高甘油三酯血症性急性胰腺炎21例临床诊治分析

Clinical diagnosis and treatment of 21 patients with hyperlipidemic acute pancreatitis

目的研究高脂血症性急性胰腺炎（HLAP）的诊断及临床治疗措施。方法回顾性分析比较2006年6月至2011年6月南阳市第二人民医院诊断的21例HLAP患者与同期42例非高脂血症性急性胰腺炎患者的临床资料，并对血甘油三酯（TG）值和RANSON积分进行相关分析。结果与对照组相比，HLAP组男性居多，男女比例6：1，平均年龄46．3岁，发病年龄较低；HLAP组TG、空腹血糖（GLU）、C-反应蛋白（CRP）、丙氨酸氨基转移（ALT）及天门冬氨酸氨基转移酶（AST）水平转氨酶均明显高于对照组。两组间比较差异均有统计学意义（P〈0．05）。HLAP组RANSON积分平均值明显高于对照组（P〈0．05）。63例AP的TG与RANSON积分存在显著相关性（P〈0．01）。HLAP组中TG与RANSON积分的相关性更为显著（P〈0．01），其中尤以胆源性病例为甚。结论高甘油三酯血症与AP的关系密切，血清甘油三酯水平与AP的病变程度呈正相关。AP患者合并高TG血症，则预示着病变程度可能加重、预后差。因此AP患者应常规进行血脂的检测，做到早期诊断、早期治疗，以预防复发。

Objective To investigate the clinical diagnostic and therapeutic measures of hyperlipidemic acute pancreatitis （HLAP）. Methods A retrospective study on the clinical data of 21 patients with HLAP was conducted in comparison with the data of 42 patients with non-HLAP during the period between Jun, 2006 and Jun, 2011. And the correlation between TG and RANSON score was analyzed. Results For patients with HLAP： six out of seven patients studied were male, with the average onset age being 46.3 years old. Compared with the non-HLAP group, the HLAP group had more male and younger patients, and the levels of TG, blood glucose, CRP, ALT and AST were evidently higher than those in the non-HLAP group. And there were significant differences between the two groups （P 〈 0.05 ）. The RANSON score in HLAP group was obviously higher than that in non-HLAP group （P 〈 0. 05 ）. Furthermore, the correlation between TG and RANSON score in all the patients, especially in the HLAP group with acute biliary pancreatitis （P 〈 0. 01 ）. Conclusions There is an close relationship between hypertriglyceridemia and acute pancreatitis, the high level of plasma TG plays a key role in acute pancreatitis, acute pancreatitis patients with hypertriglyceridemia are more likely to be severe and has poor prognosis. So early blood lipid test, diagnosis and treatment of HLAP should be carried out to prevent relapse of the disease.