甘油三酯水平与急性高甘油三酯血症性胰腺炎严重程度的关系

Association between triglyceride level and the severity of acute hypertriglyceridemic pancreatitis

目的探讨血清甘油三酯(TG)水平与急性高甘油三酯血症性胰腺炎(AHTGP)严重程度之间的关系。方法回顾性分析2015年9月-2018年6月在首都医科大学附属北京安贞医院住院治疗的63例AHTGP患者,根据亚特兰大新分类标准,分为轻症急性胰腺炎组(MAP组,n=32)、中度重症急性胰腺炎组(MSAP,n=20)和重症急性胰腺炎(SAP,n=11)。记录AHTGP患者入院时和入院后48 h血清TG水平。符合正态分布的计量资料多组间比较采用单因素方差分析,不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料多组间比较采用χ~2检验; Spearman相关性分析用于评价数据间的相关性,受试者工作特征曲线(ROC曲线)用于评价指标的诊断效能。结果 3组患者入院后48 h血清TG水平、急性生理与慢性健康评分Ⅱ、改良CT严重程度指数、急性胰腺炎床旁严重程度指数和Ranson评分比较差异均有统计学意义(F=14. 423,χ~2值分别为44. 094、39. 654、30. 445、29. 426,P值均<0. 05)。入院时血清TG水平仅与Ranson评分呈正相关(相关系数为0. 491,P <0. 001);入院后48 h血清TG水平与亚特兰大新分类标准、急性生理与慢性健康评分Ⅱ、改良CT严重程度指数、急性胰腺炎床旁严重程度指数和Ranson评分均呈正相关(相关系数分别为0. 396、0. 392、0. 400、0. 476、0. 400,P值均<0. 05)。入院时和入院后48 h预测病情严重程度的曲线下面积分别为0. 652(P=0. 115)和0. 895 (P <0. 001),最佳阈值分别为34. 10 mmol/L和6. 95 mmol/L。结论入院后48 h血清TG水平在预测AHTGP严重程度上具有一定的临床价值。

Objective To investigate the association between serum triglyceride （ TG）level and the severity of acute hypertriglyceridemicpancreatitis （ AHTGP） . Methods A retrospective analysis was performed for the clinical data of 63 patients with AHTGP who were hospitalized and treated in Beijing Anzhen Hospital,Capital Medical University,from September 2015 to June 2018,and according to the new Atlanta classification criteria,these patients were divided into mild acute pancreatitis （ MAP）group with 32 patients,moderate - severe acutepancreatitis （ MSAP）group with 20 patients,and severe acute pancreatitis （ SAP）group with 11 patients. Serum TG level was recorded onadmission and at 48 hours after admission. A one - way analysis of variance was used for comparison of normally distributed continuous databetween multiple groups,and the Kruskal -Wallis H test was used for comparison of non - normally distributed continuous data between multiple groups;the chi - square test was used for comparison of categorical data between multiple groups;the Spearman correlation analysis wasused to evaluate the correlation between data;the receiver operating characteristic （ ROC）curve was used to evaluate the diagnostic efficacyof assessment indices. Results There were significant differences between the three groups in serum TG level at 48 hours after admission,Acute Physiology and Chronic Health Evaluation II （ APACHE II）score,modified CT severity index,bedside index for severity of acutepancreatitis,and Ranson score （ F = 14. 423,χ^2= 44. 094,39. 654,30. 445,and 29. 426,all P 〈 0. 05） . Serum TG level on admissionwas only positively correlated with Ranson score （ r = 0. 491,P 〈 0. 001） ;serum TG level at 48 hours after admission were positively correlated with the new Atlanta classification criteria,APACHE II score,modified CT severity index,bedside index for severity of acute pancreatitis,and Ranson score （ r = 0. 396,0. 392,0. 400,0. 476,and 0. 400,all P 〈 0. 05） . The areas under the ROC curve of serum TG levelon admission and at 48 hours after admission in predicting disease severity were 0. 652 （ P = 0. 115）and 0. 895 （ P 〈 0. 001） ,respectively,with optimal cut - off values of 34. 10 mmol / L and 6. 95 mmol / L,respectively. Conclusion Serum TG level at 48 hours after admission hasa certain clinical value in predicting the severity of AHTGP.