高脂血症性重症急性胰腺炎的临床特征分析

Analysis of clinical features of hyperlipidemic severe acute pancreatitis

目的探讨高脂血症性重症急性胰腺炎的临床特点。方法回顾近8年收治的114例重症急性胰腺炎(SAP)患者的临床资料,比较高脂血症组(HL组21例)和非高脂血症组(NHL组93例)的临床特征、并发症及预后差异。结果高脂血症性重症急性胰腺炎(HL-SAP)在性别组成、年龄、ranson评分方面与非高脂血症组均无统计学差异(P>0.05);但体质量指数[(24.451±3.752)vs.(22.468±2.434),P=0.030],既往胰腺炎发作史(23.8%vs.7.5%,P=0.046)及血性腹水发生率(95.24%vs.46.24%,P<0.001)两组间差异有统计学意义;腹腔脓肿,ARDS,肾衰竭,应激性溃疡,DIC,假性囊肿等并发症发生率两组间差异均无统计学意义(P>0.05);MODS发生率HL组高于NHL组(52.4%vs.29%,P=0.04);手术率(66.7%vs.80.6%,P=0.178),住院天数[(25.476±14.383)vs.(22.796±7.191),P=0.216)]及病死率(28.6%vs.11.8%,P=0.069)两组间差异无统计学意义。结论HL-SAP具有体质量较重、多有既往发作史及血性腹水发生率较高,易发生多器官衰竭等特点。

Objective To study the clinical features of hyperlipidemie severe acute pancreatitis. Methods From January 2 000 to June 2008, 114 cases of severe acute panereatitis treated in our hospital were divided into hyperlipidemia group （ HL-group, 21eases ） and non-hyperlipidemia group （ NHL-group, 93 cases ） . Clinical features, complications, and outcome were assessed and compared. Results There were no differences in gender composition, age and ranson score （ P 〉 0.05 ） , between the two groups, but in body mass index [ （ 24.451 ± 3. 752 ） vs （ 22. 468 ± 2. 434 ） , P = 0. 030 ] , previous history of pancreatitis （23.8% vs. 7. 5% , P =0. 046） and bloody ascites （95. 24% vs. 46. 24% , P 〈0. 001） in HL-group were higher than those in NHL-group. The rates of the complications, such as abdominal abscess, ARDS, renal failure, stress ulcer, DIC, and pseudoeyst were of no statistical difference between the two groups（P 〉0. 05）. MODS rate was higher in HL-group （52. 4% vs. 29%, P =0. 04）. The two groups had similar operation rates （ 66. 7% vs 80. 6% , P = 0. 178 ） , hospitalization days [ （ 25.476± 14.383） vs （22.796±7. 191） , P：0.216] and mortality rate （28.6% vs. 11.8% , P=0.069）. Conclusions Hyperlipidemie severe acute panereatitis has the characters of heavier weight habitus, history of frequent recurrence, high incidence of bloody ascites and prone to develop MOF.