血清甘油三酯水平对急性胆源性胰腺炎预后的影响

蒋鑫; 严永峰; 钟瑞; 徐欢; 彭燕; 汤小伟

doi:10.3969/j.issn.1001-5256.2020.11.022

血清甘油三酯水平对急性胆源性胰腺炎预后的影响

DOI: 10.3969/j.issn.1001-5256.2020.11.022

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）；

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中图分类号: R576
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出版历程
- 收稿日期: 2020-05-20
- 出版日期: 2020-11-20

Influence of serum triglyceride level on the prognosis of acute biliary pancreatitis

Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
目的探讨血清甘油三酯（TG）水平对于急性胆源性胰腺炎（ABP）结局的影响。方法回顾性分析2018年9月-2019年8月西南医科大学附属医院收治的249例ABP患者,将患者分为血脂正常组（n=156）、轻度高脂组（n=25）、中度高脂组（n=44）、重度高脂组（n=24）。收集患者一般资料、病死率、病情严重程度及并发症情况。不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Dunn-Bonferroni检验。计数资料无序分类变量多组间及两两比较采用χ2检验,有序多分类变量多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U秩和检验。患者发生器官衰竭和胰腺感染坏死影响因素采用多因素logistic回归分析。绘制受试者工作特征曲线评价不同指标对SAP的预测价值。结果 4组年龄和BISAP评分比较差异均具有统计学意义（χ2值分别为25.057、10.430,P值均<0.05）,重度高脂组发生感染性胰腺坏死（IPN）、多器官功能衰竭综合症（MODS）比例均大...
- 胰腺炎 /
- 甘油三酯类 /
- 预后
Abstract:
Objective To investigate the influence of serum triglyceride( TG) level on the outcome of acute biliary pancreatitis( ABP).Methods A retrospective analysis was performed for 249 ABP patients who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019,and the patients were divided into normal blood lipid group( n = 156) and mild( n = 25),moderate( n = 44),and severe( n = 24) hyperlipidemia groups. The patients' data were collected for analysis. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Dunn-Bonferroni test was used for further comparison between two groups. The chi-square test was used for comparison of nominal categorical variables between multiple or two groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables between multiple groups,and the Mann-Whitney U rank sum test was used for further comparison between two groups. A multivariate logistic regression analysis was used to investigate the influencing factors for organ failure and infectious pancreatic necrosis( IPN),and the receiver operating characteristic( ROC) curve was used to evaluate the value of different indices in predicting severe acute pancreatitis( SAP). Results There were significant differences in age and BISAP between four groups( χ2= 25. 057,10. 430,all P < 0. 05). Compared with the normal blood lipid group,the severe hyperlipidemia group had a significantly higher proportion of patients with IPN or multiple organ failure syndrome( MODS)( both P < 0. 05),and the moderate hyperlipidemia group had a significantly higher proportion of patients with MODS( P < 0. 05),while the severe hyperlipidemia had a significantly higher proportion of patients with systemic inflammation reaction syndrome than the other three groups( all P<0. 05). Compared with the normal blood lipid group,the moderate and severe hyperlipidemia groups had a significant increase in the risk of MODS( moderate hyperlipidemia group: odds ratio [OR]= 3. 500,95% confidence interval [CI]: 1. 193-10. 270,P < 0. 05; severe hyperlipidemia group: OR = 6. 167,95% CI: 1. 921-19. 792,P < 0. 05),and after adjustment,the risk of MODS in the severe hyperlipidemia group was 3. 430 times that in the normal blood lipid group( 95% CI: 1. 198-9. 825,P = 0. 022). The severe hyperlipidemia group had a significant increase in the risk of IPN( OR = 4. 351,95% CI: 1. 719-11. 008,P < 0. 05),and after adjustment,the risk of IPN in the severe hyperlipidemia group was 5. 819 times that in the normal blood lipid group( 95% CI: 1. 489-22. 745,P < 0. 05). Blood lipids had a good value in predicting SAP,with an area under the ROC curve of 0. 626( 95% CI: 0. 530-0. 723,P = 0. 008). Conclusion Compared with the ABP patients with normal TG,ABP patients with elevated TG tend to have a younger age,more complications,and a higher mortality rate,especially those with a TG level of >5. 65 mmol/L,and therefore,antihyperlipidemic treatment for such patients should be taken seriously to improve their survival rate and prognosis.
- pancreatitis /
- triglycerides /
- prognosis

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参考文献(25)

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