胆源性急性胰腺炎与高甘油三酯血症性急性胰腺炎临床特点对比分析

蒋鑫; 严永峰; 钟瑞; 徐欢; 彭燕; 汤小伟

doi:10.3969/j.issn.1001-5256.2020.09.028

胆源性急性胰腺炎与高甘油三酯血症性急性胰腺炎临床特点对比分析

DOI: 10.3969/j.issn.1001-5256.2020.09.028

西南医科大学附属医院消化内科

基金项目:

泸州市科技局基金(17246)；泸州市三方联合基金(Z1437)；西南医科大学附属医院科研基金(07037);西南医科大学附属医院博士启动基金(16229)；

详细信息

中图分类号: R576
计量
- 文章访问数: 1282
- HTML全文浏览量: 20
- PDF下载量: 133
- 被引次数: 0
出版历程
- 出版日期: 2020-09-20

Clinical features of biliary acute pancreatitis versus hypertriglyceridemic acute pancreatitis

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
目的探讨胆源性急性胰腺炎（BAP）与高甘油三酯血症性急性胰腺炎（HTGAP）的临床特点。方法选取2018年9月-2019年8月西南医科大学附属医院收治的378例急性胰腺炎患者,其中BAP患者（胆道组） 229例,HTGAP患者（高脂组） 149例。分析两组患者的临床特点,包括年龄、性别、基础疾病、实验室指标、病情严重程度、局部并发症及全身并发症、结局指标等。符合正态分布的计量资料两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher精确概率法;有序多分类变量比较采用Mann-Whitney U检验。应用多因素logistic回归分析急性肝损伤、全身炎症反应综合征、多器官功能障碍综合征的独立危险因素。结果高脂组患者年龄（t=7.192）、转诊率（χ2=7.680）均低于胆道组,其男性构成比（χ2=16.987）、BMI（t=-4.171）、BISAP评分（Z=-2.701）、高脂饮食率（χ2=6.702）、复发率（χ2=6.702）、糖尿病（χ2=8.567）、吸烟（χ2=9.291）、饮酒（χ2...
- 胰腺炎 /
- 高甘油三酯血症 /
- 疾病特征
Abstract:
Objective To investigate the clinical features of biliary acute pancreatitis( BAP) and hypertriglyceridemic acute pancreatitis( HTGAP). Methods A total of 378 patients with acute pancreatitis who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled,among whom 229 patients had BAP( BAP group) and 149 had HTGAP( HTGAP group). Clinical features were analyzed for both groups,including age,sex,underlying diseases,laboratory markers,disease severity,local and systemic complications,and outcome measures. The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed 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,and the Mann-Whitney U test was used for comparison of ordinal categorical data between groups. A logistic regression analysis was used to investigate the independent risk factors for acute liver injury,systemic inflammatory response syndrome,and multiple organ dysfunction syndrome. Results Compared with the BAP group,the HTGAP group had a significantly younger age( t = 7. 192,P < 0. 05),a significantly lower referral rate( χ2= 7. 680,P < 0. 05),and significantly higher constituent ratio of male patients( χ2= 16. 987,P < 0. 05),body mass index( BMI)( t =-4. 171,P < 0. 05),BISAP score( Z =-2. 701,P < 0. 05),rate of high-fat diet( χ2= 6. 702,P < 0. 05),recurrence rate( χ2=6. 702,P < 0. 05),and proportion of patients with diabetes( χ2= 8. 567,P < 0. 05),smoking( χ2= 9. 291,P < 0. 05) or drinking( χ2=11. 934,P < 0. 05). Compared with the HTGAP group,the BAP group had significantly higher amylase( Z =-3. 298,P < 0. 05),alanine aminotransferase( Z =-5. 290,P < 0. 05),aspartate aminotransferase( Z =-6. 247,P < 0. 05),total bilirubin( Z =-3. 626,P <0. 05),direct bilirubin( Z =-8. 803,P < 0. 05),and D-dimer( Z =-3. 511,P < 0. 05) and significantly lower white blood cell count( Z =-3. 344,P < 0. 05),hemoglobin( t =-7. 496,P < 0. 05),and hematocrit( t =-3. 812,P < 0. 05). Compared with the HTGAP group,the BAP group had a significantly higher proportion of patients with pancreatic pseudocyst or acute liver injury( χ2= 11. 131 and19. 089,both P < 0. 05),and compared with the BAP group,the HTGAP group had a significantly higher proportion of patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome( χ2= 3. 848 and 4. 485,both P < 0. 05). There were also significant differences between the two groups in surgical rate( χ2= 18. 348,P < 0. 05) and length of hospital stay( Z =-2. 002,P < 0. 05).The multivariate logistic regression analysis showed that hypertriglyceridemia( odds ratio [OR] = 0. 347,95% confidence interval [CI]:0. 152-0. 793,P = 0. 012),BMI( OR = 1. 113,95% CI: 1. 031-1. 202,P = 0. 006),and diabetes( OR = 0. 379,95% CI: 0. 160-0. 896,P = 0. 027) were independent influencing factors for acute liver injury; hypertension( OR = 4. 050,95% CI: 1. 820-9. 011,P =0. 001) was an independent influencing factor for systemic inflammatory response syndrome; hypertriglyceridemia( OR = 3. 741,95% CI:1. 170-11. 956,P = 0. 026) was an independent influencing factor for multiple organ dysfunction syndrome. Conclusion Compared with BAP patients,HTGAP patients tend to have a younger age,a higher proportion of male patients,a higher rate of high-fat diet,and a higher BMI. HTGAP patients are more likely to develop systemic inflammatory response syndrome and multiple organ dysfunction syndrome than BAP patients,while BAP patients are more likely to develop pancreatic pseudocyst and acute liver injury.
- pancreatitis /
- hypertriglyceridemia /
- disease attributes

HTML全文

参考文献(23)

[1] CROCKETT SD,WANI S,GARDNER TB,et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis[J]. Gastroenterology,2018,154(4):1096-1101.

[2] PETROV MS,YADAV D. Global epidemiology and holistic prevention of pancreatitis[J]. Nat Rev Gastroenterol Hepatol,2019,16(3):175-184.

[3] 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.

[4] CARR RA,REJOWSKI BJ,COTE GA,et al. Systematic review of hypertriglyceridemia-induced acute pancreatitis:A more virulent etiology?[J]. Pancreatology,2016,16(4):469-476.

[5] BANKS PA,BOLLEN TL,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.

[6] ALFRED A,EMMANOUIL P,MARTIN C,et al. A systematic review of the epidemiology,pathophysiology and current management of hyperlipidaemic pancreatitis[J]. Clin Nutr,2018,37(6 Pt A):1810-1822.

[7] ATHYROS VG,GIOULEME OI,NIKOLAIDIS NL,et al. Longterm follow-up of patients with acute hypertriglyceridemia-induced pancreatitis[J]. J Clin Gastroenterol,2002,34(4):472-475.

[8] CHEN CH,DAI CY,HOU NJ,et al. Etiology,severity and recurrence of acute pancreatitis in southern Taiwan[J]. J Formos Med Assoc,2006,105(7):550-555.

[9] HUANG YX,JIA L,JIANG SM,et al. Incidence and clinical features of hyperlipidemic acute pancreatitis from guangdong,China:A retrospective multicenter study[J]. Pancreas,2014,43(4):548-552.

[10] JIN M,BAI X,CHEN X,et al. A 16-year trend of etiology in acute pancreatitis:The increasing proportion of hypertriglyceridemia-associated acute pancreatitis and its adverse effect on prognosis[J]. J Clin Lipidol,2019,13(6):947-953.

[11] ZHANG R,DENG L,JIN T,et al. Hypertriglyceridaemia-associated acute pancreatitis:Diagnosis and impact on severity[J]. HPB(Oxford),2019,21(9):1240-1249.

[12] 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.

[13] 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]. PLo S Med,2018,15(8):e1002618.

[14] URUSHIHARA H,TAKETSUNA M,LIU Y,et al. Increased risk of acute pancreatitis in patients with type 2 diabetes:An observational study using a Japanese hospital database[J].PLo S One,2012,7(12):e53224.

[15] SHAO M,LUO HS. Comparison of clinical features and severity of acute pancreatitis in patients with and without type 2 diabetes mellitus[J]. Chin J Gastroenterol Hepatol,2019,28(9):1035-1037,1041.(in Chinese)邵茗，罗和生．合并与不合并2型糖尿病的急性胰腺炎患者临床特点比较及病情严重程度分析[J]．胃肠病学和肝病学杂志，2019,28(9):1035-1037,1041.

[16] JIANG H,GAO JP,WANG H,et al. Relationship between diabetes mellitus and mortality of acute pancreatitis[J]. Chin J Dig,2018,38(10):697-699.(in Chinese)姜华，高建鹏，王辉，等．糖尿病与急性胰腺炎病死率的关系[J]．中华消化杂志，2018,38(10):697-699.

[17] LANKISCH PG,BREUER N,BRUNS A,et al. Natural history of acute pancreatitis:A long-term population-based study[J]. Am J Gastroenterol,2009,104(11):2797-2805.

[18] YADAV D,LOWENFELS AB. The epidemiology of pancreatitis and pancreatic cancer[J]. Gastroenterology,2013,144(6):1252-1261.

[19] RANGASWAMY R,SINGH CG,SINGH HM,et al. Impact of biliary calculi on the liver[J]. J Clin Diagn Res,2017,11(4):pc04-pc07.

[20] YANG N,ZHANG DL,HAO JY. Coagulopathy and the prognostic potential of D-dimer in hyperlipidemia-induced acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int,2015,14(6):633-641.

[21] TAI WP,LIN XC,LIU H,et al. A retrospective research of the characteristic of hypertriglyceridemic pancreatitis in Beijing,China[J]. Gastroenterol Res Pract,2016,2016:6263095.

[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] LIAO X,GAO L,HAO T,el al. The relationship between FFA and type 2 diabetic nephropathy[J]. Chin J Diabetes,2009,17(6):415-417.(in Chinese)廖鑫，高琳，郝涛，等．游离脂肪酸与2型糖尿病肾病的关系[J]．中国糖尿病杂志，2009,17(6):415-417.

施引文献

资源附件(0)

访问统计