高脂血症性急性胰腺炎与糖尿病、微循环障碍关系的探讨

Discussion on the relationship between hyperlipidemic acute pancreatitis,diabetes and microcirculation disorders

目的探讨高脂血症性急性胰腺炎与糖尿病、微循环障碍的关系,观察高甘油三酯(TG)血症、高血糖对急性胰腺炎病情的影响。方法选取我院收治的急性胰腺炎病例105例,按病因分为高脂血症性胰腺炎(HLAP)组与其他病因组,比较两组患者体温、白细胞、血细胞压积(HCT)、血黏度(高切、低切)、D-二聚体等血生化指标的差异及局部和全身并发症出现的情况;观察HLAP患者降脂治疗后体温、WBC、TG下降规律及APACHE-Ⅱ、Glasgow评分变化;6个月后观察患者病情恢复情况。结果HLAP与其他病因组比较,其血黏度、HCT、D-二聚体明显升高,局部及全身并发症出现较多,两组比较差异有统计学意义(P<0.05);连续血液滤过(CBP)治疗后患者病情恢复较快;远期随访HLAP复发率较高,出现继发性糖尿病患者较多,且腹腔包裹性积液吸收较差,两组比较差异有统计学意义(P<0.05)。结论高TG血症、高血糖影响急性胰腺炎病情及预后,胰腺微循环障碍是急性胰腺炎发生和发展的主要致病因素。

Objective To investigate the relationship between hyperlipidemic acute pancreatitis,diabetes and microcirculation disorders,and to observe the effects of hypertriglyceridemia and hyperglycemia on the condition of acute pancreatitis.Methods 105 cases of acute pancreatitis treated in our hospital were selected and divided into hyperlipidemic acute pancreatitis(HLAP)group and other etiology group according to the etiology.The body temperature,white blood cells,and hematocrit(HCT),blood viscosity(high-cut,low-cut),D-dimer and other blood biochemical indicators,as well as occurrence of local and systemic complications of the two groups were compared.The decline in body temperature,WBC and TG,as well as changes of APACHE-Ⅱscore and Glasgow score of HLAP patients after lipid-lowering treatment were observed.After 6 months,the condition recovery of patients was observed.Results Compared with other etiology group,blood viscosity,HCT and D-dimer of HLAP were significantly increased,and the incidences of local and systemic complications were higher.The differences between the two groups were statistically significant(P<0.05).The patients recovered quickly after continuous blood purification(CBP)treatment.During long-term follow-up,the recurrence rate of HLAP was high,the number of patients with secondary diabetes was large,and the absorption of peritoneal effusion was poor.The differences between the two groups were statistically significant(P<0.05).Conclusion Hypertriglyceridemia and hyperglycemia affect the condition and prognosis of acute pancreatitis.Pancreatic microcirculation disorder is the main pathogenic factor of the occurrence and development of acute pancreatitis.