高脂血症性和胆源性急性胰腺炎患者血钙和全段甲状旁腺素的变化及其与病情的相关性

Changes and differences of serum calcium and intact parathyroid hormone in patients with hyperlipidemic or biliogenic acute pancreatitis

目的检测高脂血症性胰腺炎（HIJAP）和胆源性急性胰腺炎（BAP）患者血钙（Ca）和全段甲状旁腺素（i-PTH）水平，分析它们间的相关性。方法收集2012年1月至2014年1月间首都医科大学附属北京朝阳医院收治的80例AP患者。检测就诊时的血常规、肝肾功能、血脂、血Ca和i-PTH水平。分析血Ca、i-PTH水平在HLAP组和BAP组间的差异及与AP病情严重程度的相关性。结果80例AP患者中HLAP43例，BAP37例；轻度AP（MAP）55例，中度AP（MSAP）25例。HLAP组中男性34例，女性9例，平均年龄（37±11）岁；MAP31例，MSAP12例。BAP组中男性17例，女性20例，平均年龄（58±15）岁；MAP24例，MSAP13例。HLAP组的男性比例显著高于BAP组，而平均年龄显著低于BAP组，差异均有统计学意义（P值均〈0．01）；两组MAP与MSAP患者比例的差异无统计学意义。HLAP组患者血ca水平显著低于BAP组[（1．92±0．24）mmol／L比（2．14±1．99）mmol／L]，差异有统计学意义（P〈0．01），但两组患者血i-PTH水平的差异无统计学意义。HLAP组MAP、MSAP患者的血Ca水平分别为（1．98±0．20）、（1．76±0．27）mmol／L，BAP组分别为（2．23±0．15）、（1．98±0．19）mmol／L，两组MSAP患者的血ca水平均显著低于MAP患者（P值均〈0．01）；HIJAP组MAP、MSAP患者的血i-PTH水平分别为（43．41±18．40）、（56．07±33．61）ng／L，BAP组分别为（39．22±17．19）、（52．73±29．42）ng／L，两组MSAP患者i-PTH水平均显著高于MAP患者，但差异无统计学意义。HLAP组患者的血ca水平与低密度脂蛋白胆固醇（LDL—C）、三酰甘油（TG）水平呈负相关（P值均〈0．05）；BAP组患者的血Ca水平与i-PTH水平呈负相关（P〈0．05）。结论HLAP和BAP患者的血ca水平均随病情加重而降低。HLAP患者血Ca水平下降与LDL—C和TG水平升高相关，而BAP患者血ca水平下降与i-PTH水平升高相关。

Objective To investigate the correlation and differences of serum calcium（Ca） and intact parathyroid hormone（i-PTH） in patients with hyperlipidemic or biliogenic acute pancreatitis（AP）. Methods From Jan 2012 to Jan 2014, total 80 AP patients admitted to Bejing Chaoyang Hospital were enrolled. According to the etiology, AP patients were divided into 2 groups, hyperlipidemic acute pancreatitis （HLAP） group and biliogenic acute pancreatitis （BAP） group. Blood routine, function of liver and kidney, blood lipids, Ca, and i-PTH were measured. Differences between Ca and i-PTH in HLAP group and BAP group were analyzed, and found the correlation with disease severity of AP. Results 80 AP patients included 43 HLAP and 37 BAP patients, 55 mild acute pancreatitis（MAP） and 25 moderately severe acute pancreatitis（MSAP） patients. HLAP group had 34 male and 9 female patients, average age was 37 years, 31 MAP and 12 MSAP patients. BAP group had 17 male and 20 female patients, average age was 58 years, 24 MAP and 13 MSAP patients, proportion of males was significantly higher in HLAP group than BAP group, on the contrary, average age was significantly lower （P 〈0.01 and 〈0.01, respectively）. No significantly difference was found in MAP/MSAP ration. Level of serum Ca in HLAP group was significantly decreased than BAP group （ 1.92 ±0. 24 mmol/L vs 2.14 ± 1.99 mmol/L, P 〈 0.05 ）. No significantly difference was found in i-PTH between two groups. Level of serum Ca in MAP and MSAP subgroup in HLAP group were 1.98 ± 0.20 mmol/L and 1.76 ±0. 27 mmol/L. Accordingly, Level of serum Ca were 2.23 ± 0.15 mmo]/L and 1.98 ±0.19 mmol/L in BAP group, i-PTH in MAP and MSAP subgroup in HLAP group were 43.41±18.40 ng/L and 56.07± 33.61 ng/L. Accordingly, i-PTH was 39.22 ± 17.19 mmol/L and 52.73±29.42 mmol/L in BAP group. Compared to MAP, Ca in MSAP group was significantly decreased in HLAP and BAP group（ P〈0. 01 and 〈0.05, respectively）. In HLAP group, Ca was a negative correlation with low density lipoprotein cholesterol（LDL-C） and triglycerides （TG） （ P 〈 0.05 and 〈 0.01, respectively）. In BAP group, Ca was a negative correlation with i-PTH （ P 〈 0.05 ）. Conclusions Serum Ca is decreased with severity of HLAP and BAP. Decreased Ca has correlation with increased LDL-C, TG in HLAP and increased i-PTH in BAP.