高脂血症性急性胰腺炎初发和复发临床特点分析
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摘要
目的分析高脂血症性急性胰腺炎(hypertriglyceridemia acute pancreatitis,HLAP)的初发及复发患者的临床特点。方法选取2016年1月—2018年6月在本院治疗的高脂血症并急性胰腺炎患者共计105例作为研究对象,住院次数165人次。收集初发及复发患者临床特点、病情严重程度及并发症的变化。结果患者年龄平均(44±12.7)岁,男68例(64.7%),TG≥11.30 mmol/L占48.6%,至少存在1种高危因素(糖尿病、饮酒、肥胖和药物)占患者总数的78%,复发病情分级为轻度60.7%,中度25.3%,重度13.9%。患者复发率为38.1%,多发生在糖尿病、饮酒及血脂控制不佳的患者。病程中可观察到胰或胰周坏死的占18. 2%,其发生率呈累积增加趋势,局部并发症在TG≥11. 30 mmol/L患者中明显增高。结论具有糖尿病、饮酒、肥胖等高危风险因素的患者其高脂血症相关性胰腺炎的发病率增高,复发因素通常取决于高危因素或血脂控制情况。TG≥11.30 mmol/L是局部并发症发生的高危因素。
Objective To analyze the clinical profile of recurrent and first attack hypertriglyceridemia acute pancreatitis( HLAP). Methods Medical records of 105 patients suffering 165 attacks of HLAP between January,2016 and August,2018 treated in people ' s hospital of Huadu district were retrospectively studied.Structured data were collected on initial presentation. Clinical characteristics,severity of disease and changes of complications of the patients were analyzed.Results The average age of the patients was( 44±12.7) years,64.7%of them were male.48.6% of them with the serum TG record above or equal to 11.30 mmol/L. 78% of the patients have at least one kind of risk factor( diabetes,drinking,obesity or drug use). Recurrent HLAP attack varied in severity between mild( 60.7%),moderate( 25.3%),and severe( 13.9%).Recurrent HLAP attacks occurred in 38.1% of the patients,often in patients with poorly controlled diabetes,alcoholism,and TG levels. A cumulative increase in prevalence of pancreatic and/or peripancreatic necrosis was observed,with 18. 2% having it at some time during observation.Local complications were higher in patients with serum TG≥11.30 mmol/L.Conclusions Patients with HTG-related pancreatitis have a high prevalence of secondary risk factors such as diabetes,drinking,obesity.Frequent recurrences in them are usually due to poor control of secondary factors or TG. Serum TG≥11.30 mmol/L increases the risk of local complications.
Objective To analyze the clinical profile of recurrent and first attack hypertriglyceridemia acute pancreatitis( HLAP). Methods Medical records of 105 patients suffering 165 attacks of HLAP between January,2016 and August,2018 treated in people ' s hospital of Huadu district were retrospectively studied.Structured data were collected on initial presentation. Clinical characteristics,severity of disease and changes of complications of the patients were analyzed.Results The average age of the patients was( 44±12.7) years,64.7%of them were male.48.6% of them with the serum TG record above or equal to 11.30 mmol/L. 78% of the patients have at least one kind of risk factor( diabetes,drinking,obesity or drug use). Recurrent HLAP attack varied in severity between mild( 60.7%),moderate( 25.3%),and severe( 13.9%).Recurrent HLAP attacks occurred in 38.1% of the patients,often in patients with poorly controlled diabetes,alcoholism,and TG levels. A cumulative increase in prevalence of pancreatic and/or peripancreatic necrosis was observed,with 18. 2% having it at some time during observation.Local complications were higher in patients with serum TG≥11.30 mmol/L.Conclusions Patients with HTG-related pancreatitis have a high prevalence of secondary risk factors such as diabetes,drinking,obesity.Frequent recurrences in them are usually due to poor control of secondary factors or TG. Serum TG≥11.30 mmol/L increases the risk of local complications.
引文
[1] Saligram S,Lo D,Saul M,et al.Analyses of hospital administrative data that use diagnosis codes overestimate the cases of acute pancreatitis[J]. Clin Gastroenterol Hepatol,2012,10(7):805-811.
[2] Sandhu S,Al-Sarraf A,Taraboanta C,et al. Incidence of pancreatitis,secondary causes,and treatment of patients referred to a specialty lipid clinic with severe hypertriglycer-idemia:a retrospective cohort study[J]. Lipids Health Dis,2011,10(1):157.
[3]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委.中国急性胰腺炎诊治指南(2013年,上海)[J].中华消化杂志,2013,18(7):428-433.
[4]左丽婷,陈建,张海蓉.高脂血症性胰腺炎的研究进展[J].中国全科医学,2017,20(9):1141-1146.
[5] Zheng Y,Zhou Z,LI H,et al. A muticenter study on etiology of acute pancreatitis in Beijing during 5 years[J].Pancreas,2015,44(3):409-414.
[6]焦晨阳,李梦颖,马晨,等.急性复发性胰腺炎的相关危险因素分析[J].中华消化杂志,2017,37(4):249-253.
[7] Girman CJ,Kou TD,Cai B,et al. Patients with type 2 diabetes mellitus have higher risk for acute pancrititis compared with those without diabetes[J].Diabetes Obes Metab,2010,12(9):766-771.
[8] Gonzalez-Perez A, Schlienger RG, Rodriguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs:a population-based gohort study[J]. Diabetes Care,2010,33(12):2580-2585.
[9] Penn AH,Schmid-schonbein GW. The intestine as source of cytotoxic mediators in shock:free fatty acids and degradation of lipid-binding proteins[J]. Am J Physiol Heart Circ Physiol,2008,294(4):H1779-1792.
[10] Zhang W,Zhao Y,Zeng Y,et al. Hyperlipidemic versus normallipid acute necrotic pancreatitis:proteomic analysis using an animal model[J].Pancreas,2012,41(2):317-322.
[11] Kishore V,Chris S,Alessandro F. Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis[J].Clin Gastroenterol,2017,51(1):77-85.
[2] Sandhu S,Al-Sarraf A,Taraboanta C,et al. Incidence of pancreatitis,secondary causes,and treatment of patients referred to a specialty lipid clinic with severe hypertriglycer-idemia:a retrospective cohort study[J]. Lipids Health Dis,2011,10(1):157.
[3]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委.中国急性胰腺炎诊治指南(2013年,上海)[J].中华消化杂志,2013,18(7):428-433.
[4]左丽婷,陈建,张海蓉.高脂血症性胰腺炎的研究进展[J].中国全科医学,2017,20(9):1141-1146.
[5] Zheng Y,Zhou Z,LI H,et al. A muticenter study on etiology of acute pancreatitis in Beijing during 5 years[J].Pancreas,2015,44(3):409-414.
[6]焦晨阳,李梦颖,马晨,等.急性复发性胰腺炎的相关危险因素分析[J].中华消化杂志,2017,37(4):249-253.
[7] Girman CJ,Kou TD,Cai B,et al. Patients with type 2 diabetes mellitus have higher risk for acute pancrititis compared with those without diabetes[J].Diabetes Obes Metab,2010,12(9):766-771.
[8] Gonzalez-Perez A, Schlienger RG, Rodriguez LA. Acute pancreatitis in association with type 2 diabetes and antidiabetic drugs:a population-based gohort study[J]. Diabetes Care,2010,33(12):2580-2585.
[9] Penn AH,Schmid-schonbein GW. The intestine as source of cytotoxic mediators in shock:free fatty acids and degradation of lipid-binding proteins[J]. Am J Physiol Heart Circ Physiol,2008,294(4):H1779-1792.
[10] Zhang W,Zhao Y,Zeng Y,et al. Hyperlipidemic versus normallipid acute necrotic pancreatitis:proteomic analysis using an animal model[J].Pancreas,2012,41(2):317-322.
[11] Kishore V,Chris S,Alessandro F. Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis[J].Clin Gastroenterol,2017,51(1):77-85.