高脂血症性急性胰腺炎与胆源性胰腺炎的临床对比分析

Comparative analysis of clinical features of hyperlipidemic acute pancreatitis and acute biliary pancreatitis

目的:对比分析高脂血症性急性胰腺炎(HLAP)与急性胆源性胰腺炎(ABP)的临床特点,提高对HLAP认识和临床诊治水平。方法:以2008-01-2013-12我院急诊科确诊为HLAP(45例)和ABP(92例)的患者为研究对象,记录2组患者的年龄、性别、体质指数(BMI)、实验室指标、影像学表现、伴发疾病、治疗经过、禁食时间、住院时间、病死率及1年内复发率,并记录Ranson评分、APACHEⅡ评分和胰腺Balthazar CT评分。HLAP组又分为血浆置换亚组(12例)和常规治疗亚组(33例),对结果进行比较分析。结果:与ABP组比较,HLAP在年龄、性别、BMI、血甘油三酯(TG)、血清淀粉酶及1年内复发率差异均有统计学意义(P<0.05或P<0.01),而禁食时间、住院时间、Ranson评分、APACHEⅡ评分、胰腺Balthazar CT评分和病死率差异无统计学意义。血浆置换亚组的腹部症状缓解时间、禁食时间、住院时间均显著低于常规治疗亚组,TG正常时间和亚组间的病死率差异无统计学意义。结论:HLAP多见于青壮年男性,BMI严重超标,大多合并有脂肪肝,易于复发。血TG显著升高,而血清淀粉酶升高不明显,临床症状较重,但血脂水平与疾病严重程度无相关性。对于重症患者早期行血浆置换有利于缓解症状,但不改善预后。

Objective：To comparatively analyze the clinical features of hyperlipidemic acute pancreatitis（HLAP）and acute biliary pancreatitis（ABP）so as to enhance the understanding of HLAP and promote the clinical diagnosis and treatment.Method：There were 45 patients diagnosed hyperlipidemic acute pancreatitis in the HLAP group and 92 patients diagnosed acute biliary pancreatitis in the ABP group in the Emergency Department of Subei People＇s Hospital from January 2008 to December 2013.Meanwhile,the HLAP group was further divided into plasma exchange subgroup with 12 patients and routine treatment subgroup with 33 patients.The age,gender,BMI,laboratory index,imaging manifestations,complications,treatment process,fasting and hospitalization time,mortality rate and reoccurrence rate in one year of the two groups were recorded.Ranson grading,APACHE-Ⅱ grading and pancreas Balthazar CT grading were also recorded.Result：Compared with ABP group,the differences in age,gender,BMI,blood triglyceride,serum amylase and reoccurrence rate in one year in HLAP group were statistically significant（P〈0.05 or P〈0.01）while there were no statistically significant differences in fasting and hospitalization time,Ranson grading,APACHE-Ⅱ grading,Balthazar CT grading and mortality rate（P〉0.05）.Abdominal remission time,fasting and hospitalization time in plasma exchange subgroup were significantly lower than that in the routine treatment subgroup and there was no statistically significant difference between TG normal time and mortality rate in subgroups.Conclusion：HLAP mostly occurs in young male with overweight and fatty liver.Blood TG of patients with HLAP accompanying with serious clinical symptoms was remarkably improved,but there was no obvious rise in serum amylase level.However,blood lipid level was not associated with severity of diseases.Early plasma exchange was favorable to relieve the symptoms of patients but difficult to improve prognosis.