高脂血症性急性胰腺炎的临床特征分析
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摘要
目的分析高脂血症性急性胰腺炎(HLAP)的临床特点及三酰甘油(TG)水平对HLAP病情严重程度的影响。方法选择2013年1月至2017年1月复旦大学附属华东医院消化内科收治的33例HLAP患者和163例胆源性急性胰腺炎(BAP)患者。收集患者的一般资料、伴随疾病、治疗方法、预后以及空腹血糖(FPG)、血清胆固醇(TC)、TG、淀粉酶(AMY)、尿酸(UA)、D-二聚体(D-D)水平。将HLAP患者根据血清TG水平分为TG≥11.3 mmol/L组和5.65 mmol/L≤TG<11.3 mmol/L且血清呈乳糜状组,比较两组的病情严重程度。结果 HLAP组的男性、肥胖、糖尿病、脂肪肝比例以及血清TC、TG、FPG、UA、D-D水平明显高于BAP组(P<0.05)。HLAP组的发病年龄、血清AMY水平低于BAP组(P<0.05)。两组的外科手术率差异无统计学意义(P>0.05)。HLAP组的血液净化比例、病死率与复发率明显高于BAP组(P<0.05)。不同血清TG水平的HLAP患者的病情严重程度差异无统计学意义(P>0.05)。结论HLAP患者发病年龄较低,男性较多,多伴有代谢综合征表现,血清AMY升高不明显,血清TG显著升高但与病情的严重程度无明显相关性,病死率高,易复发。
Objective This paper intends to analyze the clinical features of hyperlipidemic acute pancreatitis(HLAP)and the effect of triglyceride(TG)levels on the severity of HLAP.MethodsThirty-three patients with HLAP and 163 patients with biliary acute pancreatitis(BAP)admitted to the Department of Gastroenterology,Huadong Hospital,Fudan University from January 2013 to January2017 were enrolled,whose general information,accompanying disease,treatment,prognosis,fasting blood glucose(FPG),serum cholesterol(TC),TG,amylase(AMY),uric acid(UA),and D-dimer(D-D)were collected.According to the level of TG,the HLAP patients were divided into the TG≥11.3 mmol/L group and the 5.65 mmol/L≤TG<11.3 mmol/L serum milky and squamous group.The severity of disease of the two groups was analyzed and compared.Results The male,obese,diabetic,fatty liver ratio and serum TC,TG,FPG,UA,D-D levels in the HLAP group were significantly higher than those in the BAP group(P<0.05).The age of onset and serum AMY level in the HLAP group were lower than those in the BAP group(P<0.05).There was no significant difference in the surgical rate between the two groups(P>0.05).The blood purification rate,mortality,and recurrence rate of the HLAP group were significantly higher than those of the BAP group(P<0.05).There was no significant difference in the severity of HLAP patients with different serum TG levels(P>0.05).Conclusions The age of onset of HLAP patients is lower,and there are more males,most of which have metabolic syndrome.The serum AMY is not significantly elevated,the serum TG is significantly increased,but there exist no significant correlation with the severity of the disease.The mortality rate is high,and it is easy to relapse.
Objective This paper intends to analyze the clinical features of hyperlipidemic acute pancreatitis(HLAP)and the effect of triglyceride(TG)levels on the severity of HLAP.MethodsThirty-three patients with HLAP and 163 patients with biliary acute pancreatitis(BAP)admitted to the Department of Gastroenterology,Huadong Hospital,Fudan University from January 2013 to January2017 were enrolled,whose general information,accompanying disease,treatment,prognosis,fasting blood glucose(FPG),serum cholesterol(TC),TG,amylase(AMY),uric acid(UA),and D-dimer(D-D)were collected.According to the level of TG,the HLAP patients were divided into the TG≥11.3 mmol/L group and the 5.65 mmol/L≤TG<11.3 mmol/L serum milky and squamous group.The severity of disease of the two groups was analyzed and compared.Results The male,obese,diabetic,fatty liver ratio and serum TC,TG,FPG,UA,D-D levels in the HLAP group were significantly higher than those in the BAP group(P<0.05).The age of onset and serum AMY level in the HLAP group were lower than those in the BAP group(P<0.05).There was no significant difference in the surgical rate between the two groups(P>0.05).The blood purification rate,mortality,and recurrence rate of the HLAP group were significantly higher than those of the BAP group(P<0.05).There was no significant difference in the severity of HLAP patients with different serum TG levels(P>0.05).Conclusions The age of onset of HLAP patients is lower,and there are more males,most of which have metabolic syndrome.The serum AMY is not significantly elevated,the serum TG is significantly increased,but there exist no significant correlation with the severity of the disease.The mortality rate is high,and it is easy to relapse.
引文
1王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013年,上海)[J].临床肝胆病杂志,2013,29(9):656-660.
2 van Geenen EJ,van der Peet DL,Bhagirath P,et al.Etiology and diagnosis of acute biliary pancreatitis[J]. Nat Rev Gastroenterol Hepatol,2010,7(9):495-502.
3 Klatskin G, Gordon M. Relationship between relapsing pancreatitis and essential hyperlipemia[J].Am J Med,1952,12(1):3-23.
4 Amblee A,Mohananey D,Morkos M,et al.Acute pancreatitis in patients with severe hypertriglyceridemia in a multi-ethnic minority population[J].Endocr Pract,2018,24(5):429-436.
5 马江辰,保志军.高脂血症性急性胰腺炎发病机制的研究进展[J].国际消化病杂志,2017,37(1):24-27.
6 Li X,Ke L,Dong J,et al.Significantly different clinical features betweenhypertriglyceridemiaandbiliaryacute pancreatitis:a retrospective study of 730patients from a tertiary center[J].BMC Gastroenterol,2018,18(1):89.
7 Mikolasevic I,Milic S,Orlic L,et al.Metabolic syndrome and acute pancreatitis[J].Eur J Intern Med,2016,32:79-83.
8 Click B,Ketchum AM,Turner R,et al.The role of apheresis in hypertriglyceridemia-induced acute pancreatitis:A systematic review[J].Pancreatology,2015,15(4):313-320.
9 Lai SW,Liao KF,Lin CL,et al.Pyogenic liver abscess correlates with increased risk of acute pancreatitis:apopulationbased cohort study[J].J Epidemiol,2015,25(3):246-253.
10 陈雷,余保平,林梦娟.胆源性急性胰腺炎与高脂血症性急性胰腺炎的比较及急性胰腺炎与三酰甘油的相关性研究[J].胃肠病学和肝病学杂志,2017,26(7):749-753.
11 胡维林.高甘油三脂血症相关性急性胰腺炎发病的危险因素分析[J].临床肝胆病杂志,2017,33(8):1518-1521.
12 毛恩强,汤耀卿,张圣道.高脂血症性重症急性胰腺炎规范化治疗方案的探讨[J].中国实用外科杂志,2003,23(9):542-545.
13 Balachandra S,Virlos IT,King NK,et al.Hyperlipidaemia and outcome in acute pancreatitis[J].Int J Clin Pract,2006,60(2):156-159.
14 Zhang XL,Li F,Zhen YM,et al.Clinical study of 224patients with hypertriglyceridemia pancreatitis[J].Chin Med J,2015,128(15):2045-2049.
15 Wang Q,Wang G,Qiu Z,et al.Elevated serum triglycerides in the prognostic assessment of acute pancreatitis:A systematic review and meta-analysis of observational studies[J].J Clin Gastroenterol,2017,51(7):586-593.
16 王萍,严华.外周血三酰甘油水平与急性胰腺炎类型、病情和预后的相关性[J].热带医学杂志,2018,40(5):662-665,669.
17 Kimura W, M9ssner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
18 Yadav D,Pitchumoni CS.Issues in hyperlipidemic pancreatitis[J].J Clin Gastroenterol,2003,36(1):54-62.
2 van Geenen EJ,van der Peet DL,Bhagirath P,et al.Etiology and diagnosis of acute biliary pancreatitis[J]. Nat Rev Gastroenterol Hepatol,2010,7(9):495-502.
3 Klatskin G, Gordon M. Relationship between relapsing pancreatitis and essential hyperlipemia[J].Am J Med,1952,12(1):3-23.
4 Amblee A,Mohananey D,Morkos M,et al.Acute pancreatitis in patients with severe hypertriglyceridemia in a multi-ethnic minority population[J].Endocr Pract,2018,24(5):429-436.
5 马江辰,保志军.高脂血症性急性胰腺炎发病机制的研究进展[J].国际消化病杂志,2017,37(1):24-27.
6 Li X,Ke L,Dong J,et al.Significantly different clinical features betweenhypertriglyceridemiaandbiliaryacute pancreatitis:a retrospective study of 730patients from a tertiary center[J].BMC Gastroenterol,2018,18(1):89.
7 Mikolasevic I,Milic S,Orlic L,et al.Metabolic syndrome and acute pancreatitis[J].Eur J Intern Med,2016,32:79-83.
8 Click B,Ketchum AM,Turner R,et al.The role of apheresis in hypertriglyceridemia-induced acute pancreatitis:A systematic review[J].Pancreatology,2015,15(4):313-320.
9 Lai SW,Liao KF,Lin CL,et al.Pyogenic liver abscess correlates with increased risk of acute pancreatitis:apopulationbased cohort study[J].J Epidemiol,2015,25(3):246-253.
10 陈雷,余保平,林梦娟.胆源性急性胰腺炎与高脂血症性急性胰腺炎的比较及急性胰腺炎与三酰甘油的相关性研究[J].胃肠病学和肝病学杂志,2017,26(7):749-753.
11 胡维林.高甘油三脂血症相关性急性胰腺炎发病的危险因素分析[J].临床肝胆病杂志,2017,33(8):1518-1521.
12 毛恩强,汤耀卿,张圣道.高脂血症性重症急性胰腺炎规范化治疗方案的探讨[J].中国实用外科杂志,2003,23(9):542-545.
13 Balachandra S,Virlos IT,King NK,et al.Hyperlipidaemia and outcome in acute pancreatitis[J].Int J Clin Pract,2006,60(2):156-159.
14 Zhang XL,Li F,Zhen YM,et al.Clinical study of 224patients with hypertriglyceridemia pancreatitis[J].Chin Med J,2015,128(15):2045-2049.
15 Wang Q,Wang G,Qiu Z,et al.Elevated serum triglycerides in the prognostic assessment of acute pancreatitis:A systematic review and meta-analysis of observational studies[J].J Clin Gastroenterol,2017,51(7):586-593.
16 王萍,严华.外周血三酰甘油水平与急性胰腺炎类型、病情和预后的相关性[J].热带医学杂志,2018,40(5):662-665,669.
17 Kimura W, M9ssner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
18 Yadav D,Pitchumoni CS.Issues in hyperlipidemic pancreatitis[J].J Clin Gastroenterol,2003,36(1):54-62.