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合并脂肪肝对急性胰腺炎严重程度的影响
DOI: 10.3969/j.issn.1001-5256.2022.07.025
伦理学声明：本研究方案于2021年11月25日经由内蒙古科技大学包头医学院第一附属医院伦理委员会审批，批号：20200011。
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：张利荣、张苗负责课题设计，资料分析，撰写论文；罗琳、陈强参与修改论文；陈强负责拟定写作思路，指导撰写文章并最后定稿。
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摘要:
目的 通过对比急性胰腺炎(AP)合并脂肪肝及不合并脂肪肝患者的临床及影像资料，评价合并脂肪肝对AP严重程度的影响。 方法 收集2017年12月—2020年5月于内蒙古科技大学包头医学院第一附属医院收治的328例AP患者的临床资料，根据AP患者是否存在脂肪肝分为AP合并脂肪肝组(FLAP)和非合并脂肪肝组(NFLAP)。比较两组患者的一般资料、实验室检查指标及合并既往慢性病等参数之间的差异。分类变量以χ2检验进行组间的比较，连续性变量采用t检验或Mann-Whitney U检验进行数据的比较。采用Pearson线性相关分析连续性变量之间的相关性；采用Spearman等级相关分析等级变量之间的相关性。采用多因素logistic回归分析和卡方检验的方法分别评价中重度AP发生的影响因素及可能的风险预测指标。 结果 在328例纳入研究的AP患者中，FLAP患者133例(40.55%)，NFLAP患者195例(59.45%)。AP的主要病因为高脂血症(42.1%)，其次为胆石症(39.3%)。FLAP患者的平均年龄显著低于NFLAP[(41.32 ±11.43)岁vs (54.83±15.21)岁, t=8.704, P＜0.001]，而FLAP的男性比例(78.95% vs 55.38%, χ2=19.281, P＜0.001)、合并慢性疾病比例(70.68% vs 45.64%, χ2=20.094, P＜0.001)及中重度AP的发生率(59.4% vs 41.0%, χ2=10.686, P＜0.01)显著高于NFLAP。FLAP的TG、TC、空腹血糖以及患者入院第1、2天的C-反应蛋白水平均显著高于NFLAP(Z值分别为-8.216、-5.637、-4.001、-3.053、-3.325，P值均＜0.05)。FLAP的血淀粉酶、血脂肪酶、高密度脂蛋白、ALT、AST、TBil水平显著低于NFLAP(Z值分别为-5.401、-2.842、-3.594、-2.276、-2.643、-2.339，P值均＜0.05)。低龄者(＜50岁)(OR=1.84, 95%CI: 1.18~2.89, P＜0.01)、既往患有高血压(OR=3.58, 95%CI: 1.96~6.54, P＜0.001)及高脂血症(OR=3.36, 95%CI: 1.03~10.94, P＜0.05)者均有较高的中重度AP患病风险。FLAP患者发生中重度AP的风险显著高于NFLAP(OR=2.10, 95%CI: 1.34~3.29, P＜0.01)。 结论 FLAP患者的发病年龄较轻，多伴有高脂血症，且发生中重度AP的比例更高。脂肪肝不仅是中重度AP发生的影响因素，也是中重度AP风险预测的重要指标。 Abstract:Objective To investigate the influence of fatty liver on the severity of acute pancreatitis (AP) by comparing clinical and imaging data between AP patients with fatty liver and those without fatty liver. Methods Clinical data were collected from 328 AP patients who were admitted to The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, from December 2017 to May 2020, and according to the presence or absence of fatty liver, they were divided into fatty liver+AP group (FLAP group) and non-fatty liver AP group (NFLAP group). The two groups were compared in terms of the indices such as general information, laboratory markers, and chronic diseases. The chi-square test was used to compare the rates of binary variables, and the t-test or the Mann-Whitney U test was used for comparison of continuous variables. The Pearson liner correlation analysis was used to investigate the correlation between continuous variables, and the Spearman rank correlation analysis was used to investigate the correlation between rank variables. The multivariate logistic regression analysis and the chi-square test were used to investigate the influencing factors and possible risk predictive factors for moderate-severe AP (MSAP) and severe AP (SAP). Results Among the 328 AP patients enrolled, there were 133(40.55%) in the FLAP group and 195(59.45%) in the NFLAP group. Hyperlipidemia (42.1%) was the main cause of AP, followed by gallstone disease (39.3%). Compared with the NFLAP group, the FLAP group had a significantly lower mean age (41.32±11.43 years vs 54.83±15.21 years, t=8.704, P < 0.001) and significantly higher proportion of male patients (78.95% vs 55.38%, χ2=19.281, P < 0.001), proportion of patients with chronic disease (70.68% vs 45.64%, χ2=20.094, P < 0.001), and incidence rate of MSAP+SAP (59.40% vs 41.03%, χ2=10.686, P < 0.01). Compared with the NFLAP group, the FLAP group had significantly higher levels of triglyceride, total cholesterol, fasting blood glucose, and C-reactive protein on days 1 and 2 after admission (Z=-8.216, -5.637, -4.001, -3.053, and -3.325, all P < 0.05), as well as significantly lower levels of blood amylase, blood lipase, high-density lipoprotein, alanine aminotransferase, aspartate aminotransferase, and total bilirubin (Z=-5.401, -2.842, -3.594, -2.276, -2.643, and -2.339, all P < 0.05). Patients with a relatively young age (< 50 years) (odds ratio [OR]=1.84, 95% confidence interval [CI]: 1.18-2.89, P < 0.01) and a past history of hypertension (OR=3.58, 95%CI: 1.96-6.54, P < 0.001) or hyperlipidemia (OR=3.36, 95%CI: 1.03-10.94, P < 0.05) had a relatively high risk of MSAP+SAP. The FLAP group had a significantly higher risk of MSAP+SAP than the NFLAP group (OR=2.10, 95%CI: 1.34-3.29, P < 0.01). Conclusion FLAP patients often have a relatively young age of onset, hyperlipidemia, and a relatively high proportion of patients with MSAP+SAP. Fatty liver is not only an influencing factor for MSAP+SAP, but also an important predictive factor for the risk of MSAP+SAP. -
Key words:
- Pancreatitis /
- Fatty Liver /
- Risk Factors
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表 1 FLAP与NFLAP病因比较
Table 1. Comparison of etiology between FLAP and NFLAP
病因 FLAP (n=133) NFLAP (n=195) χ2值 P值 高脂血症[例(%)] 112(84.2) 26(13.3) 162.982 ＜0.001 胆石症[例(%)] 9(6.8) 120(61.5) 99.409 ＜0.001 酒精性[例(%)] 8(6.0) 17(8.7) 0.820 0.365 其他[例(%)] 4(3.0) 32(16.4) 14.537 ＜0.001 
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表 2 FLAP与NFLAP合并慢性病比较
Table 2. Comparison of chronic diseases between FLAP and NFLAP
既往疾病 FLAP(n=133) NFLAP(n=195) χ2值 P值 合并慢性病[例(%)] 94(70.68) 89(45.64) 20.094 ＜0.001 高血压[例(%)] 26(19.55) 44(22.56) 0.428 0.513 糖尿病[例(%)] 39(29.32) 35(17.95) 5.856 0.016 高脂血症[例(%)] 57(42.86) 14(7.18) 59.342 ＜0.001 心脑血管疾病[例(%)] 5(3.76) 8(4.10) 0.024 0.876
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表 3 FLAP与NFLAP实验室检查指标比较
Table 3. Comparison of laboratory indicators between FLAP and NFLAP
指标 FLAP (n=133) NFLAP(n=195) Z值 P值 血淀粉酶(U/L) 247(117~708) 825(263~1474) -5.401 ＜0.001 血脂肪酶(U/L) 543.1(232.0~1428.6) 1049.5(397.5~1767.2) -2.842 0.004 尿淀粉酶(U/L) 3753(1723~7773) 6250(1641~10 817) -1.394 0.163 TG(mmol/L) 3.41(2.01~6.83) 1.41(0.91~2.43) -8.216 ＜0.001 TC(mmol/L) 5.37(4.01~6.67) 3.90(3.31~4.81) -5.637 ＜0.001 HDL(mmol/L) 0.80(0.56~0.97) 0.93(0.70~1.22) -3.594 ＜0.001 LDL(mmol/L) 2.42(1.54~3.19) 2.38(1.89~2.92) -0.054 0.957 空腹血糖(mmol/L) 8.4(6.1~14.4) 7.1(5.4~9.2) -4.001 ＜0.001 ALT(U/L) 33.50(21.25~60.75) 47.00(20.00~197.00) -2.276 0.023 AST(U/L) 25.50(19.00~46.50) 33.00(18.00~141.50) -2.643 0.008 TBil(μmol/L) 15.45(10.30~20.93) 18.75(11.68~30.45) -2.339 0.019 LDH(U/L) 255.00(202.00~354.00) 236.00(187.25~325.75) -1.771 0.077 Cr(μmol/L) 69.00(56.00~84.00) 67.00(55.00~78.25) -1.003 0.316 WBC(×109/L) 11.56(8.55~15.05) 11.11(8.27~13.80) -1.076 0.282 NEUT(%) 82.60(75.10~87.50) 83.50(75.05~88.90) -1.071 0.284 CRPd1(mg/L) 13.50(3.23~82.58) 5.40(0.70~35.80) -3.053 0.002 CRPd2(mg/L) 155.30(95.60~265.00) 76.10(40.05~150.35) -3.325 0.001 CRPd3(mg/L) 131.20(66.05~213.90) 118.90(64.08~179.05) -0.376 0.707 CRPmax(mg/L) 115.35(35.13~206.18) 93.10(36.90~160.70) -1.410 0.159
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表 4 AP严重程度影响因素的logistic回归分析
Table 4. Multivariate logistic regression analysis of the factors affecting the severity of AP
因素 中重度AP(%) 轻度AP(%) P值 OR 95%CI 一般指标 年龄(＜50岁) 30.8 46.2 0.008 1.84 1.18~2.89 性别(男) 62.9 66.9 0.199 1.36 0.85~2.18 既往疾病 高血压 20.1 22.5 ＜0.001 3.58 1.96~6.54 糖尿病 26.4 18.9 0.079 0.51 0.24~1.08 高脂血症 27.0 16.6 0.045 3.36 1.03~10.94 心脑血管疾病 4.4 3.6 0.477 0.82 0.47~1.43 AP病因 胆石症 31.4 46.7 0.752 0.89 0.42~1.89 高脂血症 50.3 34.3 0.033 1.93 1.23~3.66 酒精性 8.8 6.5 0.272 1.78 0.64~5.00
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表 5 中重度AP风险预测指标分析
Table 5. ModerateandsevereAP risk prediction index analysis
因素 中重度AP(%) 轻度AP(%) χ2值 P值 OR 95%CI 临床指标 血压异常 30.2 28.4 0.126 0.407 1.09 0.68~1.75 心动过速 8.2 4.7 2.328 0.097 2.06 0.80~5.31 呼吸增快 29.6 17.2 7.076 0.006 2.03 1.20~3.43 发热 30.8 13.6 14.160 ＜0.001 2.83 1.63~4.92 脂肪肝 49.7 32.0 10.686 ＜0.001 2.10 1.34~3.29 实验室指标 血淀粉酶明显升高 50.3 38.1 3.009 0.087 1.49 0.95~2.35 血脂肪酶明显升高 84.3 82.8 0.095 0.868 1.11 0.58~2.14 尿淀粉酶明显升高 64.6 49.4 3.829 0.057 1.87 0.99~3.53 TG升高 61.7 53.2 2.237 0.163 1.42 0.90~2.24 TC升高 26.8 18.2 3.266 0.075 1.65 0.96~2.85 HDL升高 6.0 6.5 0.026 0.871 0.93 0.37~2.35 LDL升高 15.4 19.5 0.858 0.369 0.75 0.42~1.37 Cr升高 34.2 37.9 0.483 0.492 0.85 0.54~1.34 WBC升高 74.7 61.2 6.710 0.012 1.87 1.16~3.00 NEUT%升高 85.4 66.1 16.410 ＜0.001 3.02 1.75~5.21 TBil升高 48.1 49.4 0.055 0.825 0.95 0.62~1.49 LDH升高 60.9 34.1 22.640 ＜0.001 3.01 1.90~4.76 血糖升高 77.3 61.3 9.400 0.002 2.14 1.31~3.50 尿糖阳性 47.4 23.0 18.810 ＜0.001 3.01 1.82~5.00 CRPd1极度升高 15.2 14.9 0.005 0.946 1.03 0.49~2.15 CRPd2极度升高 69.8 41.5 6.820 0.015 3.26 1.36~8.01 CRPd3极度升高 74.2 44.0 10.958 0.001 3.67 1.67~8.04 注：血压异常包括血压升高，平均动脉压升高及脉压升高；检查指标升高表示指标超过标准值上限；明显升高表示指标为标准值上限的3倍以上；极度增高表示指标为标准值上限的10倍以上。
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