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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 445 -448. doi: 10.3877/cma.j.issn.2095-3232.2020.05.011

所属专题： 文献；

临床研究

高甘油三酯血症急性胰腺炎与胆源性急性胰腺炎临床特征比较
严舒1, 李勇2, 范婧妍2, 吴妮莎1, 周国俊1, 李建水1, 冷政伟1,†()   
  1. 1. 637000　四川省南充市，川北医学院附属医院肝胆外科二
    2. 637000　四川省南充市，川东北急性胰腺炎中心
  • 收稿日期:2020-05-13 出版日期:2020-10-10
  • 通信作者: 冷政伟
  • 基金资助:
    国家自然科学基金(81402444); 四川省科技厅项目(2018JY0489，2017JY0170)

Comparison of clinical features between hypertriglyceridemia-induced acute pancreatitis and biliary acute pancreatitis

Shu Yan1, Yong Li2, Jingyan Fan2, Nisha Wu1, Guojun Zhou1, Jianshui Li1, Zhengwei Leng1,†()   

  1. 1. Department Ⅱ of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
    2. Acute Pancreatitis Center of Northeast Sichuan, Nanchong 637000, China
  • Received:2020-05-13 Published:2020-10-10
  • Corresponding author: Zhengwei Leng
  • About author:
    Corresponding author: Leng Zhengwei, Email:
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引用本文：

严舒, 李勇, 范婧妍, 吴妮莎, 周国俊, 李建水, 冷政伟. 高甘油三酯血症急性胰腺炎与胆源性急性胰腺炎临床特征比较[J]. 中华肝脏外科手术学电子杂志, 2020, 09(05): 445-448.

Shu Yan, Yong Li, Jingyan Fan, Nisha Wu, Guojun Zhou, Jianshui Li, Zhengwei Leng. Comparison of clinical features between hypertriglyceridemia-induced acute pancreatitis and biliary acute pancreatitis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(05): 445-448.

目的

探讨高甘油三酯血症急性胰腺炎（HTG-AP）和胆源性急性胰腺炎（BAP）临床特征的差异。

方法

回顾性分析2008年7月至2016年10月川北医学院附属医院收治的465例急性胰腺炎患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男343例，女122例；年龄38～54岁，中位年龄51岁。HTG-AP组51例，BAP组414例。观察两组患者一般资料、并发症等临床特征差异。两组淀粉酶、脂肪酶等比较采用t检验，率的比较采用χ2检验或Fisher确切概率法。

结果

HTG-AP组平均年龄（40±2）岁，明显低于BAP组的（52±2）岁（t=-38.52，P<0.05）；男性、糖尿病患者比例分别为90%（46/51）、31%（16/51），明显高于BAP组的72%（297/414）、12%（48/414） （χ2=7.93，14.97；P<0.05）。HTG-AP组BMI、C-反应蛋白（CRP）分别为（30.6±2.2）kg/m2、（129±8）mg/L，明显高于BAP组的（26.0±1.5）kg/m2、（58±4）mg/L（t=19.49，103.90；P<0.05）。HTG-AP组患者急性呼吸窘迫综合征（ARDS）、急性肾损伤（AKI）、多器官功能障碍综合征（MODS）发生率分别为16%（8/51）、22%（11/51）、16%（8/51），明显高于BAP组的3%（12/414）、1%（5/414）、2%（10/414） （χ2=18.04，56.66，21.49；P<0.05）。

结论

与BAP相比，HTG-AP以年轻、肥胖男性患者多发，合并糖尿病患者较多，器官衰竭等严重并发症发生率较高。

关键词: 胰腺炎, 高甘油三酯血症, 并发症
Objective

To compare the clinical features between hypertriglyceridemia-induced acute pancreatitis (HTG-AP) and biliary acute pancreatitis (BAP).

Methods

Clinical data of 465 patients with acute pancreatitis admitted to Affiliated Hospital of North Sichuan Medical College from July 2008 to October 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 343 patients were male and 122 female, aged 38-54 years with a median age of 51 years. 51 patients were assigned into the HTG-AP group and 414 cases in the BAP group. Clinical features, such as baseline data and postoperative complications, were observed between two groups. The amylase and lipase levels between two groups were statistically compared by t test. The rate comparison was conducted by Chi-square test or Fisher's exact test.

Results

The average age of patients in the HTG-AP group was (40±2) years, significantly younger than (52±2) years in the BAP group (t=-38.52, P<0.05). In the HTG-AP group, the proportion of male, diabetes mellitus patients were 90%(46/51) and 31%(16/51) respectively, significantly higher than 72%(297/414) and 12%(48/414) in the BAP group (χ2=7.93, 14.97; P<0.05). Body mass index (BMI) and C-reactive protein (CRP) in the HTG-AP group were (30.6±2.2) kg/m2 and (129±8) mg/L, significantly higher than (26.0±1.5) kg/m2 and (58±4) mg/L in the BAP group (t=19.49, 103.90; P<0.05). The incidence of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS) in the HTG-AP group was 16%(8/51), 22%(11/51) and 16%(8/51), significantly higher than 3%(12/414), 1%(5/414) and 2%(10/414) in the BAP group (χ2=18.04, 56.66, 21.49; P<0.05).

Conclusions

Compared with BAP, HTG-AP is more common in young and obese men with a higher incidence of diabetes mellitus and severe complications, such as organ failure.

Key words: Pancreatitis, Hypertriglyceridemia, Complications
表1 HTG-AP组与BAP组患者临床特征比较
组别 例数 年龄（岁，±s） 性别（男/女） BMI（kg/m2，±s） APACHE评分（±s） 高血压（例） 糖尿病（例） MAP（例） MSAP（例） SAP（例）
HTG-AP组 51 40±2 46/5 30.6±2.2 26.4±2.7 11 16 32 13 6
BAP组 414 52±2 297/117 26.0±1.5 26.1±2.0 73 48 269 115 32
统计值 ? t=-38.52 χ2=7.93 t=19.49 t=0.97 χ2=0.48 χ2=14.97 χ2=0.10 χ2=0.12 χ2=0.99
P值 ? <0.001 0.005 <0.001 0.333 0.491 <0.001 0.753 0.730 0.321
表2 HTG-AP组与BAP组患者实验室指标比较（±s）
组别 例数 淀粉酶（U/L） 脂肪酶（U/L） WBC（个/ L） CRP（mg/L） PCT（μg/L） Scr（μmol/L） TB（μmol/L） ALT（U/L） AST（U/L） Hb（g/L） Plt（×109个/ L） PT（s） APTT（s）
HTG-AP组 51 653±101 951±54 15±6 129±8 1.25±0.17 76±14 48±6 86±7 104±16 148±22 246±40 13±5 35±5
BAP组 414 678±31 961±43 13±5 58±4 1.25±0.09 78±13 47±5 85±6 102±17 146±22 242±25 12±6 35±4
t值 ? -43.39 -1.52 2.63 103.90 0.00 -1.03 1.32 1.10 0.80 0.61 1.00 1.14 0.00
P值 ? <0.001 0.129 0.009 <0.001 0.999 0.305 0.189 0.271 0.426 0.541 0.319 0.254 0.999
表3 HTG-AP组与BAP组患者并发症发生率比较（例）
组别 例数 ARDS AKI 腹内高压 休克 腹腔内出血 门静脉血栓 深静脉血栓 急性肝损伤 胃肠道瘘 消化道出血 肠梗阻 MODS 急性胰周积液 胰腺假性囊肿 急性坏死性积液
HTG-AP组 51 8 11 1 1 0 0 0 1 0 1 0 8 14 2 4
BAP组 414 12 5 2 15 1 1 1 8 6 2 16 10 111 9 12
χ2值 ? 18.04 56.66 1.55 0.38 - - - 0.00 - 1.55 - 21.49 0.01 0.60 3.34
P值 ? <0.001 <0.001 0.214 0.539 0.725 0.725 0.725 0.989 0.387 0.214 0.153 <0.001 0.923 0.438 0.068
[1]
Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156(7):2008-2023.
[2]
Pang Y, Kartsonaki C, Turnbull I, et al. Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: a prospective cohort study of 0.5 million people[J]. PLoS Med, 2018, 15(8):e1002618.
[3]
Hansen SEJ, Madsen CM, Varbo A, et al. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis: a study of more than 115000 individuals from the general population[J]. Clin Chem, 2019, 65(2):321-332.
[4]
Li X, Ke L, Dong J, et al. Significantly different clinical features between hypertriglyceridemia and biliary acute pancreatitis: a retrospective study of 730 patients from a tertiary center[J]. BMC Gastroenterol, 2018, 18(1):89.
[5]
Li H, Yang Z, Tian F. Clinical characteristics and risk factors for sinistral portal hypertension associated with moderate and severe acute pancreatitis: a seven-year single-center retrospective study[J]. Med Sci Monit, 2019(25):5969-5976.
[6]
Huang L, Chen C, Yang L, et al. Neutrophil-to-lymphocyte ratio can specifically predict the severity of hypertriglyceridemia-induced acute pancreatitis compared with white blood cell[J]. J Clin Lab Anal, 2019, 33(4):e22839.
[7]
Zheng L, Hong W, Geng W, et al. A comparison of the BISAP score and Amylase and BMI (CAB) score versus for predicting severe acute pancreatitis[J]. Acta Gastroenterol Belg, 2019, 82(3):397-400.
[8]
Siregar GA, Siregar GP. Management of severe acute pancreatitis[J]. Open Access Maced J Med Sci, 2019, 7(19):3319-3323.
[9]
Harshit Kumar A, Singh Griwan M. A comparison of APACHEⅡ, BISAP, Ranson's score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification[J]. Gastroenterol Rep, 2018, 6(2):127-131.
[10]
Guo YY, Li HX, Zhang Y, et al. Hypertriglyceridemia-induced acute pancreatitis: progress on disease mechanisms and treatment modalities[J]. Discov Med, 2019, 27(147):101-109.
[11]
Villegas-Comonfort S, Guzmán-Silva A, Romero-ávila MT, et al. Receptor tyrosine kinase activation induces free fatty acid 4 receptor phosphorylation, β-arrestin interaction, and internalization[J]. Eur J Pharmacol, 2019(855):267-275.
[12]
Zhang Q, Qin M, Liang Z, et al. The relationship between serum triglyceride levels and acute pancreatitis in an animal model and a 14-year retrospective clinical study[J]. Lipids Health Dis, 2019, 18(1):183.
[13]
Biczo G, Vegh ET, Shalbueva N, et al. Mitochondrial dysfunction, through impaired autophagy, leads to endoplasmic reticulum stress, deregulated lipid metabolism, and pancreatitis in animal models[J]. Gastroenterology, 2018, 154(3):689-703.
[14]
Zhao Q, Wei Y, Pandol SJ, et al. STING signaling promotes inflammation in experimental acute pancreatitis[J]. Gastroenterology, 2018, 154(6):1822-1835, e2.
[15]
Li M, Xing XK, Lu ZH, et al. Comparison of scoring systems in predicting severity and prognosis of hypertriglyceridemia-induced acute pancreatitis[J]. Dig Dis Sci, 2020, 65(4):1206-1211.
[16]
Jo SI, Chang JH, Kim TH, et al. Subsets associated with developing acute pancreatitis in patients with severe hypertriglyceridemia and the severity of pancreatitis[J]. Pancreatology, 2019, 19(6):795-800.
[17]
Baass A, Paquette M, Bernard S, et al. Familial chylomicronemia syndrome: an under-recognized cause of severe hypertriglyceridaemia[J]. J Intern Med, 2020, 287(4): 340-348.
[18]
Singh RG, Nguyen NN, DeSouza SV, et al. Comprehensive analysis of body composition and insulin traits associated with intra-pancreatic fat deposition in healthy individuals and people with new-onset prediabetes/diabetes after acute pancreatitis[J]. Diabetes Obes Metab, 2019, 21(2):417-423.
[19]
Abdelsadik A. High-fat diet modifies cytokine gene expression and exacerbates the effects of acute pancreatitis in the liver of rats[J]. J Basic Clin Physiol Pharmacol, 2018, 29(6):651-658.
[20]
Singh RG, Cervantes A, Kim JU, et al. Intrapancreatic fat deposition and visceral fat volume are associated with the presence of diabetes after acute pancreatitis[J]. Am J Physiol Gastrointest Liver Physiol, 2019, 316(6):G806-815.
[21]
Dobszai D, Mátrai P, Gyöngyi Z, et al. Body-mass index correlates with severity and mortality in acute pancreatitis: a meta-analysis[J]. World J Gastroenterol, 2019, 25(6):729-743.
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