Magnetic resonance imaging for acute pancreatitis in type 2 diabetes patients

Type 2 diabetes mellitus(T2DM)and its complications have significantly increased the burden of mortality and disability globally,making diabetes one of the most dangerous and prevalent chronic diseases.Acute pancreatitis(AP)is one of the most frequent gastrointestinal causes for hospital admission,which is a common exocrine pancreatic inflammatory disease that can cause severe abdominal pain and multiple organ dysfunction.There is an inseparable relationship between AP and diabetes.Diabetes is a high risk factor of AP,and patients with AP can develop pancreatogenic diabetes.In T2DM patients,the incidence rate of AP is significantly higher than that of the general population,and the clinical symptoms are more severe,with the majority of cases being moderate to severe AP.This review briefly introduces the pathogenesis and clinical features of AP in T2DM patients,focusing on the magnetic resonance imaging(MRI)manifestations of AP in T2DM patients.Our aim is to evaluate the severity of AP in patients with T2DM by MRI,so as to help clinicians assess the patient's condition and prognosis.

Blockade of high mobility group box-1 protein attenuates experimental severe acute pancreatitis

AIM: To examine the effects of anti-high mobility group box 1 (HMGB1) neutralizing antibody in experimental se-vere acute pancreatitis (SAP).METHODS: SAP was induced by creating closed duode-nal loop in C3H/HeN mice. SAP was induced immediately after intraperitoneal injection of anti-HMGB1 neutralizing antibody (200 μg). Severity of pancreatitis, organ injury (liver, kidney and lung), and bacterial translocation to pancreas was examined 12 h after induction of SAP.RESULTS: Anti-HMGB1 neutralizing antibody significant-ly improved the elevation of the serum amylase level and the histological alterations of pancreas and lung in SAP. Anti-HMGB1 antibody also significantly ameliorated the elevations of serum alanine aminotransferase and cre-atinine in SAP. However, anti-HMGB1 antibody worsened the bacterial translocation to pancreas.CONCLUSION: Blockade of HMGB1 attenuated the development of SAP and associated organ dysfunction, suggesting that HMGB1 may act as a key mediator for inflammatory response and organ injury in SAP.

Delayed ethyl pyruvate therapy attenuates experimental severe acute pancreatitis via reduced serum high mobility group box 1 levels in rats

AIM: To investigate the effect of delayed ethyl pyruvate (EP) delivery on distant organ injury, survival time and serum high mobility group box 1 (HMGB1) levels in rats with experimental severe acute pancreatitis (SAP). METHODS: A SAP model was induced by retrograde injection of artificial bile into the pancreatic ducts of rats. Animals were divided randomly into three groups (n = 32 in each group): sham group, SAP group and delayed EP treatment group. The rats in the delayed EP treatment group received EP (30 mg/kg) at 12 h, 18 h and 30 h after induction of SAP. Animals were sacrificed, and samples were obtained at 24 h and 48 h after induction of SAP. Serum HMGB1, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr) levels were measured. Lung wet-to-dry-weight (W/D) ratios and histological scores were calculated to evaluate lung injury. Additional experiments were performed between SAP and delayed EP treatment groups to study the in? uence of EP on survival times of SAP rats. RESULTS: Delayed EP treatment significantly reduced serum HMGB1 levels, and protected against liver, renal and lung injury with reduced lung W/D ratios (8.22 ±0.42 vs 9.76 ± 0.45, P < 0.01), pulmonary histological scores (7.1 ± 0.7 vs 8.4 ± 1.1, P < 0.01), serum AST (667 ± 103 vs 1 368 ± 271, P < 0.01), ALT (446 ± 91 vs 653 ± 98, P < 0.01) and Cr (1.2 ± 0.3 vs 1.8 ± 0.3, P < 0.01) levels. SAP rats had a median survival time of 44 h. Delayed EP treatment signifi cantly prolonged median survival time to 72 h (P < 0.01). CONCLUSION: Delayed EP therapy protects against distant organ injury and prolongs survival time via reduced serum HMGB1levels in rats with experimental SAP. EP may potentially serve as an effective new therapeutic option against the inflammatory response and multiple organ dysfunction syndrome (MODS) in SAP patients.

Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis:A retrospective single-center study

BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)has increased yearly,but updated population-based estimates on the incidence of HTG-AP are lacking.Reducing serum triglyceride(TG)levels quickly is crucial in the early treatment of HTG-AP.Decreased serum TG levels are treated by non-invasive methods,which include anti-lipidemic agents,heparin,low-molecular weight heparin,and insulin,and invasive methods,such as blood purification including hemoperfusion(HP),plasmapheresis,and continuous renal replacement therapy.However,authoritative guidelines have not been established.Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.AIM To evaluate the effect between patients treated with intravenous insulin(INS)and HP to guide clinical treatment.METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021.The inpatient medical and radiologic records were reviewed to determine clinical features,severity,complications,mortality,recurrence rate,and treatment.Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP.Propensity score matching was used to compare the clinical outcomes of INS and HP.RESULTS A total of 371 patients met the HTG-AP criteria.The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years(8.4%in April 2012-March 2013 and 22.3%in April 2020-March 2021).The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years.The amylase level was elevated in 80.1%of patients but was only three times the normal value in 46.9%of patients.The frequency of severe acute pancreatitis(26.9%),organ failure(31.5%),rate of recurrence(32.9%),and mortality(3.0%)of HTG-AP was high.Improved Marshall score,modified computed tomography severity index score,baseline TG,baseline amylase,C-reactive protein(CRP),albumin,aspartate aminotransferase,low-density lipoprotein cholesterol,urea nitrogen,creatinine,calcium,hemoglobin,free triiodothyronine,admission to intensive care unit,and mortality were significantly different between patients with different grades of severity(P<0.050).Multivariate logistic regression analysis confirmed that high CRP[P=0.005,odds ratio(OR)=1.011,95%CI:1.003-1.019],low calcium(P=0.003,OR=0.016,95%CI:0.001-0.239),and low albumin(P=0.023,OR=0.821,95%CI:0.693-0.973)were risk factors of severe HTG-AP.After propensity score matching adjusted by sex,age,severity of HTG-AP,and baseline TG,the serum TG significantly decreased in patients treated with INS(P<0.000)and HP(P<0.000)within 48 h.However,the clearance rate of TG(57.24±33.70%vs 56.38±33.61%,P=0.927)and length of stay(13.04±7.92 d vs 12.35±6.40 d,P=0.730)did not differ between the two groups.CONCLUSION The incidence of HTG-AP exhibited a significant increase,remarkable severity,and recurrent trend.Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.

Abdominal paracentesis drainage attenuates intestinal inflammation in rats with severe acute pancreatitis by inhibiting the HMGB1-mediated TLR4 signaling pathway

BACKGROUND Our previous studies confirmed that abdominal paracentesis drainage(APD)attenuates intestinal mucosal injury in rats with severe acute pancreatitis(SAP),and improves administration of enteral nutrition in patients with acute pancreatitis(AP).However,the underlying mechanisms of the beneficial effects of APD remain poorly understood.AIM To evaluate the effect of APD on intestinal inflammation and accompanying apoptosis induced by SAP in rats,and its potential mechanisms.METHODS SAP was induced in male adult Sprague-Dawley rats by 5%sodium taurocholate.Mild AP was induced by intraperitoneal injections of cerulein(20μg/kg body weight,six consecutive injections).Following SAP induction,a drainage tube connected to a vacuum ball was placed into the lower right abdomen of the rats to build APD.Morphological changes,serum inflammatory mediators,serum and ascites high mobility group box protein 1(HMGB1),intestinal barrier function indices,apoptosis and associated proteins,and toll-like receptor 4(TLR4)signaling molecules in intestinal tissue were assessed.RESULTS APD significantly alleviated intestinal mucosal injury induced by SAP,as demonstrated by decreased pathological scores,serum levels of D-lactate,diamine oxidase and endotoxin.APD reduced intestinal inflammation and accompanying apoptosis of mucosal cells,and normalized the expression of apoptosis-associated proteins in intestinal tissues.APD significantly suppressed activation of the intestinal TLR4 signaling pathway mediated by HMGB1,thus exerting protective effects against SAP-associated intestinal injury.CONCLUSION APD improved intestinal barrier function,intestinal inflammatory response and accompanying mucosal cell apoptosis in SAP rats.The beneficial effects are potentially due to inhibition of HMGB1-mediated TLR4 signaling.

Abdominal paracentesis drainage ameliorates myocardial injury in severe experimental pancreatitis rats through suppressing oxidative stress

BACKGROUND Abdominal paracentesis drainage(APD)is a safe and effective strategy for severe acute pancreatitis(SAP)patients.However,the effects of APD treatment on SAPassociated cardiac injury remain unknown.AIM To investigate the protective effects of APD on SAP-associated cardiac injury and the underlying mechanisms.METHODS SAP was induced by 5%sodium taurocholate retrograde injection in Sprague-Dawley rats.APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after SAP induction.Morphological staining,serum amylase and inflammatory mediators,serum and ascites high mobility group box(HMGB)1,cardiac-related enzymes indexes and cardiac function,oxidative stress markers and apoptosis and associated proteins were assessed in the myocardium in SAP rats.Nicotinamide adenine dinucleotide phosphate oxidase activity and mRNA and protein expression were also examined.RESULTS APD treatment improved cardiac morphological changes,inhibited cardiac dysfunction,decreased cardiac enzymes and reduced cardiomyocyte apoptosis,proapoptotic Bax and cleaved caspase-3 protein levels.APD significantly decreased serum levels of HMGB1,inhibited nicotinamide adenine dinucleotide phosphate oxidase expression and ultimately alleviated cardiac oxidative injury.Furthermore,the activation of cardiac nicotinamide adenine dinucleotide phosphate oxidase by pancreatitis-associated ascitic fluid intraperitoneal injection was effectively inhibited by adding anti-HMGB1 neutralizing antibody in rats with mild acute pancreatitis.CONCLUSION APD treatment could exert cardioprotective effects on SAP-associated cardiac injury through suppressing HMGB1-mediated oxidative stress,which may be a novel mechanism behind the effectiveness of APD on SAP.

急性重症胰腺炎中医证型分布与病情转归的关系分析

目的分析急性重症胰腺炎中医证型分布,探讨其与病情转归的关系。方法回顾性分析河南中医药大学第一附属医院2018年5月至2023年4月收治的107例急性重症胰腺炎患者的临床资料,统计患者中医证型分布和入院14 d病情转归情况。统计学方法采用t检验、χ^(2)检验,多因素分析采用Cox回归分析模型。结果107例急性重症胰腺炎患者中医证型占比从高到低依次为腑实热结证[39.25%(42/107)]、肝胆湿热证[30.84%(33/107)]、瘀毒互结证[18.69%(20/107)]、内闭外脱证[10.28%(11/107)]、肝郁气滞证[0.93%(1/107)];不同证型病因分布比较,差异有统计学意义(χ^(2)=64.08,P<0.05);急性重症胰腺炎患者病情加重发生率为19.63%(21/107),多因素Cox回归分析结果显示,瘀毒互结证[风险比(HR)=5.307,95%置信区间(CI)1.394~20.201,P=0.014]、内闭外脱证(HR=7.941,95%CI 2.204~28.614,P=0.001)、入院时急性生理学和慢性健康状况评分Ⅱ(HR=1.384,95%CI 0.732~2.617,P=0.008)、入院时兰森(Ranson)评分(HR=1.639,95%CI 1.165~2.305,P=0.005)是急性重症胰腺炎病情加重的危险因素。结论急性重症胰腺炎患者中医证型以腑实热结证为主,瘀毒互结证、内闭外脱证是急性重症胰腺炎患者病情转归的影响因素。

老年重症急性胰腺炎继发胰腺感染的病原菌分布及其与血清PCT、PA、FIB、HSP70和HMGB1的相关性

目的探讨老年重症急性胰腺炎继发胰腺感染患者的病原菌分布及其与血清降钙素原(PCT)、前白蛋白(PA)、纤维蛋白原(FIB)、热休克蛋白70(HSP70)、高迁徙率族蛋白1(HMGB1)水平的相关性。方法选择2019年1月至2022年12月东莞东华医院收治的62例老年重症急性胰腺炎患者作为研究对象,根据是否继发胰腺感染分为感染组20例和未感染组42例,另选择同期健康体检的80例健康者作为对照组。记录感染组患者病原菌分布情况,比较三组受试者及感染组不同病原菌感染类型患者的血清PCT、PA、FIB、HSP70和HMGB1水平,并采用Pearson相关性分析法分析血清PCT、PA、FIB、HSP70及HMGB1水平和胰腺感染的相关性。结果感染组患者病原菌感染类型主要为细菌感染,占90.00%,其中细菌感染类型中革兰阴性菌占55.00%,革兰阳性菌占35.00%;感染组患者血清PCT、HSP70、HMGB1水平分别为(2.49±0.53)μg/L、(9.12±1.86)ng/mL、(18.33±2.61)ng/mL,明显高于未感染组的(1.56±0.41)μg/L、(5.73±1.45)ng/mL、(13.62±2.47)ng/mL和对照组的(0.23±0.06)μg/L、(0.97±0.13)ng/mL、(0.73±0.15)ng/mL,PA、FIB分别为(0.17±0.02)g/L、(2.06±0.21)g/L,明显低于未感染组的(0.23±0.04)g/L、(2.75±0.30)g/L和对照组的(0.30±0.03)g/L、(3.23±0.36)g/L,且未感染组患者的血清PCT、HSP70、HMGB1水平均高于对照组,PA、FIB均低于对照组,差异均有统计学意义(P<0.05);感染组细菌感染患者的血清PCT、HSP70、HMGB1水平分别为(2.74±0.31)μg/L、(11.06±1.43)ng/mL、(20.68±2.05)ng/mL,明显高于真菌感染患者的(2.13±0.25)μg/L、(7.93±1.05)ng/mL、(16.27±1.76)ng/mL,PA、FIB水平分别为(0.11±0.02)g/L、(1.91±0.24)g/L,明显低于真菌感染患者的(0.17±0.04)g/L、(2.58±0.34)g/L,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示,血清PCT、HSP70、HMGB1与胰腺感染呈正相关(r=0.581、0.613、0.567,P<0.05),与PA、FIB呈负相关(r=-0.463、-0.531,P<0.05)。结论老年重症急性胰腺炎继发胰腺感染患者的病原菌类型主要为细菌感染,患者血清PCT、HSP70、HMGB1水平明显升高,PA、FIB明显降低,且与胰腺感染的发生有明显相关性,临床上应予以密切关注。

NLPR、hsCRP/PA、PCT联合检测对重症急性胰腺炎的预测价值

目的 探讨中性粒细胞与淋巴细胞和血小板比值(NLPR)、超敏C反应蛋白(hsCRP)/前白蛋白(PA)、降钙素原(PCT)与重症急性胰腺炎(SAP)的相关性,并分析上述3个指标单独及联合检测对SAP的预测价值。方法 选取2016年2月—2022年1月宜宾市第一人民医院收治的急性胰腺炎(AP)患者205例,按病情严重程度分为非SAP组(n=155)和SAP组(n=50)。比较两组一般临床特征及评分,进行单因素分析,应用二元Logistic回归对NLPR、hsCRP/PA、PCT进行分析,比较联合预测因子、BISAP及Ranson评分预测价值。结果 二元Logistic回归分析发现NLPR、hsCRP/PA、PCT均为预测SAP的独立影响因素;ROC曲线结果显示,NLPR曲线下面积为0.68,最佳阈值为4.73;PCT曲线下面积为0.93,最佳阈值为0.39;hsCRP/PA曲线下面积为0.82,最佳阈值为0.44;联合预测因子曲线下面积为0.94,最佳阈值为0.13;联合预测因子的灵敏度及阴性预测率高于Ranson评分及BISAP评分。结论 NLPR、hsCRP/PA、PCT各指标在一定程度上可反映AP严重程度,可被视为早期预测SAP的指标,其联合预测因子具有较好的临床应用价值。

MCTSI、CTSI、MPV、HMGB-1、AChE活性与急性胰腺炎患者病情及预后的关系

目的 探讨改良CT严重指数(MCTSI)、CT严重指数(CTSI)、平均血小板体积(MPV)、高迁移率族蛋白-1(HMGB-1)、乙酰胆碱酯酶(AChE)活性与急性胰腺炎(AP)患者病情及预后的关系。方法 选取220例AP患者,根据病情将其分为轻症急性胰腺炎(MAP)组(n=63)、中重症急性胰腺炎(MSAP)组(n=85)和重症急性胰腺炎(SAP)组(n=72)。所有患者行MCTSI、CTSI评分,同时检测血清MPV、HMGB-1、AChE水平,采用Pearson法验证各指标的相关性。随访3个月,依据预后分组,比较不同预后AP患者MCTSI、CTSI评分及MPV、HMGB-1、AChE差异,采用受试者工作特征(ROC)曲线分析上述指标对AP预后的预测价值。结果 三组MCTSI、CTSI评分、MPV、HMGB-1、AChE比较,差异均有统计学意义(F分别=34.90、154.62、230.50、92.35、101.20,P均<0.05),SAP组MCTSI、CTSI评分、MPV、HMGB-1明显高于MSAP组和MAP组(LSD-t分别=8.32、11.43、15.16、24.66、17.50、30.24、14.32、18.28,P均<0.05),AChE明显低于MSAP组和MAP组(LSD-t分别=13.08、19.79,P均<0.05)。AP患者MCTSI、CTSI评分分别与MPV、HMGB-1呈正相关(r分别=0.21、0.21、0.18、0.25,P均<0.05),与AChE呈负相关(r分别=-0.33、-0.34,P均<0.05)。预后不良组MCTSI、CTSI评分、MPV、HMGB-1高于预后良好组,AChE低于预后良好组,差异均有统计学意义(t分别=10.66、5.63、24.15、7.02、-14.54,P均<0.05)。ROC曲线显示,MCTSI、CTSI、MPV、HMGB-1、AChE联合预测AP患者不良预后的ROC曲线下面积(AUC)为0.91(95%CI 0.86~0.94),高于各指标单独预测(Z分别=2.78、3.39、2.78、2.44、2.89,P均<0.05)。结论 AP患者随着病情加重,MCTSI、CTSI评分及MPV、HMGB-1显著升高,AChE活性降低,联合检测MCTSI、CTSI、MPV、HMGB-1、AChE对AP患者病情及预后评估均有较高的应用价值。

TyG指数、GLR联合BISAP评分对高甘油三酯血症性急性胰腺炎严重程度的早期预测价值分析

目的分析甘油三酯-葡萄糖(TyG)指数、葡萄糖与淋巴细胞比值(GLR)联合急性胰腺炎严重程度床边指数(BISAP)评分对高甘油三酯血症性急性胰腺炎(HTG-AP)严重程度的早期预测价值。方法回顾性分析2018年5月至2023年5月武汉市第三医院收治的166例HTG-AP患者的临床资料,其中非重症组113例,重症组53例。比较两组入院24 h内采集的临床资料,采用多因素logistic回归分析重症HTG-AP发生的独立影响因素,采用受试者工作特征(ROC)曲线分析TyG指数、GLR、BISAP评分预测重症HTG-AP的效能。结果重症组高血压病、糖尿病人数比例大于非重症组,住院时间长于非重症组,淋巴细胞(LYM)、钙(Ca^(2+))水平低于非重症组,红细胞体积分布宽度(RDW)、D-二聚体(DDI)、C反应蛋白(CRP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、TyG指数、GLR水平及BISAP评分高于非重症组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,较高水平的TyG指数、GLR、BISAP评分均是促进重症HTG-AP发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,TyG指数、GLR、BISAP评分均具有预测重症HTG-AP发生的应用价值(P<0.05),且BISAP评分联合TyG指数或GLR的预测效能较单一指标更优。结论TyG指数、GLR及BISAP评分与HTG-AP严重程度相关,TyG指数或GLR联合BISAP评分对HTG-AP严重程度有较高的早期预测价值。

重症急性胰腺炎肺损伤发病机制中的肺泡Ⅱ型上皮细胞凋亡的作用及乌司他丁干预的实验研究

目的探讨重症急性胰腺炎(SAP)发病机制中其肺泡Ⅱ型上皮细胞凋亡的作用并对乌司他丁对其干预的作用进行分析。方法将42只健康大鼠随机分为3组,分别为假手术组、模型组与乌司他丁干预组,每组14只,以向大鼠十二指肠乳头内侧胰胆管注射脱氧胆酸钠建立SAP大鼠模型,假手术组大鼠仅打开大鼠腹腔轻轻翻动其胰腺后关闭腹腔,乌司他丁干预组于大鼠建模后给予乌司他丁注射。对几组大鼠术后肺组织及胰腺组织的病理变化及相关指标差异进行分析。结果与假手术组比较,SAP组及乌司他丁干预组TNF⁃α、AMY及MDA水平明显更高,乌司他丁干预组与SAP组比较,TNF⁃α、AMY及MDA水平明显更低(P<0.05)。SAP大鼠伴随着明显的肺损伤状况,假手术组、SAP组、乌司他丁干预组肺湿/干比值分别为3.62±0.56、6.48±0.77、4.69±0.63,血气指标PaCO_(2)、PaO_(2)分别为(31.25±1.03)mmHg、(106.52±2.03)mmHg,(48.67±2.01)mmHg、(73.57±2.44)mmHg和(35.22±1.32)mmHg、(90.22±3.01)mmHg),SAP组及乌司他丁干预组大鼠肺湿/干比值及PaCO_(2)明显上升,PaO_(2)明显下降,相较于SAP组,乌司他丁干预组大鼠的肺湿/干比值及PaCO_(2)更低,PaO_(2)更高(P<0.05)。假手术组大鼠肺泡Ⅱ型上皮细胞凋亡率[(3.58±0.57)%]及Ca^(2+)浓度[(34.52±2.35)%]均显著低于SAP组凋亡率[(29.67±4.52)%]及Ca^(2+)浓度[(82.66±4.66)%]及乌司他丁干预组凋亡率[(14.62±3.67)%]及Ca^(2+)浓度[(46.77±5.02)%],乌司他丁干预组大鼠肺泡Ⅱ型上皮细胞凋亡率及Ca^(2+)浓度显著低于SAP组(P<0.05)。假手术组大鼠Caspasee⁃8、BaxmRNA表达均显著低于SAP组及乌司他丁干预组,乌司他丁干预组大鼠Caspasee⁃8、BaxmRNA表达显著低于SAP组(P<0.05)。SAP肺损伤大鼠线粒体细胞破坏明显,乌司他丁对减少线粒体细胞破坏数量具有明显作用。结论SAP肺损伤中肺泡Ⅱ型上皮细胞凋亡可能参与了其作用机制,TNF⁃α、AMY、MDA、Caspasee⁃8、BaxmRNA在肺损伤机制中存在重要作用,乌司他丁干预有利于缓解SAP肺损伤状况,有利于控制病情进展。

乌司他丁联合序贯透析、持续血滤治疗重症急性胰腺炎致脓毒症休克疗效研究

目的探讨乌司他丁联合序贯透析、持续血滤治疗重症急性胰腺炎(SAP)所致脓毒症休克的疗效,并分析其对血清炎症因子、高迁移率族蛋白1(HMGB1)、肥胖抑制素(Obestatin)及肝肾功能的影响。方法选取自2019年1月至2021年8月收治的70例SAP所致脓毒症休克患者为研究对象,按照随机数字表法分为A组(n=35)与B组(n=35)。A组给予乌司他丁治疗,B组在A组基础上创建体外循环,进行序贯透析、持续血滤治疗。两组患者均治疗7 d,评估并比较两组患者临床疗效。记录并比较两组患者治疗前、治疗后急性生理与慢性健康评分(APACHEⅡ),序贯器官衰竭(SOFA)评分,血清炎症因子[白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)]、HMGB1、Obestatin水平,及肝肾功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐(SCr)、血尿素氮(BUN)]。记录并比较两组患者28 d病死率。结果治疗后,B组总有效率为91.4%(32/35),高于A组的71.4%(25/35),差异有统计学意义(P<0.05)。治疗后,两组APACHEⅡ评分、SOFA评分及血清IL-6、IL-8、TNF-α、HMGB1、Obestatin、ALT、AST、BUN、SCr水平均较治疗前降低,且B组低于A组,差异有统计学意义(P<0.05)。B组28 d病死率为8.6%(3/35),低于A组的28.6%(10/35),差异有统计学意义(P<0.05)。结论乌司他丁联合序贯透析、持续血滤可有效缓解SAP所致脓毒症休克患者炎症反应,促进病情恢复,改善患者预后。

血液滤过治疗高脂血症重症急性胰腺炎的临床疗效分析

目的 观察血液滤过治疗高脂血症重症急性胰腺炎(HL-SAP)的效果。方法 80例HL-SAP患者,依据随机数字表法分为A组和B组,每组40例。A组患者给予常规对症干预治疗,B组患者在A组基础上给予血液滤过治疗。对比两组患者不同时间点生化指标[甘油三酯(TG)、血淀粉酶(AMS)、尿AMS]水平,不同时间点炎性因子指标[C反应蛋白(CRP)、前白蛋白、肿瘤坏死因子-α(TNF-α)]水平,不同时间点全身炎症反应综合征(SIRS)评分、急性生理功能和慢性健康状况评估系统Ⅱ(APACHE Ⅱ)评分、Ranson评分,治疗后并发症发生情况及死亡情况。结果 治疗前,两组患者的TG、血AMS、尿AMS水平对比差异无统计学意义(P>0.05);治疗第2、7天,两组患者的TG、血AMS、尿AMS水平均低于本组治疗前,B组患者的TG、血AMS、尿AMS水平均低于A组,差异具有统计学意义(P<0.05)。治疗前,两组患者的CRP、前白蛋白、TNF-α水平对比差异无统计学意义(P>0.05);治疗第2、7天,两组患者的CRP、TNF-α水平均低于本组治疗前,前白蛋白水平均高于本组治疗前,B组患者的CRP、TNF-α水平均低于A组,前白蛋白水平均高于A组,差异具有统计学意义(P<0.05)。治疗前,两组患者的SIRS评分、APACHE Ⅱ评分、Ranson评分对比差异无统计学意义(P>0.05);治疗第2天,两组患者的SIRS评分、APACHE Ⅱ评分、Ranson评分均低于本组治疗前,B组患者的SIRS评分(1.90±0.29)分、APACHE Ⅱ评分(7.16±2.47)分、Ranson评分(2.29±1.19)分均低于A组的(2.33±0.36)、(11.25±2.58)、(3.08±1.21)分,差异具有统计学意义(P<0.05);治疗第7天,两组患者的SIRS评分、APACHE Ⅱ评分均低于本组治疗前,B组患者的SIRS评分(1.37±0.26)分、APACHE Ⅱ评分(6.10±2.39)分均低于A组的(1.98±0.29)、(10.10±2.39)分,差异具有统计学意义(P<0.05)。B组患者治疗后并发症发生率为7.50%,死亡率为0,均显著低于A组的25.00%、10.00%,差异具有统计学意义(P<0.05)。结论 给予HL-SAP患者血液滤过治疗,能有效降低TG水平,改善临床症状,减轻炎症水平,减少治疗后并发症,提高预后,非常值得临床应用、推广。

血糖、甘油三酯、D-二聚体、C反应蛋白水平对急性胰腺炎病情严重程度及预后的判断价值

目的分析血糖、甘油三酯、D-二聚体、C反应蛋白在急性胰腺炎中的表达水平与病情严重程度及预后的相关性。方法择取2019年1月~2021年6月收治的急性胰腺炎患者160例作为观察组,同时择取60例同期体检的健康者作为对照组。对观察组和对照组患者的临床资料进行回顾性分析,并对其实验室检验结果进行对比,同时对观察组患者中不同病情轻重程度患者的实验室检验结果进行比较。结果观察组空腹血糖、甘油三酯、D-二聚体、C反应蛋白均高于对照组,差异有统计学意义(P<0.05)。重症急性胰腺炎患者的随机血糖、甘油三酯、D-二聚体、C反应蛋白均高于轻症急性胰腺炎患者,差异有统计学意义(P<0.05)。预后不良患者的随机血糖、甘油三酯、D-二聚体、C反应蛋白均高于预后良好患者,差异有统计学意义(P<0.05)。血糖、甘油三酯、D-二聚体、C反应蛋白与急性胰腺炎的病情严重程度呈正相关,与患者的预后呈负相关,差异有统计学意义(P<0.05)。结论血糖、甘油三酯、D-二聚体、C反应蛋白等指标与急性胰腺炎的病情严重程度及预后具有一定的关系,临床用于判断患者病情的严重程度和预后,临床应用价值较高。

甘油三酯-葡萄糖指数与中度重症及重症急性胰腺炎并发急性肾损伤的相关性

目的探讨甘油三酯-葡萄糖指数(TyG指数)与中度重症及重症急性胰腺炎(MS-SAP)并发急性肾损伤(AKI)的关系。方法回顾性收集2018年1月-2022年7月扬州大学附属医院初诊为MS-SAP的161例患者的临床资料,根据AKI发生情况分为AKI组75例和无AKI组86例。比较2组患者的临床资料、实验室指标及TyG指数。采用Pearson相关性分析评价TyG指数与临床资料、实验室指标的相关性;采用Logistic回归分析探讨MS-SAP患者并发AKI的独立危险因素。结果AKI组与非AKI组的序贯器官衰竭评分(SOFA评分)、胰腺炎严重程度评分(Ranson评分)及急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(P<0.05)。与无AKI组相比,AKI组患者血清葡萄糖(GLU)、C反应蛋白(CRP)、甘油三酯(TG)、总胆固醇(TC)、血清肌酐(Scr)、TyG指数水平升高,高密度脂蛋白(HDL)和钙离子水平降低,差异有统计学意义(P<0.05)。Pearson相关性分析发现,TyG指数与合并糖尿病、SOFA评分、APACHEⅡ评分、TC、CRP、Scr呈正相关(P<0.05),与患者年龄、合并高血压、HDL、谷氨酸-丙酮酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、镁离子、钙离子呈负相关(P<0.05)。Logistic回归分析显示,TyG指数、SOFA评分是MS-SAP患者并发AKI的独立影响因素(P<0.05)。结论MS-SAP并发AKI患者TyG指数水平明显升高。高水平TyG指数可能是MS-SAP患者并发AKI的影响因素之一,胰岛素抵抗是参与MS-SAP并发AKI的可能机制之一。

急性冠脉综合征合并2型糖尿病患者冠脉病变与中性粒细胞与高密度脂蛋白比值、单核细胞与高密度脂蛋白比值的相关性研究

目的:探讨急性冠脉综合征(acute coronary syndrome,ACS)合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者冠状动脉病变程度与中性粒细胞与高密度脂蛋白比值(neutrophil to high-density lipoprotein ratio,NHR)、单核细胞与高密度脂蛋白比值(monocyte to high-density lipoprotein ratio,MHR)的相关性。方法:选取2019年6月-2021年6月于包头市中心医院住院经冠状动脉造影确诊为ACS合并T2DM患者(151例),并按照冠脉病变程度将ACS合并T2DM组分为轻度组(Gensini评分≤40分)(69例)和重度组(Gensini评分>40分)(82例)。结果:NHR、MHR在重度组中高于轻度组,差异有统计学意义,ACS合并T2DM组MNR、NHR与Gensini评分呈正相关。多因素Logistic分析发现NHR升高是ACS合并T2DM冠脉病变严重程度的危险因素。绘制ROC曲线NHR预测ACS合并T2DM患者冠脉病变程度的最佳值为5.276,灵敏度是61.0%,特异度是94.2%,曲线下面积为0.726。结论:ACS合并T2DM患者冠脉病变程度与NHR、MHR呈正相关。

营养风险指数、全身免疫炎症指数和三酰甘油葡萄糖指数预测急性胰腺炎患者病情及预后的价值

目的探讨营养风险指数(NRI)、全身免疫炎症指数(SⅡ)和三酰甘油葡萄糖(TyG)指数对急性胰腺炎(AP)患者病情及预后的预测价值。方法选取AP患者173例,根据其严重程度分为MAP轻度急性胰腺炎(79例)组、MSAP中度急性胰腺炎(44例)组和SAP重度急性胰腺炎(50例)组。50例SAP患者根据死亡情况分为死亡组(19例)和存活组(31例)。记录各组NRI、SⅡ及TyG指数并进行比较。应用受试者工作特征(ROC)曲线分析NRI、SⅡ及TyG指数预测SAP发生及死亡的价值。应用Pearson相关分析SAP患者NRI、SⅡ及TyG指数三者之间的相关性。结果SAP组(89.25±4.50)NRI低于MSAP组(93.40±6.25)和MAP组(97.62±8.60),而SAP组SⅡ及TyG指数(2706.30±1052.74,7.84±1.21)高于MSAP组(1937.24±983.48,6.52±1.05)和MAP组(1280.58±717.36,4.65±0.58),差异有统计学意义(P<0.001)。死亡组NRI(86.40±3.70)低于存活组(91.46±5.28),而死亡组SⅡ及TyG指数(3085.73±1192.48,9.05±1.37)高于存活组(2270.26±994.53,6.70±1.10),差异有统计学意义(P<0.001)。ROC曲线显示,NRI、SⅡ及TyG指数三者联合预测SAP发生及死亡的AUC分别为0.850(95%CI:0.792~0.908)、0.905(95%CI:0.843~0.966)。相关分析显示,SAP患者NRI与SⅡ及TyG指数均呈负相关(r=-0.761,P<0.001;r=-0.813,P<0.001),而SⅡ与TyG指数呈正相关(r=0.842,P<0.001)。结论NRI、SⅡ及TyG指数与AP患者病情严重程度及死亡有关,三者联合预测SAP发生及预后有较好的价值。

TyG指数联合NLR对急性胰腺炎严重程度的预测价值

目的 探讨甘油三酯-葡萄糖(triglyceride-glucose, TyG)指数联合中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)对急性胰腺炎(acute pancreatitis, AP)严重程度的预测价值。方法 回顾性分析2019年8月~2021年12月就诊于徐州医科大学附属医院的202例AP患者的病例资料,基于2012年亚特兰大修订的AP分级标准,分为轻症急性胰腺炎(mild acute pancreatitis, MAP)119例、中度重症急性胰腺炎(moderately severe acute pancreatitis, MSAP)38例、重症急性胰腺炎(severe acute pancreatitis, SAP)45例。收集研究对象的一般资料、入院24h内实验室检查及影像学检查结果,比较不同严重程度AP的各项指标水平,采用Logistic回归分析筛选出独立危险因素,受试者操作者特征(receiver operating characteristic, ROC)曲线用于评价各项指标对AP严重程度的预测价值。结果 NLR及TyG指数在不同严重程度AP组间比较,差异均有统计学意义(P均<0.001)。AP严重程度与入院早期NLR及TyG指数呈显著正相关(r值分别为0.360、0.416,P<0.001)。多因素Logistic回归分析结果显示,NLR、TyG指数为预测非MAP及SAP的独立危险因素(P<0.05)。在ROC曲线中,NLR、TyG指数均对非MAP、SAP有预测价值,两者联合对AP严重程度的预测价值优于单一指标及BISAP评分。结论 入院早期NLR、TyG指数可作为预测AP严重程度的良好指标,两者联合可提高预测的准确性。

免疫微生态肠内营养方案可改善重症急性胰腺炎患者肠道菌群和预后

目的:研究免疫增强型(IE)与免疫微生态(IM)肠内营养方案对重症急性胰腺炎(SAP)患者肠道菌群及预后的影响。方法:选择86例符合早期肠内营养支持的SAP患者病例资料,采用数字表随机法分为IE组(43例)和IM组(43例),均给予相同的基础治疗和对症支持治疗,在此基础上IE组给予免疫增强型肠内营养方案,IM组给予免疫微生态肠内营养方案。治疗前、治疗7 d后取粪便标本检测并比较2组肠道菌群变化;进行急性生理学与慢性健康状况评估(APACHE)Ⅱ、Ranson及Balthazar CT评分,比较2组预后;记录2组患者并发症发生情况。结果:2组治疗7 d后双歧杆菌均较治疗前明显增加,IM组乳杆菌较治疗前明显增加,肠杆菌数量明显减少(P均<0.05)。治疗7 d后IM组双歧杆菌、乳杆菌数量明显高于IE组,肠球菌、肠杆菌数量均低于IE组(P均<0.05)。2组均无死亡病例,2组治疗7 d后Balthazar CT评分差异无统计学意义(P>0.05)。IM组住院时间短于IE组,住院费用低于IE组(P均<0.05)。IM组感染发生率明显低于IE组(16.28%vs 27.91%,P<0.05)。2组肠内营养不耐受、多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)、胰腺囊肿发生率比较,差异无统计学意义(P均>0.05)。结论:SAP患者早期应用免疫微生态肠内营养方案在改善肠道菌群和预后、降低感染方面均优于免疫增强型肠内营养方案。