低分子肝素联合胰岛素对高脂血症性急性胰腺炎的疗效及预后观察

Clinical efficacy of low-molecular-weight heparin combined with insulin on hypertriglyceridemic acute pancreatitis and its prognosis

目的观察低分子肝素、胰岛素联合治疗高脂血症性急性胰腺炎(HLAP)的临床疗效,探讨预测患者死亡的危险因素。方法收集2015年12月至2021年12月住院HLAP患者的病例资料,随机将患者分为低分子肝素组40例、胰岛素组40例、对照组40例、低分子肝素联合胰岛素组(联合组)192例,比较4组患者的临床疗效,以及急性生理与慢性健康评分(APACHEⅡ)、三酰甘油(TG)水平的变化。根据临床结局将低分子肝素联合胰岛素组患者分为生存组(173例)和死亡组(19例),采用多因素二分类logistic回归分析HLAP死亡的独立危险因素,绘制受试者工作特征曲线(ROC)、计算曲线下面积(AUC),评估各项指标预测患者死亡的价值。结果低分子联合胰岛素组患者肠鸣音恢复时间、腹痛缓解时间、住院时间指标均明显优于其他3组,差异均有统计学意义(P<0.05)。联合组患者治疗后APACHEⅡ以及TG水平明显低于其他3组(P<0.05)。多因素Logistic回归分析,联合组患者C-反应蛋白(CRP)、降钙素原(PCT)、D-二聚体、血糖、入院48 h的TG水平为患者死亡的独立危险因子(P<0.05)。ROC分析CRP、PCT、D-二聚体、血糖、入院48 h的TG的AUC分别为0.732,0.972,0.900,0.726,0.972;对应的灵敏度分别为57.90%,94.70%,53.26%,52.60%,94.70%;特异度分别为78.00%,88.20%,97.70%,90.20%,93.60%;对应的临界值分别为158 mg/L,2.55μg/L,5.21μg/ml,14.35 mmol/L,19.74 mmol/L。结论低分子肝素联合胰岛素治疗HLAP患者的疗效显著,能够明显改善患者的临床及血清指标,入院时CRP、PCT、D-二聚体、血糖、入院48 h的TG水平可作为HLAP患者的预后评价指标。

Objective To observe the efficacy of low-molecular-weight heparin combined with insulin on hypertriglyceridemic acute pancreatitis(HLAP),and to investigate the risk factors for predicting mortality of HLAP.Methods During December 2015 to December 2021,hospitalized HLAP patients were recruited and their clinical data were collected.They were randomly divided into low-molecular-weight heparin group(n=40),insulin group(n=40),control group(n=40)and combined group(n=192).After treatment,clinical efficiency,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and the serum triglyceride(TG)level were compared among four groups.According to the clinical outcome,patients in the combined group were subgrouped into survival group(n=173)and death group(n=19).A multivariate binary logistic regression analysis was performed to investigate the independent risk factors for predicting the mortality in HLAP patients treated with low-molecular-weight heparin combined with insulin.The receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated to evaluate the effectiveness of the risk factors for predicting the mortality.Results The abdominal pain relief time,recovery time of bowel sound and length of stay in the combined group were significantly better than those in other groups(P<0.05).After treatment,the APACHEⅡscore and the level of TG in the combined group were significantly lower than those in other groups(P<0.05).The multivariable Logistic regression analysis showed that C-reactive protein(CRP),procalcitonin(PCT),D-dimer,blood glucose at admission and serum TG level at 48 hours after admission were all independent risk factors for predicting the mortality in HLAP patients treated with low-molecular-weight heparin combined with insulin(P<0.05).In the result of ROC analysis,AUC of CRP,PCT,D-dimer,blood glucose at admission and serum TG level at 48 hours after admission was 0.732,0.972,0.900,0.726,and 0.972,respectively.Their sensitivity was 57.90%,94.70%,53.26%,52.60%and 94.70%,respectively,and the specificity was 78.00%,88.20%,97.70%,90.20%,and 93.60%,respectively.The cut-off value of them was 158mg/L,2.55μg/L,5.21μg/ml,14.35mmol/L,and 19.74mmol/L,respectively.Conclusion Low-molecular-weight heparin combined with insulin has an acceptable efficacy on HLAP patients,which can significantly improve the clinical and serum parameters.CRP,PCT,D-dimer,blood glucose at admission and serum TG level at 48 hours can be used to predict the mortality of HLAP.