重症高甘油三酯性急性胰腺炎的临床特征分析

唐永凤; 唐国都; 梁志海; 覃蒙斌; 黄华丽; 覃敏珍

doi:10.3969/j.issn.1001-5256.2019.04.024

重症高甘油三酯性急性胰腺炎的临床特征分析

DOI: 10.3969/j.issn.1001-5256.2019.04.024

广西医科大学第一附属医院消化内科

基金项目:

国家自然科学基金项目(8156040100)；

详细信息

中图分类号: R576
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- 被引次数: 16
出版历程
- 收稿日期: 2018-10-31
- 出版日期: 2019-04-20

Clinical features of severe acute hypertriglyceridemic pancreatitis

Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University

Research funding:

摘要

摘要: 目的分析重症急性高甘油三酯性急性胰腺炎（HTGP）的临床特点。方法收集2013年1月-2016年6月广西医科大学第一附属医院179例中度重症急性胰腺炎（MSAP）和重症急性胰腺炎（SAP）患者资料。按病因分为4组:重症胆源性急性胰腺炎68例、重症酒精性急性胰腺炎39例、HTGP 45例及其他重症急性胰腺炎组（其他组） 27例,记录前3组有明确病因患者的人口学资料、入院第1天TG水平、病因、胰腺坏死,全身并发症[急性呼吸窘迫综合征（ARDS）、急性肾功能损伤、低血压、弥散性血管内凝血],其他临床结果（是否入住ICU、住院时间、病死率）。为了进一步了解TG浓度对AP患者转归的影响,根据入院第1天TG水平不同分为血脂正常（82例）、轻度（52例）、中度（28例）、重度（17例） 4组,对不同水平组全身并发症、胰腺坏死、临床结果的发生率进行分析。计量资料多组间比较采用Kruskal-Wallis H检验,计数资料组间比较采用χ2检验,采用Spearman秩相关作相关分析。结果结果显示,胆道疾病仍然是SAP的第一大病因（38%）,而高甘油三酯血症成为了SAP的第二大病因（25%）。全身并发症的比...
- 胰腺炎,急性坏死性 /
- 高甘油三酯血症 /
- 体征和症状
Abstract: Objective To investigate the clinical features of severe acute hypertriglyceridemic pancreatitis ( HTGP) . Methods A retrospective analysis was performed for the clinical data of 179 patients with moderate severe pancreatitis ( MSAP) or severe acute pancreatitis ( SAP) who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2016. According to the etiology, these patients were divided into severe biliogenic acute pancreatitis ( biliogenic AP) group with 68 patients, severe alcoholic acute pancreatitis ( alcoholic AP) group with 39 patients, severe acute HTGP group with 45 patients, and severe acute pancreatitis group with other causes ( other group) with 27 patients. Related data of the patients with clear causes in the former three groups were recorded, including demographic data, blood triglyceride ( TG) level on the first day of admission, cause, pancreatic necrosis, systemic complications [acute respiratory distress syndrome ( ARDS) , acute renal injury, hypotension, and disseminated intravascular coagulation ( DIC) ], and related clinical outcomes ( admission to the intensive care unit, length of hospital stay, and mortality rate) . In order to investigate the influence of TG concentration on the prognosis of AP patients, the patients were divided into normal blood lipid group with 82 patients, mild dyslipidemia group with 52 patients, moderate dyslipidemia group with 28 patients, and severe dyslipidemia group with 17 patients, according to the TG level on the first day of admission, and the incidence rates of systemic complications, pancreatic necrosis, and clinical outcomes were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and the Spearman rank correlation test was used for correlation analysis. Results Biliary tract disease remained the leading cause of SAP ( 38%) , followed by hypertriglyceridemia ( 25%) . As for systemic complications, the HTGP group had a significantly higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group ( P = 0. 014 and0. 022) . In the groups with different TG levels, the incidence rates of ARDS and acute renal injury were positively correlated with TG level ( r = 0. 966 and 0. 982, P = 0. 004 and 0. 019) . Conclusion The HTGP group has a higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group, and the risk of ARDS and acute renal injury tends to increase with the increasing TG level.
- pancreatitis, acute necrotizing /
- hypertriglyceridemia /
- signs and symptoms

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参考文献(31)

[1]Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association, Editorial Board of Chinese Journal of Pancreatology, Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shanghai, 2013) [J]. J Clin Hepatol, 2013, 29 (9) :656-660. (in Chinese) 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》编辑委员会.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]NAWAZ H, MOUNZER R, YADAV D, et al. Revised atlanta and determinant-based classification:Application in a prospective cohort of acute pancreatitis patients[J]. Am J Gastroenterol, 2013, 108 (12) :1911-1917.

[3]XU HF, LI Y, YAN J, et al. Severity analyese of acute pancreatitis based on etiology[J]. Natl Med J China, 2014, 94 (41) :3220-3223. (in Chinese) 徐海峰, 李勇, 颜骏, 等.急性胰腺炎病因与其严重程度的关系[J].中华医学杂志, 2014, 94 (41) :3220-3223.

[4]HE WH, ZHU Y, ZHU Y, et al. Comparison of severity and clinical outcomes between hypertriglyceridemic pancreatitis and acute pancreatitis due to other causes[J]. Natl Med J China, 2016, 96 (32) :2569-2572. (in Chinese) 何文华, 祝荫, 朱勇, 等.高甘油三酯血症与其他病因所致急性胰腺炎的病情严重程度及预后比较[J].中华医学杂志, 2016, 96 (32) :2569-2572.

[5]ZHENG YM, ZHOU Z, LI HC, et al. A multicenter study on etiology of acute pancreatitis in Beijing during 5 years[J]. Pancreas, 2015, 44 (3) :409-414.

[6]FAN JJ, DING L, LU YY, et al. Epidemiology and etiology of acute pancreatitis in urban and suburban areas in Shanghai:A retrospective study[J]. Gastroenterol Res Pract, 2018, 2018:1420590.

[7]NESVADERANI M, ESLICK G, VAGG D, et al. Epidemiology, aetiology and outcomes of acute pancreatitis:A retrospective cohort study[J]. Int J Surg, 2015, 23 (Pt A) :68-74..

[8]WANG Q, WANG G, QIU ZY, 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.

[9]BERGLUND L, BRUNZELL JD, GOLDBERG AC, et al. Evaluation and treatment of hypertriglyceridemia:An Endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2012, 97 (9) :2969-2989.

[10]China Adult Lipid Abnormality Prevention and Treatment Guidelines Revision Committee. Guidelines for the prevention and treatment of adult hyperlipidemia in China (2016 Revision) [J]. Chin Circulation J, 2016, 31 (10) :937-953. (in Chinese) 中国成人血脂异常防治指南修订委员会.中国成人血脂异常防治指南 (2016年修订版) [J].中国循环杂志, 2016, 31 (10) :937-953.

[11]BURSTOW M, YUNUS R, HOSSAIN M, et al. Meta-analysis of early endoscopic retrograde cholangiopancreatography (ERCP) ±endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP) [J]. Surg Laparosc Endosc Percutan Tech, 2015, 25 (3) :185-203.

[12]LLORET L, PELLETIER A, CZERNICHOW S, et al. Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia[J]. Pancreas, 2008, 37 (1) :13-20.

[13]GOYAL H, SMITH B, BAYER C, et al. Differences in severity and outcomes between hypertriglyceridemia and alcohol-induced pancreatitis[J]. N Am J Med Sci, 2016, 8 (2) :82-87.

[14]ZHENG YM, ZHOU X, GAO CC, et al. Risk factors analysis of early death for severe acute pancreatitis patients[J]. China Med Herald, 2017, 14 (13) :61-64. (in Chinese) 郑亚民, 周震, 高崇崇, 等.急性重症胰腺炎早期死亡的风险因素分析[J].中国医药导报, 2017, 14 (13) :61-64.

[15]CARIOCA A, JOZALA D, BEM L, et al. Severity assessment of acute pancreatitis:Applying Marshall scoring system[J].Rev Col Bras Cir, 2015, 42 (5) :325-327.

[16]BANKS P, BOLLEN T, DERVENIS C, et al. Classification of acute pancreatitis—2012:Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62 (1) :102-111.

[17]PETROV M, SHANBHAG S, CHAKRABORTY M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis[J]. Gastroenterology, 2010, 139 (3) :813-820.

[18]KIM D, CHUNG W, LEE J, et al. Analysis of factors associated with the severity of acute pancreatitis according to etiology[J]. Gastroenterol Res Pract, 2017, 2017:1219464.

[19]ZENG Y, ZHANG W, LU YY, et al. Impact of hypertriglyceridemia on the outcome of acute biliary pancreatitis[J]. Am J Med Sci, 2014, 348 (5) :399-402.

[20]WU CY, KE L, TONG ZH, et al. Hypertriglyceridemia is a risk factor for acute kidney injury in the early phase of acute pancreatitis[J]. Pancreas, 2014, 43 (8) :1312-1316.

[21]LI XY, 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 gastroenterology, 2018, 18 (1) :89.

[22]NAWAZ H, KOUTROUMPAKIS E, EASLER J, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis[J]. Am J Gastroenterol, 2015, 110 (10) :1497-1503.

[23]TSUANG W, NAVANEETHAN U, RUIZ L, et al. Hypertriglyceridemic pancreatitis:Presentation and management[J]. Am J Gastroenterol, 2009, 104 (4) :984-991.

[24]ALDIVIELSO P, RAMIREZ-BUENO A, EWALD N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med, 2014, 25 (8) :689-694.

[25]CHRISTIAN J, ARONDEKAR B, BUYSMAN E, et al. Clinical and economic benefits observed when follow-up triglyceride levels are less than 500 mg/dl in patients with severe hypertriglyceridemia[J]. J Clin Lipidol, 2012, 6 (5) :450-461.

[26]CHAUDHARY A, IQBAL U, ANWAR H, et al. Acute Pancreatitis secondary to severe hypertriglyceridemia:Management of severe hypertriglyceridemia in emergency setting[J]. Gastroenterology Res, 2017, 10 (3) :190-192.

[27]YANG LL, LI C, WEI XH, et al. Study on the influence of continuous blood purification for serum disease related indexes of patients with severe acute pancreatitis[J]. J Clin Exp Med, 2017, 16 (2) :193-195. (in Chinese) 杨丽丽, 李川, 魏晓华, 等.连续性血液净化对重症急性胰腺炎患者血清疾病相关指标的影响研究[J].临床和实验医学杂志, 2017, 16 (2) :193-195.

[28]STEFANUTTI C, LABBADIA G, MOROZZI C. Severe hypertriglyceridemia-related acute pancreatitis[J]. Ther Apher Dial, 2013, 17 (2) :130-137.

[29]SZCZEPIORKOWSKI Z, WINTERS J, BANDARENKO N, et al.Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis[J]. J Clin Apher, 2010, 25 (3) :83-177.

[30]HUANG SP, TOH DE, SUE Y, et al. Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia:Three case reports[J]. Medicine, 2018, 97 (44) :e12987.

[31]KANDEMIR A, COSKUN A, YAVASOGLU I, et al. Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis:the 33 cases experience from a tertiary reference center in Turkey[J]. Turk J Gastroenterol, 2018, 29 (6) :676-683.

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