CT评估的脂肪肝与高脂血症性急性胰腺炎严重程度的相关性

The association between CT measured fatty liver and the severity of hyperlipidemia acute pancreatitis

目的:探讨CT评估的脂肪肝与高脂血症性急性胰腺炎(HLAP)病情严重程度的相关性。方法:回顾性分析223例HLAP患者资料,根据肝/脾CT值将患者分为无、轻度脂肪肝组及中重度脂肪肝组。采用单因素和多因素logistic回归分析影响HLAP严重程度的独立危险因素。结果:有184例(82.5%)HLAP患者合并脂肪肝。与无、轻度脂肪肝患者相比,中重度脂肪肝患者住院时间超过2周的比率增高(55.7%vs.39.3%,P<0.05)。中重度HLAP组患者的平均血甘油三酯(TG)水平高于轻度HLAP组(P<0.01),而肝/脾CT值比低于HLAP组(P<0.01)。单因素logistic回归分析显示,合并中重度脂肪肝及TG水平高是中重度HLAP的危险因素(均P<0.05)。经多因素logistic回归分析校正后,合并中重度脂肪肝仍是中重度HLAP的独立危险因素(P<0.05)。此外,合并中重度脂肪肝HLAP患者经治疗后,67.0%转为无或轻度脂肪肝。结论:基于CT平扫评估的脂肪肝严重程度与HLAP患者严重程度和住院时间有关。

Objective:To explore the association between CT measured fatty liver and the severity of hyperlipidemic acute pancreatitis(HLAP).Methods:Clinical data from 223 HLAP patients were retrospectively collected.According to the scoring by the modified CT severity index(MCTSI),there were 62 patients with mild HLAP and 161 with moderate to severe HLAP.Based on the liver/spleen CT value ratio,the patients were divided as no-to-mild fatty liver group and moderate-to-severe fatty liver group.Univariate and multivariate logistic regression analyses were used to analyze the independent risk factors of the severity of HLAP.Results:Of the HLAP patients,184(82.5%)presented fatty liver.Compared with patients with no or mild fatty liver,patients with moderate-to-severe fatty liver had a higher probability of hospitalization by more than 2 weeks(55.7%vs.39.3%,P<0.05).Compared with the mild HLAP group,the average triglyceride(TG)level of patients in the moderate-to-severe HLAP group was significantly higher(P<0.01),while the liver/spleen CT value ratio was significantly lower(P<0.01).There were no significant differences in body mass index,waist circumference,muscle area,subcutaneous fat area,visceral fat area,visceral fat area/total fat area between the two groups(all P>0.05).Univariate Logistic regression analyses showed that a co-existence of moderate-to-severe fatty liver and a high TG level were risk factors for moderate-to-severe HLAP(both P<0.05).After adjustment by multivariate Logistic regression analyses,the presentation of moderate-to-severe fatty liver was still an independent risk factor for moderate-to-severe HLAP(P<0.05).In addition,after treatment,67.0%of the moderate-to-severe fatty liver presented in the HLAP patients were normalized to no or mild fatty liver.Conclusion:The severity of fatty liver assessed by CT was associated with the severity of HLAP patients and the length of hospitalization.