高脂血症性急性胰腺炎临床特征分析和治疗策略

Clinical features and therapeutic strategies of hyperlipidemic acute pancreatitis

目的 急性胰腺炎（AP）是临床常见的消化科急症,多由胆道疾病、酒精及高脂血症等原因引起。本文比较高脂血症性急性胰腺炎（HLAP）与胆源性胰腺炎（ABP）的临床特征,探讨其治疗策略以及提高对疾病的认识。方法 38例HLAP患者纳入研究（HLAP组）,其中,男性22例,女性16例,年龄27~74岁,平均（45.5±8.8）岁。并随即抽取同期收治的ABP患者45例作为对照（ABP组）,其中,男性26例,女性19例,年龄25~76岁,平均（47.2±6.7）岁。比较2组患者的一般资料、临床特征、APACHEⅡ评分、实验室指标、住院情况、预后情况等,统计学分析采用t检验或χ2检验。结果 2组患者性别、年龄之间差异无统计学意义（t/χ^2=0.00、1.00,P〉0.05）,HLAP组BMI显著大于ABP组（t=5.58,P〈0.05）,HLAP组脂肪肝、糖尿病和SAP患者比例显著高于ABP组（χ^2=12.38、5.03、9.91,P〈0.05）,而2组患者Ranson评分、APACHEⅡ评分和CT指数之间差异无统计学意义（t/χ^2=0.88、3.90、0.89、2.98,P〉0.05）,但HLAP组存在升高的趋势;HLAP组患者血AMY、尿AMY、血Ca2＋、ALT、GGT、TBIL和DBIL均显著低于ABP组（t=4.91、9.20、2.92、11.28、10.78、17.34、16.27,P〈0.05）;TG、TC和Glu均显著高于ABP组（t=14.16、8.45、8.52,P〈0.05）,2组患者并发症情况比较差异无统计学意义（P〉0.05）,ABP组手术患者显著多于HLAP组（χ^2=3.89,P〈0.05）,HLAP组复发人数高于ABP组（χ^2=6.02,P〈0.05）。结论 HLAP与ABP临床特征方面具有一定的差异,临床治疗高脂血症性急性胰腺炎时应注意加以辨别,制定适宜的治疗策略。

Objective Acute pancreatitis （AP） is a common clinical digestive emergency, mainly induced by biliary tract disease, alcohol and hyperlipidemia. This article is aimed to compare the clinical features between hyperlipidemie acute pancreatitis（HLAP） and acute biliary pancreatitis（ABP） and discuss the treatment strategy for improving understanding of the disease. Methods 38 cases of hyperlipidemia acute pancreatitis were included in the study（ HLAP group）. Among them ,22 cases of male, 16 cases of female, aged 27 - 74, average age 45.5 ± 8.8.45 cases of biliary panereatitis were chosen randomly as the control（ ABP group） in the same period. Among them,26 eases of male ,19 cases of female, aged 25 - 76, average age 47.2 ± 6.7. The general information, clinical features, APACHE Ⅱ scores, laboratory indicators, hos- pitalization, prognosis were compared. Statistical analysis was used t test or chi-square test. Results There were no signif- icantly different in gender and ages between two groups （t/x^2 = 0.00,1.00, P 〉 0.05 ）. BMI in HLAP group was signifi- cantly higher than that in ABP group（ t = 5.58 ,P 〈 0.05 ）. The proportions of fatty liver, diabetes and severe acute pan- creatitis cases in HLAP group were significantly higher than that in ABP group（ x^2 = 12.38,5.03,9.91 ,P 〈 0.05 ）. There were no significantly different in Ranson score, APACHE Ⅱ score and CT index between groups accompanied with rise trend in HLAP group （ t/X2 = 0. 88,3. 90,0. 89,2. 98, P 〉 0.05 ）. Blood AMY, urine AMY, blood Ca^2＋ , ALT, GGT, TBIL and DBIL in HLAP group was significantly lower than that in ABP group（t =4.91,9.20,2.92,11.28,10.78,17.34, 16.27 ,P 〈 0.05 ）. TG, TC and Glu in HLAP group were significantly higher than that in ABP group （t = 14.16,8.45, 8.52, P 〈 0.05 ）. There was no significantly different in complications between two groups （ P 〉 0. 05 ）. The proportion of who received surgical therapy in ABP group was significantly higher than that in HLAP group（ x^2 = 3.89 ,P 〈 0.05 ）. The proportion of recurrence in in HLAP group was significantly higher than that in ABP group（ x^2 = 6.02 ,P 〈 0.05 ）. Con- clusion There were several differences in clinical features of HLAP and ABP that should pay attention to distinguish for formulating appropriate treatment strategy.