高脂血症性急性胰腺炎临床特征及其影响因素分析

Clinical characteristics and influencing factors of hyperlipidemic acute pancreatitis

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。

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.