mild and moderate course of the disease. In addition, in order to determine prognostic criteria for the development of purulent-septic complications, the patients of the main group were divided into two subgroups. The first subgroup included patients with a severe course and the development of purulentseptic complications (n=59), the second (n=128) – with a severe course without the development of purulent-septic complications of acute pancreatitis. Results. When screening patients for Helicobacter pylori, the results of the express test were positive in 232 patients (82.9%), while in the main group 165 (88.2%) patients, in the comparison group – 75 (80.6%) patients (χ2= 2.9, 95% CI -1.1-17.6, p=0.08). An increase in the content of immunoglobulin M to Helicobacter pylori was also determined in patients with a severe course of acute pancreatitis after 7 and 14 days from the moment of hospitalization, which indicates the acute phase of the disease. The correlation between immunoglobulin M and procalcitonin was strong (r=0.87; p=0.0001), but the relationship between these indicators was not linear, but closer to exponential (y=1.1543-2.7292*x +2.1604*x^2). Conclusions. The results of a screening study of Helicobacter pylori in patients with acute pancreatitis allow us to consider this microorganism as one of the factors in the pathogenesis of this disease (82.9% of cases). For patients with severe acute pancreatitis, the content of immunoglobulin M to Helicobacter pylori in blood serum ≥1.24 IU/ml can be considered as a likely predictor of the development of purulent-septic complications (sensitivity 86.4%, specificity 100.0%).