血清甘油三酯水平与急性胰腺炎病情严重程度及预后相关性分析

Serum triglyceride levels are associated with the severity and prognosis of acute pancreatitis

目的探讨血清甘油三酯(triglyceride,TG)水平与急性胰腺炎(acute pancreatitis,AP)患者病情严重程度及预后的相关性。方法收集2012年1月至2015年9月期间本科466例AP患者资料,按血清TG值是否高于1.70 mmol/L分为正常组与升高组,升高组再分为轻、中、重组,比较病情严重程度及预后有无差异,以是否合并全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)为因变量,进行Logistic回归分析。比较重度血脂升高组血液净化治疗前后指标。结果 466例AP患者中血脂升高组271例(58.2%),血脂正常组195例(41.8%),血脂升高组SIRS(42.8%vs23.6%,P<0.01)、胸腔积液(55.0%vs 43.1%,P<0.05)、病情程度(30.6%vs 19.5%,P<0.01)明显高于正常组;组间器官功能障碍(13.7%vs 13.8%)差异无统计学意义(P>0.05);随着TG升高,各组并发SIRS风险越高(P<0.01)。Logistic回归分析TG与SIRS独立相关(OR=1.157,95%CI:1.102~1.215,P<0.01)。重度血脂升高组中使用血液净化(29例)治疗后,TG水平、白细胞计数、APACHEⅡ评分与治疗前比较明显降低(P<0.01)。结论 TG升高的AP患者预后更差,血清TG水平越高,SIRS发生率越高,但合并器官功能障碍无差异。血液净化能有效缓解血脂重度升高患者的病情。

Objective To investigate the association between serum triglyeeride （TG） levels and the severity and clinical outcomes of acute pancreatitis （AP）. Methods Patients with AP admitted consecutively in our department from January 2012 to September 2015 were analyzed. According to serum TG levels, the patients were divided into normal TG group and elevated TG （ 〉 1.70 mmol/L） group, and the latter was further divided into mild, moderate, and severe groups. The disease severity and clinical outcomes were compared among patients with different TG levels, and logistic regression analysis was used for analyzing systemic inflammatory response syndrome （SIRS）. The changes were analyzed in serum TG levels, white blood cell counts and APACHE ]1 scores after treatment. Results A total of 466 AP patients were enrolled, including 195 with normal TG levels and 271 with elevated TG levels （176 mild, 54 moderate and 41 severe cases）. Compared with those with normal serum TG levels, the patients with elevated TG levels were more likely to have SIRS （42.8% vs 23.6%, P 〈0. 001）, pleural effusion （55.0% vs 43.1%, P =0.011）, and severe conditions （30.6% vs 19.5% , P 〈 0. 007）, but the incidence of organ dysfunction was comparable between the 2 groups （ 13.7% vs 13.8% ）. Elevated serum TG levels was correlated with an increased risk of SIRS （P 〈 0. 001 ） , and logistic regression analysis showed that TG was independently related to SIRS （ OR = 1. 157, 95% CI： 1. 102 - 1. 215; P 〈0. 001）. TG levels, white blood cell counts and APACHE Ⅱ scores were significantly decreased （ P 〈 0. 001 ） after blood purification in 29 patients with severely elevated TG levels. Conclusion In AP patients, an elevated TG level is associated with a poorer outcome and an increased risk of SIRS but does not affect the risk of organ dysfunction. Blood purification can effectivelywere significantly decreased （ P 〈 0. 001 ） after blood purification in 29 patients with severely elevated TG levels. Conclusion In AP patients, an elevated TG level is associated with a poorer outcome and an increased risk of SIRS but does not affect the risk of organ dysfunction. Blood purification can effectively alleviate the condition of patients with severely elevated TG levels.