高脂血症型胰腺炎患者内脏脂肪组织面积与双重滤过血浆置换临床疗效的相关性分析

目的探讨高脂血症型胰腺炎(hyperlipidemic pancreatitis,HLAP)患者内脏脂肪组织面积(visceral fat area,VFA)与双重滤过血浆置换(double filtered plasmapheresis,DFPP)临床疗效的相关性。方法选取2020年1月—2022年12月自贡市第一人民医院收治的行DFPP治疗的HLAP患者,根据临床疗效不同分为有效组和无效组。比较2组的一般资料及VFA;通过多元Logistic回归分析无效结局的影响因素;分析VFA水平与疗效无效概率的剂量反应关系,基于影响因素逐步Logistic回归模型。结果共纳入225例患者,其中有效组180例,无效组45例。饮酒史(OR=3.603,95%CI:2.577~4.868,P=0.018)、高体质量指数(body mass index,BMI)(OR=2.407,95%CI:1.381~3.672,P=0.016)、高急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health status scoring system II,APACHEⅡ)评分(OR=3.087,95%CI:2.061~4.352,P=0.026)、高空腹血糖(FPG)(OR=1.313,95%CI:1.007~2.578,P=0.009)、高总胆固醇(TC)(OR=2.511,95%CI:1.485~3.776,P=0.025)、高三酰甘油(TG)(OR=4.885,95%CI:3.859~6.150,P=0.035)、高低密度脂蛋白胆固醇(LDL-C)(OR=3.165,95%CI:2.139~4.430,P=0.010)、低高密度脂蛋白胆固醇(HDL-C)(OR=4.163,95%CI:3.137~5.428,P=0.011)、高白细胞介素-6(interleukin-6,IL-6)(OR=2.117,95%CI:1.091~3.382,P=0.006)、高白细胞介素-8(interleukin-8,IL-8)(OR=3.115,95%CI:2.089~4.380,P=0.023)、高C反应蛋白(CRP)(OR=1.975,95%CI:1.049~3.240,P=0.035)、高降钙素原(procalcitonin,PCT)(OR=3.665,95%CI:2.639~4.930,P=0.036)、高血淀粉酶(OR=4.547,95%CI:3.521~5.812,P=0.041)、高血脂肪酶(OR=2.229,95%CI:1.203~3.494,P=0.043)、VFA大(OR=2.827,95%CI:1.801~4.092,P=0.031)是疗效无效的影响因素。剂量反应关系分析提示:随着VFA增加,临床疗效无效的发生概率也相应增加。回归方程P=1/[1+exp(-3.265+1.282×饮酒史+0.878×BMI+1.127×APACHEⅡ评分+0.272×FPG+0.921×TC+1.586×TG+1.152×LDLC+1.426×HDL-C+0.750×IL-6+1.136×IL-8+0.681×CRP+1.299×PCT+1.514×血淀粉酶+0.802×血脂肪酶+1.039×VFA)]。结论HLAP患者VFA与DFPP临床疗效具有显著相关性。随着VFA的增加,临床疗效无效的发生概率逐渐升高。

Postoperative excessive gain in visceral adipose tissue as well as body mass index are associated with adverse outcomes of an ileal pouch

Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with IPAA.Methods:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and 2014.The visceral fat area(VFA)was measured on CT images.The study group comprised patients with a significant VAT gain(>15%),and the control group was those without.The adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception CT.Results:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were included.Twenty-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control group.The median duration from the inception to the latest CT was 552(range:31–2598)days for the entire cohort.We compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two groups.Kaplan-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch comes.Conclusions:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated with poor long-term outcomes.