重症高脂血症性急性胰腺炎的危险因素

Risk factors for severe hyperlipidemic acute pancreatitis

目的:探讨重症高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)的危险因素。方法:回顾性分析2017年6月至2020年12月间武汉大学人民医院普外科收治的162例HLAP患者的临床资料,根据严重程度分为轻症与中度重症组(n=89)、重症组(n=73)。比较两组一般资料及入院第1天的实验室指标,将两组间存在统计学差异的实验室指标全部纳入多因素二元logistic回归分析,探究重症HLAP的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线判断各评价指标的预测性能。结果:重症HLAP组患者心率与呼吸频率高于轻症与中度重症HLAP组,既往有胰腺炎发作史的患者占比低于轻症与中度重症HLAP组患者,差异均有统计学意义(均P<0.05)。重症HLAP组患者中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、三酰甘油、凝血酶原时间、纤维蛋白原含量、乳酸脱氢酶水平均显著高于轻症与中度重症HLAP组患者;预后营养指数、白蛋白、Ca^(2+)水平均显著低于轻症与中度重症HLAP组患者,差异均有统计学意义。多因素二元logistic回归分析显示钙离子(OR=0.068,95%CI:0.007~0.690,P=0.023)水平为重症HLAP的独立保护因素,三酰甘油(OR=1.112,95%CI:1.007~1.228,P=0.035)、NLR(OR=1.183,95%CI:1.011~1.385,P=0.036)及乳酸脱氢酶(OR=1.006,95%CI:1.000~1.011,P=0.039)水平为重症HLAP的独立危险因素。ROC曲线结果表明:NLR、三酰甘油、乳酸脱氢酶、Ca^(2+)水平及4者联合预测重症HLAP的曲线下面积(area under curve,AUC)分别为0.732、0.707、0.718、0.702、0.844,皆具有良好的预测价值。结论:入院第1天NLR、三酰甘油、乳酸脱氢酶、Ca^(2+)水平为重症HLAP的独立预测指标,临床中应格外重视。

Objective:Hyperlipidemic acute pancreatitis(HLAP)is prone to severe,and its incidence has been increasing in recent years.This study aims to explore the risk factors of severe HLAP.Methods:The clinical data of 162 HLAP cases admitted to Department of General Surgery,Renmin Hospital of Wuhan University from June 2017 to December 2020 were retrospectively analyzed.According to the severity,patients were divided into a mild or moderately severe group(n=89),a severe group(n=73).Clinical data and laboratory indicators at the first day of admission were compared between the two groups,and laboratory indicators with statistically significant differences were analyzed by binary logistic regression to explore independent risk factors for severe HLAP.Receiver operating characteristic(ROC)curve was used to determine the predictive performance of each evaluation index.Results:Severe HLAP patients’heart beat and respiratory rate were higher than moderately severe or mild HLAP cases,and the percentage of patients with a history of pancreatitis was lower than mild or moderately severe HLAP,with statistically significant differences.The neutrophil-lymphocyte ratio(NLR),triglyceride,prothrombin time,fibrinogen,lactate dehydrogenase levels of the severe groups were significantly higher than those in the mild or moderately severe group.The prognostic nutritional index(PNI),albumin and calcium were significantly lower than those in the mild or moderately severe group,and all the differences were statistically significant.The analysis of binary Logistic regression model showed that calcium(OR=0.068,95%CI:0.007–0.690,P=0.023)was an independent protective factor for severe HLAP,and triglyceride(OR=1.112,95%CI:1.007–1.228 P=0.035),NLR(OR=1.183,95%CI:1.011–1.385,P=0.036)and LDH(OR=1.006,95%CI:1.000–1.011,P=0.039)were independent risk factors for severe HLAP.ROC curve showed that the area under the curve(AUC)of NLR,triglyceride,lactate dehydrogenase,calcium and their combined prediction of severe HLAP were 0.732,0.707,0.718,0.702,and 0.844,all of which had good predictive value.Conclusion:NLR,triglyceride,lactate dehydrogenase levels on the first day were independent predictors of severe HLAP,which should be paid special attention in clinical practice.