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

doi:10.3877/cma.j.issn.2095-3232.2020.05.011

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. 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. 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: lengzhengwei@163.com

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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/OL]. 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/OL]. 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

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

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