胆结石患者血浆脂多糖与胆源性胰腺炎的关系

Relation between plasma lipopolysaccharide and biliary pancreatitis in patients with gallstone

目的探讨血浆脂多糖(lipopolysaccharide,LPS)与胆源性胰腺炎发生的关系。方法选取胆结石患者(包括胆囊、胆管结石)共60例,并依据血浆LPS水平,分为低LPS组(<10 pg/ml,n=24)与高LPS组(≥10 pg/ml,n=36),并随访12个月,分析不同LPS水平的胆结石患者胆源性胰腺炎的发生率。结果最终纳入分析51例,低LPS组20例,高LPS组31例。两组间年龄,性别构成,血脂水平(TG、TCH),基础炎症水平(WBC、CRP),空腹血糖(BS)差异均无统计学意义(P>0.05)。高LPS组患者发生胆源性急性胰腺炎风险为低LPS组的2.021倍,差异有统计学意义(RR=2.021,95%CI 1.006～4.058,P=0.02),且LPS导致不同TG水平胆道结石患者发生胆源性急性胰腺炎的风险差异无统计学意义(P>0.05)。在细小结石(<0.4 cm×0.3 cm)患者中,高LPS组患者发生胆源性急性胰腺炎风险为低LPS组的2.327倍,差异有统计学意义(RR=2.327,95%CI 1.030～5.259,P=0.03)。结论血浆LPS水平的增高是高TG水平与细小胆囊结石患者易发生胆源性胰腺炎的因素之一。

Objective To investigate the correlation of plasma lipopolysaccharide （LPS） and incidence of biliary pancreatitis. Methods A total of 60 patients with gallstone were included in the present study, who were divided into low-LPS （ 〈 10 pg/ml, n = 24） and high-LPS （ ≥ 10 pg/ml, n =36） cohorts. After 12-month following up, the incidence of biliary pancreatitis was compared between two cohorts. Results There were finally 51 patients eligible for the data analysis, including 20 cases in low-LPS cohort and 31 cases in high-LPS cohort. There were no differences between two cohorts in age, gender, cholesterol （TG, TCH）, inflammatory reaction （WBC, CRP） and fasting blood-glucose （BS）. In patients with high TG level （ 〉15.65 retool/L）, the incidence rates of biliary pancreatitis in high LPS group were higher than that in low LPS group （16/19 vs 5/12, odds ratio = 2. 021, 95%CI： 1. 006 -4. 058, P = 0.02）. There was no difference in risk of biliary pancreatitis between high and low TG groups in patients with high LPS （ P 〉 0. 05 ）. In patients with smallgallstone （ 〈0.4 x0.3 cm）, the risk of pancreatitis in high LPS patients was higher than that in low LPS patients （11/19 vs 4/11, odds ratio = 2. 327, 95% CI： 1. 030 - 5. 259, P = 0. 03）. Conclusion In patients with gallstone （especially small gallstone） and with high TG, the increase in plasma LPS concentration would results in a higher probability of biliary pancreatitis.