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重症高甘油三酯性急性胰腺炎的临床特征分析
Clinical features of severe acute hypertriglyceridemic pancreatitis
文章发布日期:2019年03月07日  来源:  作者:唐永凤,唐国都,梁志海,等   点击次数:121次  下载次数:29次

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【摘要】:目的分析重症急性高甘油三酯性急性胰腺炎(HTGP)的临床特点。方法收集2013年1月-2016年6月广西医科大学第一附属医院179例中度重症急性胰腺炎(MSAP)和重症急性胰腺炎(SAP)患者资料。按病因分为4组:重症胆源性急性胰腺炎68例、重症酒精性急性胰腺炎39例、HTGP 45例及其他重症急性胰腺炎组(其他组)27例,记录前3组有明确病因患者的人口学资料、入院第1天TG水平、病因、胰腺坏死,全身并发症[急性呼吸窘迫综合征(ARDS)、急性肾功能损伤、低血压、弥散性血管内凝血],其他临床结果(是否入住ICU、住院时间、病死率)。为了进一步了解TG浓度对AP患者转归的影响,根据入院第1天TG水平不同分为血脂正常(82例)、轻度(52例)、中度(28例)、重度(17例)4组,对不同水平组全身并发症、胰腺坏死、临床结果的发生率进行分析。计量资料多组间比较采用Kruskal-Wallis H检验,计数资料组间比较采用χ2检验,采用Spearman秩相关作相关分析。结果结果显示,胆道疾病仍然是SAP的第一大病因(38%),而高甘油三酯血症成为了SAP的第二大病因(25%)。全身并发症的比较中,高甘油三酯血症组较胆源性急性胰腺炎组及酒精性急性胰腺炎组更易出现ARDS(P值分别为0.014、0.022);各TG水平组间全身并发症如ARDS、急性肾功能损伤发生率与TG水平存在正相关(r值分别为0.966、0.982,P值分别为0.004、0.019)。结论HTGP较胆源性急性胰腺炎组及酒精性急性胰腺炎组出现ARDS的发生率更高,随着TG水平升高,更容易引起ARDS、急性肾功能损伤。
【Abstract】:ObjectiveTo investigate the clinical features of severe acute hypertriglyceridemic pancreatitis (HTGP). MethodsA retrospective analysis was performed for the clinical data of 179 patients with moderate severe pancreatitis (MSAP) or severe acute pancreatitis (SAP) who were admitted to The First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2016. According to the etiology, these patients were divided into severe biliogenic acute pancreatitis (biliogenic AP) group with 68 patients, severe alcoholic acute pancreatitis (alcoholic AP) group with 39 patients, severe acute HTGP group with 45 patients, and severe acute pancreatitis group with other causes (other group) with 27 patients. Related data of the patients with clear causes in the former three groups were recorded, including demographic data, blood triglyceride (TG) level on the first day of admission, cause, pancreatic necrosis, systemic complications [acute respiratory distress syndrome (ARDS), acute renal injury, hypotension, and disseminated intravascular coagulation (DIC)], and related clinical outcomes (admission to the intensive care unit, length of hospital stay, and mortality rate). In order to investigate the influence of TG concentration on the prognosis of AP patients, the patients were divided into normal blood lipid group with 82 patients, mild dyslipidemia group with 52 patients, moderate dyslipidemia group with 28 patients, and severe dyslipidemia group with 17 patients, according to the TG level on the first day of admission, and the incidence rates of systemic complications, pancreatic necrosis, and clinical outcomes were analyzed. The Kruskal-Wallis H test was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between groups, and the Spearman rank correlation test was used for correlation analysis. ResultsBiliary tract disease remained the leading cause of SAP (38%), followed by hypertriglyceridemia (25%). As for systemic complications, the HTGP group had a significantly higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group (P=0.014 and 0022). In the groups with different TG levels, the incidence rates of ARDS and acute renal injury were positively correlated with TG level (r=0.966 and 0.982, P=0.004 and 0.019). ConclusionThe HTGP group has a higher incidence rate of ARDS than the biliogenic AP group and the alcoholic AP group, and the risk of ARDS and acute renal injury tends to increase with the increasing TG level.
【关键字】:胰腺炎, 急性坏死性; 高甘油三酯血症; 体征和症状
【Key words】:pancreatitis, acute necrotizing; hypertriglyceridemia; signs and symptoms
【引证本文】:TANG YF, TANG GD, LIANG ZH, et al. Clinical features of severe acute hypertriglyceridemic pancreatitis[J]. J Clin Hepatol, 2019, 35(4): 830-834. (in Chinese)
唐永凤, 唐国都, 梁志海, 等. 重症高甘油三酯性急性胰腺炎的临床特征分析[J]. 临床肝胆病杂志, 2019, 35(4): 830-834.

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