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非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析

梅佩 张正乐 陶京

梅佩, 张正乐, 陶京. 非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析[J]. 临床肝胆病杂志, 2021, 37(1): 94-98. DOI: 10.3969/j.issn.1001-5256.2021.01.019
引用本文: 梅佩, 张正乐, 陶京. 非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析[J]. 临床肝胆病杂志, 2021, 37(1): 94-98. DOI: 10.3969/j.issn.1001-5256.2021.01.019
MEI P, ZHANG ZL, TAO J. Association of nonalcoholic fatty liver disease with the severity of hyperlipidemic acute pancreatitis[J]. J Clin Hepatol, 2021, 37(1): 94-98. DOI: 10.3969/j.issn.1001-5256.2021.01.019
Citation: MEI P, ZHANG ZL, TAO J. Association of nonalcoholic fatty liver disease with the severity of hyperlipidemic acute pancreatitis[J]. J Clin Hepatol, 2021, 37(1): 94-98. DOI: 10.3969/j.issn.1001-5256.2021.01.019

非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析

DOI: 10.3969/j.issn.1001-5256.2021.01.019
基金项目: 

国家自然科学基金 81803030

详细信息
    作者简介:

    梅佩(1993—),女,主要从事胰腺病的治疗研究

    通讯作者:

    陶京,tj918@163.com

  • 利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突,特此声明。
  • 作者贡献声明:梅佩参与收集数据,资料分析和撰写论文;张正乐负责课题设计和拟定写作思路;陶京负责修改论文,指导撰写文章并最后定稿。
  • 中图分类号: R575.5;R657.51

Association of nonalcoholic fatty liver disease with the severity of hyperlipidemic acute pancreatitis

  • 摘要:   目的  探讨非酒精性脂肪性肝病(NAFLD)与高脂血症性急性胰腺炎(HLAP)严重程度的相关性。  方法  回顾性选取2018年2月20日—2020年1月20日武汉大学人民医院胰腺外科收治的895例急性胰腺炎患者,从中筛选出101例HLAP患者。根据患者是否合并NAFLD,将患者分为非脂肪肝组(41例)和脂肪肝组(60例)。收集患者的临床资料,包括一般资料(性别、年龄、BMI、糖尿病、高血压)、生化指标(淀粉酶、脂肪酶、ALT、AST、Alb、TBil、血尿素、血肌酐、血糖、血钠、血钙、胆固醇、TG、乳酸脱氢酶、超敏C反应蛋白)水平、WBC水平、AP严重度、CT扫描下的局部并发症、系统性炎症反应综合征、菌血症、器官衰竭情况及患者住院和HLAP复发情况(住院时间、ICU入住率、HLAP的1年内复发率及HLAP的1年内发病次数)。符合正态分布的计量资料两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验或Fisher检验。  结果  脂肪肝组患者入院时血糖、WBC水平高于与非脂肪肝组,血钠水平低于非脂肪肝组,差异有统计学意义(Z=-2.241、t=2.187、t=-2.533,P值均<0.05)。脂肪肝组患者与非脂肪肝组相比中重症AP比例更高,差异有统计学意义(75.0% vs 53.7%,χ2=4.968,P<0.05),且脂肪肝组患者的局部并发症、系统性炎症反应综合征、菌血症和呼吸衰竭的发生率较高,差异均有统计学意义(χ2值分别为6.059、4.611、4.056、4.568,P值均<0.05)。两组患者住院时间差异无统计学意义(P>0.05),而脂肪组患者的ICU入住率较高(7.3% vs 23.3%,χ2=4.463,P<0.05)。此外,两组患者HLAP的1年内复发率及HLAP的1年内发病次数差异均无统计学意义(P值均>0.05)。  结论  NAFLD与HLAP严重程度具有明显的相关性。NAFLD可能在HLAP的早期病情评估、疾病进展及预测预后中具有重要的作用。
  • 表  1  两组患者一般资料及实验室指标比较

    项目 非脂肪肝组(n=41) 脂肪肝组(n=60) 统计值 P
    男[例(%)] 24(58.5) 44(73.3) χ2=2.424 0.119
    年龄(岁) 43.02±11.41 40.70±9.96 t=1.085 0.280
    BMI(kg/m2) 26.43±1.09 26.74±1.18 t=-0.984 0.236
    糖尿病[例(%)] 9(22.0) 13(21.7) χ2=0.001 0.973
    高血压[例(%)] 7(17.1) 12(20.0) χ2=0.137 0.712
    淀粉酶(U/L) 252.0(94.0~530.5) 227.0(88.5~545.5) Z=0.104 0.917
    脂肪酶(U/L) 1243.00(473.00~4678.00) 1640.00(449.75~4657.00) Z=-0.332 0.740
    ALT(U/L) 19.0(14.0~29.5) 24.0(15.0~35.0) Z=-1.097 0.273
    AST(U/L) 25.00(19.00~36.00) 25.00(18.00~36.25) Z=0.488 0.626
    Alb(g/L) 38.73±6.53 40.17±5.90 t=-1.146 0.254
    TBil(μmol/L) 12.80(10.32~19.64) 13.97(10.65~19.02) Z=-0.322 0.748
    尿素(mmol/L) 4.25(3.21~5.43) 4.15(3.20~5.63) Z=0.508 0.611
    肌酐(μmol/L) 60.0(46.5~75.5) 54.5(44.0~72.0) Z=0.747 0.455
    血糖(mmol/L) 8.90(6.93~14.35) 12.34(8.07~16.10) Z=-2.241 0.025
    血钠(mmol/L) 137.050±5.579 134.830±4.542 t=2.187 0.031
    血钙(mmol/L) 2.10(1.95~2.24) 2.14(1.99~2.27) Z=-0.668 0.504
    胆固醇(mmol/L) 7.05(5.46~10.99) 7.70(6.20~11.45) Z=-0.861 0.389
    TG (mmol/L) 13.43±5.19 14.24±5.13 t=-0.767 0.445
    乳酸脱氢酶(U/L) 289.50(195.50~572.25) 271.75(242.75~313.25) Z=0.574 0.566
    超敏C反应蛋白(mg/L) 54.01(11.14~181.00) 128.57(39.74~174.38) Z=-1.010 0.313
    WBC(109/L) 11.07±4.76 13.36±4.21 t=-2.533 0.013
    下载: 导出CSV

    表  2  两组患者AP分型及并发症发生情况比较[例(%)]

    项目 非脂肪肝组(n=41) 脂肪肝组(n=60) χ2 P
    AP分型[例(%)] 4.968 0.026
     轻症 19(46.3) 15(25.0)
     中重症 22(53.7) 45(75.0)
    并发症[例(%)]
     局部并发症 6.059 0.048
      急性坏死物积聚 5(12.2) 16(26.7)
      感染性胰腺坏死 2(4.9) 8(13.3)
    SIRS 13(31.7) 32(53.3) 4.611 0.032
    菌血症 8(19.5) 23(38.3) 4.056 0.044
    弥漫性血管内凝血 6(14.6) 10(16.7) 0.075 0.784
    呼吸衰竭 7(17.1) 22(36.7) 4.568 0.033
    循环衰竭 4(9.8) 8(13.3) 0.054 0.816
    肾衰竭 2(4.9) 1(1.7) 0.113 0.736
    器官衰竭>48 h 3(7.3) 9(15.0) 0.737 0.390
    下载: 导出CSV

    表  3  两组患者住院及复发情况对比

    项目 非脂肪肝组(n=41) 脂肪肝组(n=60) 统计值 P
    住院时间(d) 15.0(10.5~27.0) 19.5(13.0~30.5) Z=-1.308 0.191
    ICU入住率[例(%)] 3(7.3) 14(23.3) χ2=4.463 0.035
    HLAP的1年内复发率[例(%)] 16(39.0) 20(33.3) χ2=0.344 0.558
    HLAP的1年内发病次数(次) 1(1~2) 1(1~2) Z=0.611 0.541
    下载: 导出CSV
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  • 收稿日期:  2020-07-11
  • 修回日期:  2020-08-28
  • 刊出日期:  2021-01-18
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