高脂血症性急性胰腺炎和胆源性急性胰腺炎的临床特点分析

Analysis of clinical characteristics between hyperlipidemic acute pancreatitis and biliary acute pancreatitis

目的比较高脂血症性急性胰腺炎(HLAP)与胆源性急性胰腺炎(BAP)临床特点的差异。方法采用回顾性研究方法,收集2014年1月至2017年12月首都医科大学附属北京友谊医院收治的HLAP患者88例(HLAP组),并收集同期收治的BAP患者145例(BAP组),比较两组患者的一般情况、血脂、血糖、血淀粉酶(AMY)、血钙、肝功能、白细胞(WBC)、血小板(PLT)、C反应蛋白(CRP)、D-二聚体(D-Dimer)、急性生理与慢性健康状况评分系统II(APACHE II评分)水平及合并症、并发症、死亡率;比较两组患者的腹腔内压测定值,探讨其与疾病严重程度的相关性。结果HLAP组患者的胆固醇、甘油三酯、血糖、血肌酐、WBC、PLT、APACHE II评分均高于BAP组,差异具有统计学意义(P<0.05);HLAP组患者的淀粉酶、丙氨酸氨基转移酶(ALT)、血钙均低于BAP组,差异具有统计学意义(P<0.05);HLAP和BAP组C反应蛋白、D-二聚体差异无统计学意义(P>0.05)。HLAP组患者的发病年龄低,多合并糖尿病、脂肪肝,其复发率和并发症发生率高于BAP组;腹内压与APACHE II评分、死亡率呈正相关。TG、CRP、D-Dimer能有效预测HLAP组重症急性胰腺炎(SAP),曲线下面积分别为0.895、0.978、0.990;AMY、CRP、D-Dimer能有效预测BAP组SAP,曲线下面积分别0.805、0.938、0.965。结论HLAP和BAP临床特点不同,HLAP组发病年龄更低,合并基础疾病多,易复发,并发症发生率高。BAP组AMY、ALT明显升高。WBC、CRP、D-Dimer、腹内压可以有效评估疾病严重程度。

Objective To compare clinical characteristics between hyperlipidemic acute pancreatitis(HLAP)and biliary acute pancreatitis(BAP).Methods A retrospective study was conducted to collect 88 patients with HLAP(HLAP group)hospitalized in Beijing Friendship Hospital,Capital Medical University from January 2014 to December 2017,and 145 BAP patients(BAP group)admitted in the same period were enrolled in this study.The data between the two groups,including general condition,blood lipid,blood sugar,amylase(AMY),liver function,white blood cell(WBC),Platelet(PLT)and C-reactive protein(CRP),D-dimer,acute physiology and chronic health status score II(APACHE II),complications and mortality,were compared,and the intra-abdominal pressure between the two groups were also compared.The correlation between intra-abdominal pressure and the severity of disease were analyzed.Results The levels of cholesterol,triglyceride,blood sugar,serum creatinine,WBC,PLT,and APACHE II score in HLAP group were higher than those in BAP group(P<0.05).The levels of amylase,alanine aminotransferase and serum calcium in HLAP group were lower than those in BAP group(P<0.05).There was no significant difference in CRP and D-dimer between HLAP and BAP groups(P>0.05).The age of onset in HLAP group was lower.The recurrence rate and complication rate of diabetes mellitus and fatty liver were higher than those of BAP group.The recurrence rate and mortality rate of HLAP group were higher than those of BAP group.Intra-abdominal pressure was positively correlated with APACHEII score and mortality.TG,CRP and D-Dimer can effectively predict SAP in HLAP group.The area under curve was 0.895,0.978 and 0.990 respectively.AMY,CRP and D-Dimer could effectively predict SAP in BAP group.The area under curve was 0.805,0.938 and 0.965,respectively.Conclusion The clinical characteristics of HLAP and BAP are different.The age of onset in HLAP group is lower,there are many underlying diseases,easy to recur,and the incidence of complications is higher.The levels of AMY and ALT are significantly increased in BAP group.WBC,CRP,D-Dimer and intra-abdominal pressure can be effectively used to assess the severity of the disease.