中青年高甘油三酯血症性急性胰腺炎患者临床特征及危险因素分析

Analysis of Clinical Characteristics and Risk Factors in Young and Middle-aged Patients with Hypertriglyceridemia Acute Pancreatitis

目的分析中青年高甘油三酯血症性急性胰腺炎(HTG-AP)患者的临床特征及危险因素。方法纳入2018年1月-2020年12月首都医科大学附属北京同仁医院(南区)急诊科收治的中青年急性胰腺炎患者96例,将其分为HTG-AP组(n=29)和非HTG-AP(NHTG-AP)组(n=67)。分析HTG-AP患者的临床特征及独立危险因素。ROC曲线分析HTG-AP患者危险因素对中度重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)的预测价值。结果HTG-AP组患者男性占比、合并高脂血症、糖尿病、脂肪肝及病情严重程度、48 h C反应蛋白(CRP 48 h)均高于NHTG-AP组(P<0.05);HTG-AP组APACHEⅡ评分≥8分比例高于NHTG-AP组,但差异无统计学意义(P>0.05);多因素Logistic回归分析显示,CRP 48 h、APACHEⅡ评分是中青年HTG-AP患者MSAP和SAP的独立危险因素(P<0.05);ROC曲线分析显示,HTG-AP患者CRP 48 h、APACHEⅡ评分及CRP 48 h联合APACHEⅡ评分预测MSAP和SAP的曲线下面积分别为0.772、0.794、0.808,敏感度分别为88.90%、66.70%、95.00%,特异度分别为65.00%、85.00%、66.70%。结论中青年患者中男性、合并糖尿病、高脂血症、脂肪肝者更易发生HTG-AP,CRP 48 h、APACHEⅡ评分是HTG-AP患者MSAP和SAP的独立危险因素,CRP 48h联合APACHEⅡ评分可提高预测MSAP和SAP的敏感性。

Objective To analyze the clinical characteristics and risk factors of young and middle-aged patients with hypertriglyceridemia acute pancreatitis(HTG-AP).Methods A total of 96 young and middle-aged patients with acute pancreatitis admitted to the Department of Emergency,Beijing Tongren Hospital Affiliated to Capital Medical Universityfrom January 2018 to December 2020 were included and divided into HTG-AP group(n=29)and non-HTG-AP(NHTG-AP)group(n=67).The clinical characteristics and independent risk factors of HTGAP patients were analyzed.ROC curve was used to analyze the predictive value of risk factors for moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)in patients with HTG-AP.Results The proportion of male patients,hyperlipidemia,diabetes,fatty liver and disease severity,48 h C-reactive protein(CRP 48 h)in HTG-AP group were higher than those in NHTG-AP group(P<0.05).The proportion of APACHEⅡscore≥8 scores in HTG-AP group was higher than that in NHTG-AP group,but the difference was not statistically significant(P>0.05).Multivariate Logistic regression analysis showed that CRP 48 h and APACHEⅡscore were independent risk factors for MSAP and SAP in young and middle-aged HTG-AP patients(P<0.05).ROC curve analysis showed that the area under the curve of CRP 48 h,APACHEⅡscore and CRP 48 h combined with APACHEⅡscore in predicting MSAP and SAP in HTG-AP patients was 0.772,0.794 and 0.808;the sensitivity was 88.90%,66.70%and 95.00%;and the specificity was 65.00%,85.00%and 66.70%,respectively.Conclusion Men,diabetes,hyperlipidemia and fatty liver are more likely to develop HTG-AP among young and middle-aged.CRP 48 h and APACHEⅡscore are independent risk factors for MSAP and SAP in patients with HTG-AP.CRP 48 h combined with APACHEⅡscore can improve the sensitivity of predicting MSAP and SAP.