目的 探讨高脂血症性急性胰腺炎(HLAP)的临床特征,分析其重症病例的影响因素。方法 选择2018-01至2022-05解放军总医院第六医学中心消化内科收治的97例HLAP患者及同期收治的122例胆源性急性胰腺炎(BAP)患者作为研究对象,分析两组的临床特征,包括临床资料、实验室指标、影像学资料、严重程度等,分析HLAP组重症病例的影响因素。结果 与BAP组比较,HLAP组男性发病率高、年龄小、身体质量指数(BMI)高、重症病例多、伴随糖尿病及脂肪肝等代谢综合征多,差异有统计学意义(P＜0.05);白细胞(WBC)、C反应蛋白(CRP)、三酰甘油(TG)、血糖(GLU)、D-二聚体(D-Dimer)高(P＜0.05);血淀粉酶(AMY) 、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)低(P＜0.05)。对重症HLAP患者进行多因素Logistic回归分析结果显示,TG(OR=3.461,95%CI:1.122～9.723,P=0.008)、CRP(OR=1.209,95%CI:1.030～7.593,P=0.013)、D-Dimer(OR=0.687,95%CI:0.448～0.819,P=0.022)为重症HLAP的独立危险因素。结论 HLAP多发生于中青年男性,TG明显升高,多数伴有代谢综合征,炎症反应较重,重症病例更多;TG、CRP、D-Dimer为重症HLAP的独立危险因素。
Abstract
Objective To explore the clinical characteristics of hyperlipidemic acute pancreatitis (HLAP) and analyze the influencing factors of severe cases.Methods Ninety-seven patients with HLAP and 122 patients with biliary acute pancreatitis (BAP) admitted to the Gastroenterology Department of the Sixth Medical Center of PLA General Hospital from January 2018 to May 2022 were selected as the research subjects. The clinical characteristics of the two groups of patients and the influencing factors of severe cases of HLAP were analyzed.Results Compared with BAP group, HLAP group was characterized by more male cases, higher BMI, more severe cases, and more patients with diabetes and fatty liver; and white blood cells, C-reactive protein, triglycerides, blood glucose, and D-Dimer were higher (P<0.05); serum amylase, alanine transaminase, total bilirubin and glutamyl transpeptidase were lower (P<0.05).Multivariate logistic regression analysis suggested that triglycerides (OR=3.461, 95% CI: 1.122-9.723, P=0.008), C-reactive protein (OR=1.209, 95% CI: 1.030-7.593, P=0.013), D-Dimer (OR=0.687, 95% CI: 0.448-0.819, P=0.022) were independent risk factors for severe HLAP.Conclusions Hyperlipidemic acute pancreatitis often occurs in middle-aged and young men, with a significant increase in triglycerides, mostly accompanied by metabolic syndrome, and a severe inflammatory response. Triglyceride lowering, C-reactive protein and D-Dimer levels are independent risk factors for severe HLAP
关键词
急性胰腺炎 /
高脂血症 /
胆源性急性胰腺炎 /
影响因素
Key words
acute pancreatitis /
hyperlipidemia /
biliary acute pancreatitis /
influencing factor
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参考文献
[1] 中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南(2019,沈阳)[J].中华胰腺病杂志,2019,19(5):321-331.
[2] Boxhoorn L, Voermans R P, Bouwense S A, et al. Acute pancreatitis[J].Lancet,2020,396(10252):726-734.
[3] Bang J Y, Wilcox C M, Arnoletti J P, et al. Superiority of endoscopic interventions over minimally invasive surgery for infected necrotizing pancreatitis: meta-analysis of randomized trials[J].Dig Endosc,2020,32(3): 298-308.
[4] Liu Z Y, Tian L, Sun X Y, et al.Development and validation of a risk prediction score for the severity of acute hypertriglyceridemic pancreatitis in Chinese patients[J].World J Gastroenterol,2022, 28 (33): 4846-4860.
[5] 中华医学会外科学分会胰腺外科学组.2021年中国急性胰腺炎诊治指南[J].中华消化外科杂志,2021,20(7):730-739.
[6] 甘油三酯血症性急性胰腺炎诊治急诊专家共识专家组.高甘油三酯血症性急性胰腺炎诊治急诊专家共识[J].中国全科医学杂志,2021,24(30):3781-3793.
[7] Yang Q Y,Zhao Q,Hu J W,et al.Incidence and clinical treatment of hypertriglyceridemic acute pancreatitis [J]:World J Clin Cases,2023,11(2):479-481.
[8] Chait A.Hypertriglyceridemia[J].Endocrinol Metab Clin North Am,2022,51(3):539-555.
[9] Chen Z, Huang X, Zhang M, et al.Rapid reduction in triglyceride levels by therapeutic plasma exchange in patients with hypertriglyceridemic pancreatitis[J].J Clin Apher,2022,37(1):82-90.
[10] Fahed G,Aoun L,Bou M, et al. Metabolic syndrome:updates on pathophysiology and management in 2021[J].Int J Mol Sci,2022,23(2):786.
[11] Huang Q, Wu Z, Zhang Y,et al.Obesity exacerbates acute gastrointestinal injury and intestinal barrier dysfunction in early-stage acute pancreatitis[J].Turk J Gastroenterol,2023,34(4):421-426.
[12] 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]. PLoS Med, 2018,15(8): e1002618
[13] Tung Y C, Hsiao F C, Lin C P, et al.High triglyceride variability increases the risk of first attack of acute pancreatitis[J].Am J Gastroenterol,2023,118(6):1080-1090.
[14] Sahin G K, Gulen M, Acehan S,et al.Acute pancreatitis due to hypertriglyceridemia: plasmapheresis versus medical treatment[J].Turk J Emerg Med,2023,23(2):111-118.
[15] Zádori N,Gede N,Antal J, et al.Early elimination of fatty acids in hypertriglyceridemia-induced acute pancreatitis (ELEFANT trial): protocol of an open-label, multicenter, adaptive randomized clinical trial[J].Pancreatology,2020,20(3):369-376.
[16] Xia W,Lu Z,Chen W, et al.Excess fatty acids induce pancreatic acinar cell pyroptosis through macrophage M1 polarization[J].BMC Gastroenterol,2022,22(1):72.
[17] Jiang D, Wang J, Guo S.Correlations of Triglyceride with type, severity and clinical prognosis of acute pancreatitis[J].Clin Lab,2022,68(5): 142-153.
[18] Nag S, Mandal S, Majumdar T, et al.FFA-fetuin-a regulates DPP-IV expression in pancreatic beta cells through TLR4-NFkB pathway[J].Biochem Biophys Res Commun,2023,647(5):55-61.
[19] Tao X U, Liping S,Xianwen G, et al.Free fatty acid increases the expression of NLRP3-Caspase1 in adipose tissue macrophages in obese severe acute pancreatitis[J].Dig Dis Sci,2022,67(6):2220-2231.
[20] Yin G,Cang X,Yu G,et al. Different clinical presentations of hyperlipidemic acute pancreatitis:a retrospective study[J].Pancreas,2015,44(7):1105-1110.
[21] Pasual I,Sanahuja A,García N, et al.Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: cohort analysis of 1457 patients[J]. Pancreatology, 2019,19(5): 623-629.
[22] Mosztbacher D,Hanák L, Farkas N, et al. Hypertriglyceridemiainduced acute pancreatitis:a prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases[J]. Pancreatology,2020,20(4): 608-616.
[23] Zheng J, Han M, Chen J, et al.Predictive value of D-dimer and fibrinogen degradation product for splanchnic vein thrombosis in patients with severe acute pancreatitis: a single-center retrospective study[J].Scand J Gastroenterol,2023,23(3):1-7.
[24] He Q, Ding J, He S, et al.The predictive value of procalcitonin combined with C-reactive protein and D-Dimer in moderately severe and severe acute pancreatitis[J].Eur J Gastroenterol Hepatol,2022,34(7):744-750.
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