胆源性急性胰腺炎与高甘油三酯血症性急性胰腺炎临床特点对比分析

Clinical features of biliary acute pancreatitis versus hypertriglyceridemic acute pancreatitis

目的探讨胆源性急性胰腺炎(BAP)与高甘油三酯血症性急性胰腺炎(HTGAP)的临床特点。方法选取2018年9月-2019年8月西南医科大学附属医院收治的378例急性胰腺炎患者,其中BAP患者(胆道组)229例,HTGAP患者(高脂组)149例。分析两组患者的临床特点,包括年龄、性别、基础疾病、实验室指标、病情严重程度、局部并发症及全身并发症、结局指标等。符合正态分布的计量资料两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^2检验或Fisher精确概率法;有序多分类变量比较采用Mann-Whitney U检验。应用多因素logistic回归分析急性肝损伤、全身炎症反应综合征、多器官功能障碍综合征的独立危险因素。结果高脂组患者年龄(t=7.192)、转诊率(χ^2=7.680)均低于胆道组,其男性构成比(χ^2=16.987)、BMI(t=-4.171)、BISAP评分(Z=-2.701)、高脂饮食率(χ^2=6.702)、复发率(χ^2=6.702)、糖尿病(χ^2=8.567)、吸烟(χ^2=9.291)、饮酒(χ^2=11.934)均高于胆道组,差异均有统计学意义(P值均<0.05)。胆道组患者淀粉酶(Z=-3.298)、ALT(Z=-5.290)、AST(Z=-6.247)、TBil(Z=-3.626)、DBil(Z=-8.803)、D-二聚体(Z=-3.511)均高于高脂组,WBC(Z=-3.344)、Hb(t=-7.496)、红细胞压积(t=-3.812)均低于高脂组,差异均有统计学意义(P值均<0.05)。胆道组发生胰腺假性囊肿、急性肝损伤比例高于高脂组(χ^2值分别为11.131、19.089,P值均<0.05);高脂组发生全身炎症反应综合征、多器官功能障碍综合征比例高于胆道组(χ^2值分别为3.848、4.485,P值均<0.05)。两组手术率(χ^2=18.348)、住院天数(Z=-2.002)比较,差异亦均有统计学意义(P值均<0.05)。多因素logistic回归分析结果显示,高甘油三酯血症[比值比(OR)=0.347,95%可信区间(95%CI):0.152~0.793,P=0.012]、BMI(OR=1.113,95%CI:1.031~1.202,P=0.006)、糖尿病(OR=0.379,95%CI:0.160~0.896,P=0.027)是急性肝损伤发生的独立影响因素;高血压(OR=4.050,95%CI:1.820~9.011,P=0.001)是全身炎症反应综合征发生的独立影响因素;高甘油三酯血症(OR=3.741,95%CI:1.170~11.956,P=0.026)是多器官功能障碍综合征发生的独立影响因素。结论与BAP患者相比,HTGAP患者年龄更小,男性更多,高脂饮食率及BMI更高。HTGAP患者发生全身炎症反应综合征、多器官功能障碍综合征的概率高于BAP患者,而BAP患者发生胰腺假性囊肿、急性肝损伤的可能性更大。

Objective To investigate the clinical features of biliary acute pancreatitis(BAP)and hypertriglyceridemic acute pancreatitis(HTGAP).Methods A total of 378 patients with acute pancreatitis who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled,among whom 229 patients had BAP(BAP group)and 149 had HTGAP(HTGAP group).Clinical features were analyzed for both groups,including age,sex,underlying diseases,laboratory markers,disease severity,local and systemic complications,and outcome measures.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of ordinal categorical data between groups.A logistic regression analysis was used to investigate the independent risk factors for acute liver injury,systemic inflammatory response syndrome,and multiple organ dysfunction syndrome.ResultsCompared with the BAP group,the HTGAP group had a significantly younger age(t=7.192,P<0.05),a significantly lower referral rate(χ^2=7.680,P<0.05),and significantly higher constituent ratio of male patients(χ^2=16.987,P<0.05),body mass index(BMI)(t=-4.171,P<0.05),BISAP score(Z=-2.701,P<0.05),rate of high-fat diet(χ^2=6.702,P<0.05),recurrence rate(χ^2=6.702,P<0.05),and proportion of patients with diabetes(χ^2=8.567,P<0.05),smoking(χ^2=9.291,P<0.05)or drinking(χ^2=11.934,P<0.05).Compared with the HTGAP group,the BAP group had significantly higher amylase(Z=-3.298,P<0.05),alanine aminotransferase(Z=-5.290,P<0.05),aspartate aminotransferase(Z=-6.247,P<0.05),total bilirubin(Z=-3.626,P<0.05),direct bilirubin(Z=-8.803,P<0.05),and D-dimer(Z=-3.511,P<0.05)and significantly lower white blood cell count(Z=-3.344,P<0.05),hemoglobin(t=-7.496,P<0.05),and hematocrit(t=-3.812,P<0.05).Compared with the HTGAP group,the BAP group had a significantly higher proportion of patients with pancreatic pseudocyst or acute liver injury(χ^2=11.131 and 19.089,both P<0.05),and compared with the BAP group,the HTGAP group had a significantly higher proportion of patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome(χ^2=3.848 and 4.485,both P<0.05).There were also significant differences between the two groups in surgical rate(χ^2=18.348,P<0.05)and length of hospital stay(Z=-2.002,P<0.05).The multivariate logistic regression analysis showed that hypertriglyceridemia(odds ratio[OR]=0.347,95%confidence interval[CI]:0.152-0.793,P=0.012),BMI(OR=1.113,95%CI:1.031-1.202,P=0.006),and diabetes(OR=0.379,95%CI:0.160-0.896,P=0.027)were independent influencing factors for acute liver injury;hypertension(OR=4.050,95%CI:1.820-9.011,P=0.001)was an independent influencing factor for systemic inflammatory response syndrome;hypertriglyceridemia(OR=3.741,95%CI:1.170-11.956,P=0.026)was an independent influencing factor for multiple organ dysfunction syndrome.Conclusion Compared with BAP patients,HTGAP patients tend to have a younger age,a higher proportion of male patients,a higher rate of high-fat diet,and a higher BMI.HTGAP patients are more likely to develop systemic inflammatory response syndrome and multiple organ dysfunction syndrome than BAP patients,while BAP patients are more likely to develop pancreatic pseudocyst and acute liver injury.