C-反应蛋白评估高脂血症性急性胰腺炎严重程度的意义

发布时间：2018-03-10 16:55

本文选题：C反应蛋白　切入点：高脂血症　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的研究分析高脂血症性急性胰腺炎及非高脂血症性急性胰腺炎的临床特点，评价C反应蛋白(CRP)评估两组疾病严重程度的意义，提高临床诊治水平。方法收集2009年7月至2013年6月两所三级甲等医院收治的1073例急性胰腺炎患者的临床资料，回顾分析高脂血症性急性胰腺炎（hyperlipidemic acutepancreatitis，HLAP）与非高脂血症性急性胰腺炎（non hyperlipidemic acute pancreatitis，NHLAP）的临床特点，比较两组在年龄、性别、住院天数、复发率、合并症（糖尿病、高血压及脂肪肝）、严重程度、并发症及血清C反应蛋白浓度等有无差异，受试者工作曲线（receiver operating characteristic curve，ROC curve）分析C反应蛋白在评估高脂血症性急性胰腺炎与非高脂血症性急性胰腺炎严重程度最佳诊断阈值，多元线性回归分析影响高脂血症性急性胰腺炎患者血清C反应蛋白浓度的危险因素。结果共计1073例急性胰腺炎，高脂血症性急性胰腺炎208例，非高脂血症性急性胰腺炎865例，平均年龄51.74±17.55岁。两组在年龄、性别比例、合并症（糖尿病、高血压、脂肪肝）、局部并发症、假性囊肿发生率、复发率、重度急性胰腺炎（Balthazar CT分类标准）、中度急性胰腺炎及重度急性胰腺炎（2012亚特兰大分类标准）差异具有统计学意义(P0.05)。在腹痛至入院间隔时间（P=0.970），腹痛持续时间（P=0.809）及重度急性胰腺炎（P=0.266）(2012亚特兰大分类标准）上无统计学差异（P0.05）。高脂血症性急性胰腺炎发病1周血清C反应蛋白浓度高于非高脂血症性急性胰腺炎，差异有统计学意义（P0.05）。无论Balthazar CT分级标准还是2012年修订亚特兰大分类标准评判重度急性胰腺炎，高脂血症性急性胰腺炎患者第2、3天的血清C反应蛋白浓度均高于非高脂血症性急性胰腺炎患者血清C反应蛋白浓度。Balthazar CT分级标准分为重度急性胰腺炎中，非高脂血症性急性胰腺炎患者第3天约登指数最高，对应血清C反应蛋白最佳阈值为142.50mg/L（灵敏度69%，特异度85%），而高脂血症性急性胰腺炎患者第2天约登指数最高，C反应蛋白最佳阈值为162.75mg/L（灵敏度81%，特异度84%）。根据2012亚特兰大新分类标准分为重度急性胰腺炎的患者中，高脂血症性急性胰腺炎患者第2天约登指数最高，对应的血清C反应蛋白最佳阈值为172.95mg/L（灵敏度100%，特异度73%），而非高脂血症性急性胰腺炎患者第3天约登指数最高，血清C反应蛋白最佳阈值为197mg/L（灵敏度60%，特异度89%）。在合并有糖尿病、脂肪肝和极低密度脂蛋白升高的高脂血症性急性胰腺炎患者其C反应蛋白浓度明显增高，而女性、高密度脂蛋白升高的患者血清C反应蛋白浓度较低。结论高脂血症性急性胰腺炎具有发病率高，发病年龄轻，病情严重，复发率高，，并发症多，多合并糖尿病、脂肪肝的特点。高脂血症性急性胰腺炎病程中血清C反应蛋白浓度明显高于非高脂血症性急性胰腺炎，C反应蛋白评判高脂血症性急性胰腺炎严重程度的诊断阈值不同于非高脂血症性急性胰腺炎。高脂血症性急性胰腺炎患者血清C反应蛋白浓度升高的危险因素有：男性、糖尿病、脂肪肝、低水平高密度脂蛋白及高水平极低密度脂蛋白。
[Abstract]:Objective to study and analyze the clinical characteristics of hyperlipidemic acute pancreatitis and non hyperlipidemic acute pancreatitis, and to evaluate the significance of C reactive protein (CRP) in evaluating the severity of the two groups of diseases, so as to improve the level of clinical diagnosis and treatment.
The clinical data of 1073 cases of acute pancreatitis were collected from July 2009 to June 2013 two methods from three hospitals, retrospective analysis of hyperlipidemic acute pancreatitis (hyperlipidemic, acutepancreatitis, HLAP) and non acute hyperlipidemic pancreatitis (non hyperlipidemic acute pancreatitis, NHLAP) the clinical characteristics were compared between the two groups in age, gender, the days in hospital, recurrence rate, complications (diabetes, hypertension and fatty liver), severity, the difference of protein concentration and complications such as serum C reaction, subjects working curve (receiver operating characteristic curve, ROC curve) of C reactive protein in assessing the severity of acute hyperlipidemic pancreatitis and non high in hyperlipidemic acute pancreatitis the best diagnostic threshold, multiple linear regression analysis of the concentration of serum C in patients with hyperlipidemic acute pancreatitis. C-reactive protein Risk factors.
Results a total of 1073 cases of acute pancreatitis, hyperlipidemia and acute pancreatitis in 208 cases, non hyperlipidemic acute pancreatitis in 865 cases, mean age 51.74 + 17.55 years. The two groups in age, sex ratio, comorbidities (diabetes, hypertension, fatty liver), local complications, incidence of pseudocyst recurrence rate, severe acute pancreatitis (Balthazar CT classification), moderate acute pancreatitis and severe acute pancreatitis (2012 Atlanta classification) the difference was statistically significant (P0.05). The abdominal pain to admission time interval (P=0.970), duration of abdominal pain (P=0.809) and severe acute pancreatitis (P=0.266) (2012 Atlanta classification) have no significant difference (P0.05). The incidence of hyperlipidemia of hyperlipidemic acute pancreatitis 1 weeks serum C reactive protein concentration was higher than non hyperlipidemic acute pancreatitis, the difference was statistically significant (P0.05). Both Balthazar and CT grading standards or 2 012 years of Atlanta revised classification criteria for evaluation of severe acute pancreatitis, hyperlipidemia serum C in patients with acute pancreatitis in 2,3 days C-reactive protein concentrations were higher than those of serum C in patients with acute hyperlipidemic pancreatitis.Balthazar CT reaction protein was classified into severe acute pancreatitis in non acute hyperlipidemic pancreatitis patients was third days the highest index, the corresponding optimal threshold of serum C reactive protein 142.50mg/L (sensitivity 69%, specificity 85%), and high fat second patients with hyperlipidemic acute pancreatitis days the highest Youden index, C reactive protein, the optimum threshold value was 162.75mg/L (sensitivity 81%, specificity 84%). According to the 2012 Atlanta new classification standards are divided into severe acute pancreatitis patients in second, high fat in patients with acute pancreatitis days the highest Youden index, the best threshold value of serum C reactive protein corresponding to 172.95mg/L (sensitivity 100%, Specificity 73%), rather than high fat third patients with hyperlipidemic acute pancreatitis days the highest Youden index, serum C reactive protein 197mg/L for optimal threshold (sensitivity 60%, specificity 89%). In the combined with diabetes, hyperlipidemia and acute pancreatitis in patients with fatty liver and very low density lipoprotein increased the C reactive protein the concentration increased significantly, while women, high density lipoprotein, elevated serum C reactive protein in patients with low concentration.
Conclusion high lipid of hyperlipidemic acute pancreatitis has a high incidence rate, age, severity of illness, high recurrence rate, more complications, more complicated with diabetes, characteristics of fatty liver. Serum C in hyperlipidemic acute pancreatitis and C-reactive protein concentrations were significantly higher than those in non hyperlipidemic acute pancreatitis, diagnosis and severity of C reaction threshold protein evaluation of hyperlipidemic acute pancreatitis in non acute hyperlipidemic pancreatitis. Risk factors C-reactive protein concentrations of serum C in patients with hyperlipidemic acute pancreatitis with elevated fatty liver of male, diabetes, low levels of high density lipoprotein and high levels of very low density lipoprotein.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R657.51

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