急性胰腺炎合并非酒精性脂肪性肝病的临床特征及预后分析

严永峰; 蒋鑫; 钟瑞; 徐欢; 彭燕; 汤小伟

doi:10.3969/j.issn.1001-5256.2020.05.028

急性胰腺炎合并非酒精性脂肪性肝病的临床特征及预后分析

DOI: 10.3969/j.issn.1001-5256.2020.05.028

西南医科大学附属医院消化内科

基金项目:

西南医科大学附属医院博士科研启动基金资助项目（16229）；泸州市人民政府西南医科大学科技战略合作项目（2019LZXNYDJ24）；

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中图分类号: R576;R575.5
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出版历程
- 出版日期: 2020-05-20

Clinical features and prognosis of acute pancreatitis with nonalcoholic fatty liver disease

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Research funding:

摘要

摘要:
目的探讨非酒精性脂肪性肝病（NAFLD）与急性胰腺炎（AP）严重程度的相关性。方法纳入2019年1月-2019年8月西南医科大学附属医院收治的AP患者398例,其中包括轻症急性胰腺炎（MAP）197例,中度重症急性胰腺炎（MSAP）151例,重症急性胰腺炎（SAP）50例。根据是否合并NAFLD将AP患者分为NAFLD组（206例）和非NAFLD组（192例）。分析及对比两组患者的临床特点及预后,包括基础资料、血清学指标、病原学、并发症、AP严重程度评分、住院日及病死率等。计量资料两组间比较采用t检验或Mann-WhitneyU检验;计数资料两组间比较采用χ2检验或Fisher确切检验,以发生中-重症急性胰腺炎（M-SAP）为终点,进行logistic回归分析。结果两组间年龄、男性占比、BMI、TC、TG、Na+、WBC、中性粒细胞百分比、血糖、血清肌酐差异均有统计学意义（P值均<0. 05）,NAFLD组更容易合并糖代谢异常及脂代谢异常（P值均<0. 05）。两组病原学构成差异有统计学意义（P<0. 001）,NAFLD组...
- 胰腺炎 /
- 非酒精性脂肪性肝病 /
- 危险因素 /
- 预后
Abstract:
Objective To investigate the association of nonalcoholic fatty liver disease( NAFLD) with the severity of acute pancreatitis(AP).Methods A total of 398 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January to August 2019 were enrolled, among whom there were 197 patients with mild acute pancreatitis(MAP), 151 patients with moderate-severe acute pancreatitis(MSAP), and 50 patients with severe acute pancreatitis(SAP). According to the presence or absence of NAFLD,these patients were divided into NAFLD group with 206 patients and non-NAFLD group with 192 patients. The two groups were compared in terms of the clinical features and prognosis, including baseline data, serological markers, etiology, complications, commonly used AP scores, length of hospital stay, and mortality rate. Thet-test or the Mann-WhitneyUtest was used for comparison of continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups; a logistic regression analysis was performed with the development of MSAP as the endpoint.Results There were significant differences between the two groups in age, proportion of male patients, body mass index, total cholesterol, triglyceride, Na+, white blood cell count, neutrophil count, blood glucose, and serum creatinine(allP< 0. 05), and compared with the non-NAFLD group, the NAFLD group tended to have a higher proportion of patients with abnormal glucose metabolism or abnormal lipid metabolism(P< 0. 05). There was a significant difference in etiological composition between the two groups(P< 0. 001), with the main etiology of hyperlipidemia in the NAFLD group1%) and biliary disease in the non-NAFLD group(57.8%). Compared with the non-NAFLD group, the NAFLD group had significantly higher proportion of patients with MSAP, RANSON score, and Balthazar score(allP< 0. 05), as well as significantly higher incidence rates of systemic inflammatory response syndrome(SIRS)(P< 0. 001), acute peripancreatic fluid collection （χ2 =15.820,P<0001), 2="6." and="" acute="" necrotic="" collection="" 0.="" .="" compared="" with="" the="" non-nafld="" nafld="" had="" a="" significantly="" higher="" risk="" of="" 30.="" vs="" 19.="" p="" incidence="" rate="" multiple="" organ="" 12.="" vs8.="">0. 05) and mortality rate(3. 4% vs 1. 2%,P> 0. 05). NAFLD, abnormal glucose metabolism, and lymphocyte count were in-dependent risk factors for MSAP(allP< 0. 05).Conclusion AP patients with NAFLD tend to develop SIRS and local complications of thepancreas and have a high disease grade, a poor prognosis, and a high risk of recurrence.
- pancreatitis /
- non-alcoholic fatty liver /
- disease classification /
- risk factors

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参考文献(33)

[1]LEPPÄNIEMI A,TOLONEN M,TARASCONI A,et al.2019WSES guidelines for the management of severe acute pancreatitis[J].World J Emerg Surg,2019,14:27．

[2]YIN G,CANG X,YU G et al.Diferent clinical presentations of hyperlipidemic acute pancreatitis:A retrospective study[J].Pancreas,2015,44(7):1105-1110．

[3]National Workshop on Fatty Liver and Alcoholic Liver Disease,Chinese Society of Hepatology,Chinese Medical Association;Fatty Liver Expert Committee,Chinese Medical Doctor Association.Guidelines of prevention and treatment for nonalcoholic fatty liver disease:A 2018 update[J].J Clin Hepatol,2018,34(5):947-957.(in Chinese）中华医学会肝病学分会脂肪肝和酒精性肝病学组，中国医师协会脂肪性肝病专家委员会．非酒精性脂肪性肝病防治指南（2018年更新版）[J]．临床肝胆病杂志，2018,34(5):947-957．

[4]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(Shenyang,2019)[J].J Clin Hepatol,2019,35(12):2706-2711.(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》编委会，《中华消化杂志》编委会．中国急性胰腺炎诊治指南（2019年，沈阳）[J]．临床肝胆病杂志，2019,35(12):2706-2711．

[5]NOVO S,BALBARINI A,BELCH JJ,et al.The metabolic syndrome:Definition,diagnosis and management[J].Int Angiol,2008,27(3):220-231．

[6]ZAHEER A,SINGH VK,QURESHI RO,et al.The revised Atlanta classification for acute pancreatitis:Updates in imaging terminology and guidelines[J].Abdom Imaging,2013,38(1):125-136．

[7]KWOK R,CHOI KC,WONG GL,et al.Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation parameter and liver stiffness measurements:A prospective cohort study[J].Gut,2016,65(8):1359-1368．

[8]Non-alcoholic fatty liver disease:Assessment and management[M].London:National Institute for Health and Care Excellence(UK),2016．

[9]GEORGE ES,FORSYTH A,ITSIOPOULOS C,et al.Practical dietary recommendations for the prevention and management of nonalcoholic fatty liver disease in adults[J].Adv Nutr,2018,9(1):30-40．

[10]GAO HL,WANG L,YAO P.Relationship of body mass index,blood glucose and serum triacylglycerol with severity of acute pancreatitis[J].Chin J Gastroenterol,2012,17(1):27-29.(in Chinese）高鸿亮，王磊，姚萍．体质指数、血糖和血清三酰甘油与急性胰腺炎病情严重程度的关系[J]．胃肠病学，2012,17(1):27-29．

[11]HUANG Y,WANG Y.Clinical analysis of diabetes mellitus complicated with hyperlipidemic acute pancreatitis[J].Chin JGastroenterol,2018,23(7):423-425.(in Chinese）黄瑶，王营．糖尿病合并高脂血症性急性胰腺炎的临床分析[J]．胃肠病学，2018,23(7):423-425．

[12]SHEN HN,LU CL,LI CY.Effect of diabetes on severity and hospital mortality in patients with acute pancreatitis:A national population-based study[J].Diabetes Care,2012,35(5):1061-1066．

[13]ZHANG WJ,CHEN QD,LIN YS.Research on clinical characteristics of patients with acute pancreatitis accompanied by metabolic syndrome[J].Clin Focus,2012,27(10):849-851.(in Chinese）张文洁，陈绮丹，林燕生．伴代谢综合征急性胰腺炎的临床特征研究[J]．临床荟萃，2012,27(10):849-851．

[14]MIKOLASEVIC I,MILIC S,ORLIC L,et al.Metabolic syndrome and acute pancreatitis[J].Eur J Intern Med,2016,32:79-83．

[15]MONTEIRO R,AZEVEDO I.Chronic inflammation in obesity and the metabolic syndrome[J].Mediators Inflamm,2010,2010:289645．

[16]LI HQ,LIU W,TANG J,et al.Evaluation value of triglyceride,C-reactive protein and procalcitonin on the severity and prognosis of hyperlipidemic acute pancreatitis[J].Chin J Med Offic,2019,47(9):923-925.(in Chinese）历海清，刘卫，唐郡，等．甘油三酯、C反应蛋白、降钙素原对高脂血症性急性胰腺炎病情严重程度及预后评估价值[J]．临床军医杂志，2019,47(9):923-925．

[17]XU C,QIAO Z,LU Y,et al.Influence of fatty liver on the severity and clinical outcome in acute pancreatitis[J].PLoSOne,2015,10(11):e0142278．

[18]MIKOLASEVIC I,ORLIC L,POROPAT G,et al.Nonalcoholic fatty liver and the severity of acute pancreatitis[J].Eur J Intern Med,2017,38:73-78．

[19]WU D,ZHANG M,XU S,et al.Nonalcoholic fatty liver disease aggravated the severity of acute pancreatitis in patients[J].Biomed Res Int,2019,2019:9583790．

[20]YAO J,XU YP,ZHOU CS,et al,Relationship between acute mild pancreatitis and non-alcoholic fatty liver[J].Chin J Clin Res,2016,29(3):318-320.(in Chinese）姚俊，许亚平，周春锁，等．急性轻症胰腺炎与非酒精性脂肪肝的关系[J]．中国临床研究，2016,29(3):318-320．

[21]WU D,SONG LL,ZHAO YH.Relationship between fatty liver and grade of acute pancreatitis[J].Chin J Lab Diag,2018,22(9):1557-1559.(in Chinese）吴迪，宋玲玲，赵艳辉．脂肪肝与急性胰腺炎分级的关系研究[J]．中国实验诊断学，2018,22(9):1557-1559．

[22]GAO F,QI SX,HOU Y,et al.Association between pancreatitis and fatty liver disease[J].J Clin Hepatol,2017,33(1):40-45.(in Chinese）高帆，祁兴顺，侯悦，等．胰腺炎与脂肪肝的关系探讨[J]．临床肝胆病杂志，2017,33(1):40-45．

[23]MA JC,BAO ZJ.Research progress in the pathogenesis of hyperlipidemia-induced acute pancreatitis[J].Int J Din Dis,2017,37(1):24-27.(in Chinese）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．

[24]JI GR,ZHU GL,ZHANG B,et al.Association between dyslipidemia and acute pancreatitis:A prospective cohort study[J].J Clin Hepatol,2019,35(7):1536-1540.(in Chinese）吉瑞更，朱国玲，张冰，等．血脂异常对急性胰腺炎发病影响的前瞻性队列研究[J]．临床肝胆病杂志，2019,35(7):1536-1540．

[25]SHEN ZX,XIE DH,SUN L,et al.Relationship between plasma inflammatory factor levels,glucose metabolism and insulin resistance in patients with type 2 diabetes[J].Clin J Diabetes,2010,18(4):253-254.(in Chinese）盛志新，谢丹红，孙辽，等．2型糖尿病患者血浆炎症因子水平与糖代谢及胰岛素抵抗的关系[J]．中国糖尿病杂志，2010,18(4):253-254．

[26]DU JD,ZHENG X,HUANG ZQ,et al.Effects of intensive insulin therapy combined with low molecular weight heparin anticoagulant therapy on severe pancreatitis[J].Exp Ther Med,2014,8(1):141-146．

[27]TOZLU M,KAYAR Y,INCE AT,et al.Low molecular weight heparin treatment of acute moderate and severe pancreatitis:A randomized,controlled,open-label study[J].Turk J Gastroenterol,2019,30(1):81-87．

[28]ZHAO Q,WANG B,LI ZF,et al.Clinical significance of abnormal liver function in determining the etiology and severity of acute pancreatitis[J].J Clin Hepatol,2018,34(1):152-156.(in Chinese）赵琦，王兵，李振方，等．肝功能异常对急性胰腺炎病因和病情分级判定的临床意义[J]．临床肝胆病杂志，2018,34(1):152-156．

[29]YANG MS,ZHANG HQ.Reciprocal“cause-effect”relationship between acute pancreatitis and liver dysfunction[J].World Chin J Dig,2017,25(22):1995-1999.(in Chinese）秧茂盛，张红晴．急性胰腺炎与肝功能异常之间的“因-果”关系研究进展[J]．世界华人消化杂志，2017,25(22):1995-1999．

[30]BELL JA,HILTON PJ,WALKER G.Severe hyponatraemia in hyperlipaemic diabetic ketosis[J].Br Med J,1972,4(5842):709-710．

[31]WANG Y,ATTAR BM,ABU OMAR Y,et al.Pseudohyponatremia in hypertriglyceridemia-induced acute pancreatitis:A tool for diagnosis rather than merely a laboratory error?[J].Pancreas,2019,48(1):126-130．

[32]WU BU,BATECH M,DONG EY,et al.Influence of ambulatory triglyceride levels on risk of recurrence in patients with hypertriglyceridemic pancreatitis[J].Dig Dis Sci,2019,64(3):890-897．

[33]ZAFRIR B,SALIBA W,JUBRAN A,et al.Severe hypertriglyceridemia-related pancreatitis:Characteristics and predictors of recurrence[J].Pancreas,2019,48(2):182-186．

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