甘油三酯水平与急性高甘油三酯血症性胰腺炎严重程度的关系

高峰; 闫真; 张杰

doi:10.3969/j.issn.1001-5256.2018.11.018

甘油三酯水平与急性高甘油三酯血症性胰腺炎严重程度的关系

DOI: 10.3969/j.issn.1001-5256.2018.11.018

首都医科大学附属北京安贞医院消化内科

基金项目:

国家自然科学基金(NSFC81470889)；

详细信息

中图分类号: R576
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出版历程
- 出版日期: 2018-11-20

Association between triglyceride level and the severity of acute hypertriglyceridemic pancreatitis

Research funding:

摘要

摘要:
目的探讨血清甘油三酯（TG）水平与急性高甘油三酯血症性胰腺炎（AHTGP）严重程度之间的关系。方法回顾性分析2015年9月-2018年6月在首都医科大学附属北京安贞医院住院治疗的63例AHTGP患者,根据亚特兰大新分类标准,分为轻症急性胰腺炎组（MAP组,n=32）、中度重症急性胰腺炎组（MSAP,n=20）和重症急性胰腺炎（SAP,n=11）。记录AHTGP患者入院时和入院后48 h血清TG水平。符合正态分布的计量资料多组间比较采用单因素方差分析,不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料多组间比较采用χ2检验; Spearman相关性分析用于评价数据间的相关性,受试者工作特征曲线（ROC曲线）用于评价指标的诊断效能。结果 3组患者入院后48 h血清TG水平、急性生理与慢性健康评分Ⅱ、改良CT严重程度指数、急性胰腺炎床旁严重程度指数和Ranson评分比较差异均有统计学意义（F=14. 423,χ2值分别为44. 094、39. 654、30. 445、29. 426,P值均<0. 05）。入院...
- 胰腺炎 /
- 高甘油三酯血症 /
- 疾病严重程度指数
Abstract:
Objective To investigate the association between serum triglyceride ( TG) level and the severity of acute hypertriglyceridemic pancreatitis ( AHTGP) . Methods A retrospective analysis was performed for the clinical data of 63 patients with AHTGP who were hospitalized and treated in Beijing Anzhen Hospital, Capital Medical University, from September 2015 to June 2018, and according to the new Atlanta classification criteria, these patients were divided into mild acute pancreatitis ( MAP) group with 32 patients, moderate-severe acute pancreatitis ( MSAP) group with 20 patients, and severe acute pancreatitis ( SAP) group with 11 patients. Serum TG level was recorded on admission and at 48 hours after admission. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between multiple groups; the Spearman correlation analysis was used to evaluate the correlation between data; the receiver operating characteristic ( ROC) curve was used to evaluate the diagnostic efficacy of assessment indices. Results There were significant differences between the three groups in serum TG level at 48 hours after admission, Acute Physiology and Chronic Health Evaluation II ( APACHE II) score, modified CT severity index, bedside index for severity of acute pancreatitis, and Ranson score ( F = 14. 423, χ2= 44. 094, 39. 654, 30. 445, and 29. 426, all P < 0. 05) . Serum TG level on admission was only positively correlated with Ranson score ( r = 0. 491, P < 0. 001) ; serum TG level at 48 hours after admission were positively correlated with the new Atlanta classification criteria, APACHE II score, modified CT severity index, bedside index for severity of acute pancreatitis, and Ranson score ( r = 0. 396, 0. 392, 0. 400, 0. 476, and 0. 400, all P < 0. 05) . The areas under the ROC curve of serum TG level on admission and at 48 hours after admission in predicting disease severity were 0. 652 ( P = 0. 115) and 0. 895 ( P < 0. 001) , respectively, with optimal cut-off values of 34. 10 mmol/L and 6. 95 mmol/L, respectively. Conclusion Serum TG level at 48 hours after admission has a certain clinical value in predicting the severity of AHTGP.
- pancreatitis /
- hypertriglyceridemia /
- severity of illness index

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参考文献(28)

[1] SCHERER J, SINGH V, PITCHUMONI CS, et al. Issues in hypertriglyceridemic pancreatitis-an update[J]. J Clin Gastroenterol, 2014, 48 (3) :195-203.

[2] BRISINDA G, VANELLA S, CROCCO A, et al. Severe acute pancreatitis:Advances and insights in assessment of severity and management[J]. Eur J Gastroenterol Hepatol, 2011, 23 (7) :541-551.

[3] ZHU Y, PAN X, ZENG H, et al. A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised atlanta classification in Jiangxi, China over an 8-year period[J]. Pancreas, 2017, 46 (4) :504-509.

[4] BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis-2012:Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62 (1) :102-111.

[5] KUO DC, RIDER AC, ESTRADA P, et al. Acute pancreatitis:what's the score?[J]. J Emerg Med, 2015, 48 (6) :762-770.

[6] PAPACHRISTOU GI, MUDDANA V, YADAV D, et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis[J]. Am J Gastroenterol, 2010, 105 (2) :435-441.

[7] BOHARA TP, LAUDARI U, PARAJULI A, et al. Prospective validation of a decision tree model for prediction of severity in acute pancreatitis[J]. J Nepal Health Res Counc, 2018, 16 (2) :239-244.

[8] JIN DX, LACSON R, COCHON LR, et al. A clinical model for the early diagnosis of acute pancreatitis in the emergency department[J]. Pancreas, 2018, 47 (7) :871-879.

[9] VALVERDE-LOPEZ F, MATAS-COBOS AM, ALEGRIAMOTTE C, et al. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort[J]. J Gastroenterol Hepatol, 2017, 32 (9) :1649-1656.

[10] WANG B, QI WJ, WANG H. Clinical study on the predictive value of procalcitonin in patients with severe acute pancreatitis[J]. J Clin Exp Med, 2017, 16 (11) :1110-1113. (in Chinese) 王宾, 齐文杰, 王红.降钙素原在重症急性胰腺炎中预测价值的临床研究[J].临床和实验医学杂志, 2017, 16 (11) :1110-1113.

[11] ANDERSON F, THOMSON SR, CLARKE DL, et al. Dyslipidaemic pancreatitis clinical assessment and analysis of disease severity and outcomes[J]. Pancreatology, 2009, 9 (3) :252-257.

[12] BALACHANDRA S, VIRLOS IT, KING NK, et al. Hyperlipidaemia and outcome in acute pancreatitis[J]. Int J Clin Prac, 2006, 60 (2) :156-159.

[13] VALDIVIELSO P, RAMIREZ-BUENO A, EWALD N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med, 2014, 25 (8) :689-694.

[14] Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association, Editorial Board of Chinese Journal of Pancreatology, Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shanghai, 2013) [J]. J Clin Hepatol, 2013, 29 (9) :656-660. (in Chinese) 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会.中国急性胰腺炎诊治指南 (2013年, 上海) [J].临床肝胆病杂志, 2013, 29 (9) :656-660.

[15] TAI WP, LIN XC, LIU H, et al. A retrospective research of the characteristic of hypertriglyceridemic pancreatitis in Beijing, China[J]. Gastroenterol Res Pract, 2016, 2016:6263095.

[16] PAN G, CHEN YF, CAI J, et al. The clinical value of clinical characteristics and prognosis of elderly patients with hyperlipidemic acute pancreatitis[J]. Chin J Med Offic, 2016, 44 (6) :579-582. (in Chinese) 潘刚, 陈亚峰, 蔡杰, 等.老年高脂血症性急性胰腺炎临床特点及预后评估因素分析[J].临床军医杂志, 2016, 44 (6) :579-582.

[17] HU WL. Risk factors for hypertriglyceridemia induced acute pancreatitis[J]. J Clin Hepatol, 2017, 33 (8) :1518-1521. (in Chinese) 胡维林.高甘油三脂血症相关性急性胰腺炎发病的危险因素分析[J].临床肝胆病杂志, 2017, 33 (8) :1518-1521.

[18] BAI YL, DANG RF. Influencing factors for acute pancreatitis in patients with type 2 diabetes complicated by hypertriglyceridemia[J].J Clin Hepatol, 2017, 33 (12) :2350-2354. (in Chinese) 白云磊, 党润芳. 2型糖尿病并发高甘油三酯血症息者发生急性胰腺炎的影响因素分析[J].临床肝胆病杂志, 2017, 33 (12) :2350-2354.

[19] SAHARIA P, MARGOLIS S, ZUIDEMA GD, et al. Acute pancreatitis with hyperlipemia:Studies with an isolated perfused canine pancreas[J]. Surgery, 1977, 82 (1) :60-67.

[20] KIMURA W, MOSSNER J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancre-atitis in rats[J]. Int J Pancreatol, 1996, 20 (3) :177-184.

[21] ZENG Y, WANG X, ZHANG W, et al. Hypertriglyceridemia aggravates ER stress and pathogenesis of acute pancreatitis[J]. Hepatogastroenterology, 2012, 59 (119) :2318-2326.

[22] LI J, SHANG ZH, CHEN EM. Endoplasmic reticulum stress is involved in hyperlipidemic pancreatitis[J]. China Med, 2018, 13 (3) :474-477. (in Chinese) 李菁, 商中华, 陈恩明.内质网应激参与高脂血症相关胰腺炎的研究进展[J].中国医药, 2018, 13 (3) :474-477.

[23] HE WH, LYU NH. The diagnosis and treatment of hypertriglyceridemic pancreatitis[J]. Chin J Intern Med, 2018, 57 (2) :149-151. (in Chinese) 何文华, 吕农华.高甘油三酯血症性胰腺炎的诊治[J].中华内科杂志, 2018, 57 (2) :149-151.

[24] LEI CH, LIN YF. Dachaihu decoction combined with immune three oxygen blood transfusion in the treatment of hyperlipidemic pancreatiti[J]. Trauma Crit Med, 2018, 6 (2) :103-105. (in Chinese) 雷春红, 林一帆.大柴胡汤联合免疫三氧血回输治疗高脂血症性胰腺炎疗效观察[J].创伤与急危重病医学, 2018, 6 (2) :103-105.

[25] WASSAY SAM, DAR FJ, SALEH AK, et al. Role of therapeutic plasma exchange in the treatment of severe hypertriglyceridemia:An experience[J]. Ther Adv Endocrinol Metab, 2017, 8 (12) :169-172.

[26] CLICK B, KETCHUM AM, TURNER R, et al. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis:A systematic review[J]. Pancreatology, 2015, 15 (4) :313-320.

[27] WINTERS JL, American Society for Apheresis. American Society for Apheresis guidelines on the use of apheresis in clinical practice:Practical, concise, evidence-based recommendations for the apheresis practitioner[J]. J Clin Apher, 2014, 29 (4) :191-193.

[28] LI ZJ. Correlation between severity of acute pancreatitis and abnormal lipid metabolism and its prognosis[J]. J Clin Intern Med, 2014, 31 (3) :183-185. (in Chinese) 李志娟.急性胰腺炎严重程度与血脂代谢异常的相关性及其预后研究[J].临床内科杂志, 2014, 31 (3) :183-185.

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