不同程度高甘油三酯血症对于急性胰腺炎病情严重性的影响

Effect of different degrees of hypertriglyceridemia on severity of acute pancreatitis

背景体内过多的游离脂肪酸可损伤胰腺腺泡细胞、产生大量炎症因子,导致多器官功能损伤.本研究通过观察不同程度高甘油三酯血症(hypertriglyceridemia,HTG)对急性胰腺炎(acute pancreatitis,AP)病情严重性的影响,从而证实随着血脂水平升高,重症化风险亦随之增加.目的探讨在发病初期不同程度的HTG对于高脂血症型急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)病情严重性的影响.方法回顾性分析2016-06/2019-12我院收治的87例HLAP患者临床资料,根据患者入院时血清甘油三脂(triglyceride,TG)水平,分为三组:(1)中度HTG组(TG 5.65-11.30 mmol/L);(2)重度HTG组(TG 11.3-22.3 mmol/L);(3)极重度HTG组(TG≥22.4 mmol/L),对比观察三组患者各项生化指标、改良CT严重指数(modified CT severity index,MCTSI)评分、病情严重程度的变化.结果与中度HTG组相比,重度、极重度HTG组患者MCTSI评分、C反应蛋白(C-reactive protein,CRP)明显增加,中度重症急性胰腺炎(moderately sever acute pancreatitis,MSAP)/重症急性胰腺炎(sever acute pancreatitis,SAP)的发生率显著上升;但MCTSI评分、CRP在重度、极重度HTG组之间的差异无统计学意义.结论在发病24 h内血清TG的水平影响HLAP的病情严重程度,中度HTG诱发AP的病情程度轻,出现重症化转变的风险较低;而重度/极重度HTG可能是HLAP重症化的高危因素之一.

BACKGROUND Too much free fatty acids in the body can damage pancreatic acinar cells and result in the generation of a large number of inflammatory factors,leading to multiple organ dysfunction.By observing the influence of different degrees of hypertriglyceridemia(HTG)on the severity of acute pancreatitis,this study confirmed that the risk of severe pancreatitis increases with the increase of blood lipid level.AIM To investigate the effect of different degrees of HTG at the early onset stage on the severity of hyperlipidemic acute pancreatitis(HLAP).METHODS Eighty-seven patients with HLAP treated from June 2016 to December 2019 at our hospital were retrospectively analyzed.According to the levels of serum triglyceride(TG)on admission,they were divided into three groups:(1)Moderate HTG group(TG:5.65-11.30 mmol/L);(2)severe HTG group(TG:11.3-22.3 mmol/L);and(3)very severe HTG group(TG:≥22.4 mmol/L).The changes in biochemical indicators,the modified CT severity index(MCTSI)score,and disease severity were observed.RESULTS Compared with the moderate HTG group,MCTSI scores,the levels of C-reactive protein(CRP),and the incidence of moderately severe acute pancreatitis/severe acute pancreatitis were significantly higher in the severe HTG group and very severe HTG group,but there was no significant difference in MCTSI or CRP between the severe HTG group and very severe HTG group.CONCLUSION The level of TG within 24 h after onset has an effect on HLAP severity,and the severity of acute pancreatitis induced by moderate HTG is mild and the risk of severe pancreatitis is low.Severe/very severe HTG may be associated with a high risk of severe HLAP.