中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R

Clinical features of acute pancreatitis with metabolic syndrome and influencing factors for prognosis

DOI: 10.3969/j.issn.1001-5256.2020.08.023
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  • Published Date: 2020-08-20
  • Objective To investigate the clinical features of acute pancreatitis(AP) with metabolic syndrome(MS) and the influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical data of 590 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to January 2019,and according the presence or absence of MS,they were divided into MS group with 178 patients and non-MS group with 412 patients and basic clinical features were compared between the two groups.According to the severity of AP,they were divided into mild acute pancreatitis(MAP) group with 317 patients,moderate-severe acute pancreatitis(MSAP) group with 171 patients,and severe acute pancreatitis(SAP) group with 102 patients,and the component indicators of MS were compared between the three groups.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance was used for comparison between multiple groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the Kruskal-Wallis H test was used for comparison between multiple groups;Bonferroni correction was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between groups;the trend chi-square test was used for comparison of one-way ordinal categorical data,and the Goodman-Kruskal Gamma analysis was used for two-way ordinal categorical data.An ordinal logistic regression analysis was used to investigate the correlation between body mass index(BMI) and severity of AP,and a binary logistic regression analysis was used to investigate the correlation between MS and severity of AP.Results The most common causes of MS with AP were hyperlipidemia(48.3%) and biliary disease(24.7%).The patients with SAP were more likely to have MS(χ2=141.519,P<0.001),and the patients with AP and MS tended to have a significantly higher clinical system score,significantly more local and systemic complications,significantly longer hospital stays,a significantly higher ICU admission rate,and a significantly higher mortality rate(all P<0.05).The severity of AP increased with the increase in MS components(overweight,hypertension,diabetes,and dyslipidemia),(G=0.540,P<0.001).There were significant differences between the MAP,MSAP,and SAP groups in BMI(F=9.291,P<0.001) and high-density lipoprotein cholesterol(HDL-C)(χ2=40.351,P<0.001),and the SAP group had significantly higher BMI and significantly lower HDL-C than the MAP group and the MSAP group(all P<0.05).The ordinal logistic regression analysis showed that BMI was an independent risk factor for the progression of AP(odds ratio [OR]=1.091,95% confidence interval [CI]:1.041-1.143,P<0.001).Binary logistic regression models were established based on the severity of AP,with MAP group versus non-MAP group as model 1 and SAP group versus non-SAP group as model 2.The results showed that in model 1,the incidence rate of non-MAP was 5.867 times that of MAP in patients with MS(OR=5.867,95% CI:3.072-11.207,P<0.001),and in model 2,the incidence rate of SAP was 7.214 times that of non-SAP(OR=7.214,95% CI:3.018-17.244,P<0.001).Both model 1 and model 2 showed that HDL-C was a protective factor against the progression of AP(model 1:OR=0.593,95% CI:0.387-0.910,P=0.017;model 2:OR=0.314,95% CI:0.160-0.614,P=0.001).Conclusion AP with MS on admission may suggest poor prognosis,and BMI and HDL-C are closely associated with disease progression.

     

  • [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(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.
    [2] 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.
    [3] Metabolic Syndrome Research Collaboration Group from Chinese Diabetes Society. Suggestions on metabolic syndrome from Chinese Diabetes Society[J]. Chin J Diabetes,2004,12(3):156-161.(in Chinese)中华医学会糖尿病学分会代谢综合征研究协作组.中华医学会糖尿病学分会关于代谢综合征的建议[J].中华糖尿病杂志,2004,12(3):156-161.
    [4] PREZ-MARTNEZ P,MIKHAILIDIS DP,ATHYROS VG,et al. Lifestyle recommendations for the prevention and management of metabolic syndrome:An international panel recommendation[J]. Nutr Rev,2017,75(5):307-326.
    [5] CORNIER MA,DABELEA D,HERNANDEZ TL,et al. The metabolic syndrome[J]. Endocr Rev,2008,29(7):777-822.
    [6] SHEN XB,YIN Y. The relationship between metabolic syndrome and prognosis of patients with acute cerebral infarction[J]. Traum Crit Med,2019,7(3):184-186.(in Chinese)沈小波,殷艳.代谢综合征与急性脑梗死患者预后关系研究[J].创伤与急危重病医学,2019,7(3):184-186.
    [7] DOBSZAI D,MTRAI P,GYNGYI Z,et al. Body-mass index correlates with severity and mortality in acute pancreatitis:A meta-analysis[J]. World J Gastroenterol,2019,25(6):729-743.
    [8] SAWALHI S,AL-MARAMHY H,ABDELRAHMAN AI,et al.Does the presence of obesity and/or metabolic syndrome affect the course of acute pancreatitis? A prospective study[J].Pancreas,2014,43(4):565-570.
    [9] KRISHNA SG,HINTON A,OZA V,et al. Morbid obesity is associated with adverse clinical outcomes in acute pancreatitis:A propensity-matched study[J]. Am J Gastroenterol,2015,110(11):1608-1619.
    [10] GREGOR MF,HOTAMISLIGIL GS. Inflammatory mechanisms in obesity[J]. Annu Rev Immunol,2011,29(1):415-445.
    [11] HENAO-MEJIA J,ELINAV E,JIN C,et al. Inflammasomemediated dysbiosis regulates progression of NAFLD and obesity[J]. Nature,2012,482(7384):179-185.
    [12] KHATUA B,EL-KURDI B,SINGH VP. Obesity and pancreatitis[J]. Curr Opin Gastroenterol,2017,33(5):374-382.
    [13] VARELA JE,HINOJOSA M,NGUYEN N. Correlations between intra-abdominal pressure and obesity-related co-morbidities[J]. Surg Obes Relat Dis,2009,5(5):524-528.
    [14] SADR-AZODI O,ORSINI N,ANDRN-SANDBERG A,et al. Abdominal and total adiposity and the risk of acute pancreatitis:A population-based prospective cohort study[J].Am J Gastroenterol,2013,108(1):133-139.
    [15] DING Y,ZHANG M,WANG L,et al. Association of the hypertriglyceridemic waist phenotype and severity of acute pancreatitis[J]. Lipids Health Dis,2019,18(1):93.
    [16] FREITAS RS,FONSECA MJMD,SCHMIDT MI,et al. Hypertriglyceridemic waist phenotype:Associated factors and comparison with other cardiovascular and metabolic risk indicators in the ELSA-Brasil study[J]. Cad Saude Publica,2018,34(4):e00067617.
    [17] ZHANG Y,GUO F,LI S,et al. Decreased high density lipoprotein cholesterol is an independent predictor for persistent organ failure,pancreatic necrosis and mortality in acute pancreatitis[J]. Sci Rep,2017,7(1):8064.
    [18] ZHOU CL,ZHANG CH,ZHAO XY,et al. Early prediction of persistent organ failure by serum apolipoprotein A-I and high-density lipoprotein cholesterol in patients with acute pancreatitis[J]. Clin Chim Acta,2018,476:139-145.
    [19] SILVA-VAZ P,ABRANTES AM,CASTELO-BRANCO M,et al. Multifactorial scores and biomarkers of prognosis of acute pancreatitis:Applications to research and practice[J].Int J Mol Sci,2020,21(1):e338.
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