57例高脂血症性急性胰腺炎的临床特征分析

发布时间：2018-05-10 11:11

本文选题：高脂血症 + 急性胰腺炎　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:本文旨在通过对临床病例的回顾性总结,对比高脂血症性急性胰腺炎与急性胆源性胰腺炎的临床特征,提高临床工作对HLAP的诊断、治疗水平。方法:收集兰州大学第一医院自2013年1月至2016年11月收治的57例明确诊断,且病例资料完整的高脂血症性急性胰腺炎(Hyperlipidmia acute pancreatitis,HLAP)的患者资料,同时用随机抽样的方法抽取同时期60例明确诊断为急性胆源性胰腺炎(Acute biliary pancreatitis,ABP),且病例资料完整的患者为对照组。收集两组患者的一般情况、实验室检查、影像学检查、病情严重程度、伴随疾病、并发症、治疗及效果等数据资料,对所得的数据采用Excel表及SPSS21.0软件进行数据记录及统计分析。结果:(1)基本情况:HLAP组患者年龄较ABP组低,但体质指数(BMI)相对较高,差异具有统计学意义(P0.05),而住院日期、性别无明显统计学意义(P0.05);(2)血脂:HLAP组患者甘油三酯(TG)、总胆固醇(CHOL)水平显著高于ABP组,差异具有统计学意义(P0.05),而高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDH-C)则无明显统计学意义(P0.05);(3)生化及血常规:ABP组患者天冬氨酸氨基转移酶(AST)、谷丙氨酸转氨酶(ALT)、总胆红素(TBIL)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)及尿素氮(BUN)水平均显著高于HLAP组,差异具有统计学意义(P0.05);HLAP组葡萄糖(GLU)、胆碱酯酶(CHE)、钙离子(Ca2+)水平及白细胞(WBC)水平均高于ABP组,差异具有统计学意义(P0.05),其余血淀粉酶(AMY)、尿淀粉酶(UAMY)、乳酸脱氢酶(LDH)、血肌酐(Crea)水平及中性粒细胞百分比(NEUT%)则无统计学意义(P0.05);(4)临床症状的对比中,HLAP组伴随糖尿病、脂肪肝的患者比ABP组多,但临床表现为黄疸、发热以及并发胰腺坏死及肝功能异常的较ABP组少,差异具有统计学意义(P0.05);(5)HLAP组患者表现为重症急性胰腺炎(SAP)的显著高于ABP组,与MCTSI评分结果一致,差异具有统计学意义(P0.05)。HLAP组患者手术率明显低于ABP组,差异具有统计学意义(P0.05);而两组在死亡率、复发率进行比较,差异无统计学意义(P0.05);(6)将HLAP组患者分为非重症组及重症组进行对比,重症组患者GLU水平、MCTSI评分以及BISAP评分明显高于非重症组,差异具有统计学意义(P0.05)。而在一般情况、血脂、生化、伴随糖尿病、脂肪肝、治疗效果等方面的比较两组患者无明显统计学差异(P0.05)。结论:(1)HLAP组发病多为中青年患者,其中男性患者较多;(2)HLAP患者TG显著升高,治疗中应积极降脂治疗;(3)HLAP组患者伴随糖尿病、脂肪肝的较多;(4)ALT、AST、ALP、GGT等肝功等指标可以辅助ABP的诊断肝功等指标可以辅助ABP的诊断。
[Abstract]:Objective: to compare the clinical features of hyperlipidemic acute pancreatitis and acute biliary pancreatitis by reviewing the clinical cases and to improve the clinical diagnosis and treatment of HLAP. Methods: from January 2013 to November 2016, 57 patients with hyperlipidmia and hyperlipidemia acute were collected from the first Hospital of Lanzhou University from January 2013 to November 2016. At the same time, 60 cases of acute biliary pancreatitis with complete data were selected as control group by random sampling in the same period. The data of two groups of patients were collected, such as general condition, laboratory examination, imaging examination, severity of the disease, concomitant disease, complications, treatment and effect. The data were recorded and analyzed by Excel table and SPSS21.0 software. Results the age of HLAP group was lower than that of ABP group, but the body mass index (BMI) was higher, the difference was statistically significant (P 0.05). There was no significant difference in sex (P 0.05). The serum levels of triglyceride and total cholesterol in HLAP group were significantly higher than those in ABP group. The difference was statistically significant (P 0.05), but high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDH-C) had no statistical significance. The levels of total bilirubin, alkaline phosphatase, glutamyl transpeptidase (GGTT) and urea nitrogen bun were significantly higher than those in HLAP group. There were significant differences in the levels of GLU, che, Ca 2 + and WBC in HLAP group compared with those in ABP group. The difference was statistically significant (P 0.05). There was no significant difference in the levels of serum amylase, urine amylase, lactate dehydrogenase (LDH), creatinine (crea) and neutrophilic granulocyte (n = 4). There was no significant difference in the clinical symptoms of HLAP with diabetes mellitus. There were more patients with fatty liver than those with ABP, but there were fewer patients with jaundice, fever, complicated pancreatic necrosis and abnormal liver function than those with ABP. The difference was statistically significant (P 0.05). The number of patients with severe acute pancreatitis (ABP) was significantly higher than that of ABP. In accordance with the MCTSI score, the operative rate of patients in the group of P0.05 + HLAP was significantly lower than that in the group of ABP, and the difference was statistically significant (P 0.05), and the mortality rate and recurrence rate were compared between the two groups. There was no significant difference (P 0.05). The HLAP group was divided into non-severe group and severe group for comparison. The GLU level and BISAP score of severe group were significantly higher than that of non-severe group, the difference was statistically significant (P 0.05). But in the general situation, blood lipid, biochemistry, concomitant diabetes mellitus, fatty liver, curative effect and so on aspect comparison two groups patient not to have the obvious statistical difference (P 0.05). Conclusion the incidence of HLAP group is mostly middle and young patients, among which the TG of male patients is higher than that of male patients, so it is necessary to treat the patients with diabetes mellitus by reducing blood lipid actively. The indexes of liver function, such as liver function of fatty liver such as alt, ALP, GGT and so on, can be used to assist the diagnosis of ABP and other indexes of liver function, which can assist in the diagnosis of ABP.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576;R589.2

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