急性复发性胰腺炎与高脂血症的互为因果关系及临床特点

Acute recurrent pancreatitis and hyperlipidemia:Reciprocal causal relationship and clinical features

目的比较不同血脂水平对急性复发性胰腺炎(acute recurrent pancreatitis,ARP)病情发生、发展及预后的影响,探讨伴高脂血症(hyperlipidemia,HL)与ARP的相互关系及临床特点.方法回顾性分析中国医科大学附属第一医院胰腺外科2013-01/2015-12收治的121例ARP患者的临床资料并密切随访,按入院24 h内化验的血脂水平分为abdg高脂血症组和非高脂血症组,并对两组病例进行一般情况、病情严重程度、复发情况、并发症、手术率、死亡率等指标的比较.结果HL组的平均年龄小于非HL组(38.5±8.9vs 49.8±13.2,P<0.01),,且手术率相对较低(11.3%vs 21.9%,P<0.05),男性患者比例更高(41/53 vs 40/68,P<0.05),BMI(28.2±6.0 vs22.5±5.2,P<0.01)、血糖水平(9.65±6.00 vs6.88±3.26,P<0.01)、血脂水平(13.94±8.91vs 3.22±1.47,P<0.01)高于非HL组,而血淀粉酶(332.02±246.71 vs 490.79±417.11,P<0.05)相对较低;HL组更容易合并糖尿病(34.0%vs 13.2%,P<0.01)及脂肪肝(22.6%vs7.4%,P<0.05).病因方面,观察组血脂水平升高主要由原发性的HL本身所引起(62.3%,P<0.01),而其他因素所诱发的ARP,HL则表现为其伴随症状;非HL组中,ARP以胆源性(66.1%,P<0.01)因素居多.酒精性胰腺炎在两组的发病率没有统计学差异;两组的严重程度及预后亦没有统计学差异.结论HL与ARP互为因果,且ARP的高血脂水平主要与原发性的HL有关;合并有HL的ARP患者有年轻化、男性化、外科干预率低的特点,且容易合并糖尿病及脂肪肝等并发症.

AIM To investigate the influence of serum levels of lipids on the occurrence,development and prognosis of acute recurrent pancreatitis（ARP）to discuss the reciprocal causal relationship between ARP and hyperlipidemia（HL） and their clinical features.METHODS Clinical data and follow-up information for121 patients with ARP who were treated at the First Hospital of China Medical University from January 2013 to December 2015 were retrospectively analyzed.All these patients were divided into a hyperlipidemia group（HL group） and a non-hyperlipidemia group（non-HL group） according to the serum lipid levels within 24 h after admission.General data,severity,recrudescence,complications,operation rate,and mortality were compared between the two groups.RESULTS The average age was significantly lower in the HL group than in the non-HL group（38.5± 8.9 vs 49.8 ± 13.2,P 0.01）.The operation rate was significantly lower（11.3%vs 21.9%,P 0.05） and the proportion of male patients was significantly higher（41/53 vs 40/68,P 0.05） in the HL group.BMI（28.2 ± 6.0 vs 22.5± 5.2,P 0.01）,serum levels of glucose（9.65 ±6.00 vs 6.88 ± 3.26,P 0.01） and lipids（13.94 ±8.91 vs 3.22 ± 1.47,P 0.01） were significantly higher in the HL group than in the non-HL group,while serum amylase was significantly lower in the HL group（332.02 ± 246.71 vs490.79 ± 417.11,P 0.05）.The HL group was more frequently complicated with diabetes（34.0%vs 13.2%,P 0.01） and fatty liver（22.6%vs 7.4%,P 0.05）.For the causes of ARP,elevated serum lipid levels in the observation group were mainly caused by primary HL itself（62.3%,P 0.01）,and HL appeared as a concomitant symptom in other ARP patients induced by other factors.In the non-HL group,ARP was predominantly caused by gallstones（66.1%,P 0.01）.There was no statistical difference about alcoholic pathogenesis,severity or prognosis of disease between the two groups.CONCLUSION There is a reciprocal causal relationship between HL and ARP.High serum lipid levels in the observation group are mainly related to the primary HL itself.The ARP patients with concomitant HL tend to be younger,be male,have lower surgical intervention rate,and be easily complicated with diabetes or fatty liver.