44例高脂血症性急性胰腺炎的临床特点分析
发布时间：2018-10-05 16:11
【摘要】：目的 通过对高脂血症性急性胰腺炎(Hyperlipidemic acute pancreatitis,HLAP)和胆源性急性胰腺炎(Acute biliary pancreatitis,ABP)的临床资料的对比分析,总结HLAP的临床特点,为其诊断、严重程度评估、治疗方案确定及预后判断提供指导。方法 收集宁夏医科大学总医院2013年1月-2016年1月明确诊断为急性胰腺炎(Acute pancreatitis,AP)并住院治疗的患者完整资料,按纳入标准和排除标准,最后确定135例病例资料入选。将研究对象按病因分为ABP组91例和HLAP组44例,将HLAP患者按病情严重程度分为轻度(MAP)和重度(SAP),记为HL-MAP组25例和HL-SAP组19例。收集所有患者入院时间与发病时间间隔在24小时之内,且未经治疗患者的一般资料、实验室指标、影像学检查、改良CT严重指数评分、合并症、并发症及病情严重程度等方面的数据信息,对两组资料进行统计学分析。结果 (1)与ABP组比较,HLAP组中男性患者比例及体重指数(BMI)明显升高,差异具有显著性(P0.05);HLAP组发病年龄明显低于ABP组,差异具有极显著性(P=0.000);HLAP组中平均住院日均高于ABP组,但差异无统计学意义(P0.05);(2)HLAP组的AMY、TBIL、ALT、AST水平均明显低于ABP组,差异具有极显著性(P=0.000);HLAP组的PBLC、TG、TC及Glu水平明显高于ABP组,差异有显著性(P0.05);(3)HLAP组中伴随糖尿病、脂肪肝、肥胖与并发胸腔积液、肺部感染者比例明显高于ABP组,差异具有显著性(P0.05)。而HLAP组伴随高血压者比例明显低于ABP组,差异具有显著性(P0.05);两组比较,在并发胰腺坏死、多脏器功能不全、脓毒症、胰腺假性囊肿、腹腔积液、盆腔积液等并发症方面,差异无统计学意义(P0.05);(4)治疗后与治疗前比较:HLAP组:TG水平明显降低,差异具有极显著性(P=0.000),而ALT水平、AST水平无显著改变(P0.05);ABP组:治疗后ALT水平、AST水平明显降低,差异具有显著性(P0.05),而TG水平无显著改变(P0.05);(5)HL-SAP组伴随糖尿病、并发胸腔积液、腹腔积液及肺部感染的比例明显高于HL-MAP组,差异具有显著性(P0.05),而在伴随高血压、脂肪肝和肥胖者方面差异无显著性(P0.05);(6)将HLAP患者的胸腔积液数据形成ROC曲线,其预测HL-SAP的AUC为0.729(95%CI:0.571-0.888,P=0.010),提示胸腔积液对预测SAP有较好的能力。结论 (1)HLAP好发于中青年男性,血淀粉酶升高不明显。(2)HLAP患者大多存在严重的脂代谢及糖代谢紊乱,常合并糖尿病、脂肪肝、肥胖等疾病,病情较重,易出现多种并发症。(3)ABP组更易并发肝功能损害,且治疗后肝功能较易恢复。(4)胸腔积液有较好预测HL-SAP的效能。
[Abstract]:Objective to compare and analyze the clinical data of hyperlipidemic acute pancreatitis (Hyperlipidemic acute pancreatitis,HLAP) and biliary acute pancreatitis (Acute biliary pancreatitis,ABP), and to summarize the clinical features of HLAP, and to evaluate the severity of HLAP. The determination of treatment plan and the judgment of prognosis provide guidance. Methods the complete data of patients with acute pancreatitis (Acute pancreatitis,AP) diagnosed and hospitalized in Ningxia Medical University General Hospital from January 2013 to January 2016 were collected and selected according to the inclusion criteria and exclusion criteria. The subjects were divided into ABP group (n = 91) and HLAP group (n = 44) according to the etiology. Patients with HLAP were divided into mild (MAP) group (n = 25), severe (SAP), group (n = 25) and HL-SAP group (n = 19). The general data, laboratory indexes, imaging examination, modified CT severity index score, complications were collected from all patients within 24 hours of hospitalization and onset. The complications and severity of the disease were analyzed statistically. Results (1) compared with ABP group, the percentage of male patients and body mass index (BMI) in HLAP group were significantly higher than those in ABP group (P0.05). The mean hospitalization days in HLAP group were significantly higher than those in ABP group. But there was no significant difference (P0.05); (2) AMY,TBIL,ALT,AST levels in HLAP group were significantly lower than those in ABP group. The PBLC,TG,TC and Glu levels in HLAP group were significantly higher than those in ABP group (P0.05). The difference was significant (P0.05) in HLAP group with diabetes, fatty liver, obesity and complicated with pleural effusion. The proportion of pulmonary infection was significantly higher than that of ABP group (P0.05). However, the proportion of patients with hypertension in HLAP group was significantly lower than that in ABP group (P0.05). The complications of complicated pancreatic necrosis, multiple organ dysfunction, sepsis, pancreatic pseudocyst, peritoneal effusion and pelvic effusion were compared between the two groups. There was no significant difference between the two groups (P0.05); (4). After treatment, the level of ALT decreased significantly (P0. 000), but the level of ALT was not significantly changed (P0.05). After treatment, the levels of ALT and AST decreased significantly in the control group, and there was no significant difference between the two groups (P0.05) after treatment, the level of ALT was significantly decreased in the control group (P < 0. 05), but no significant change was found in the level of ALT. The difference was significant (P0.05), but the level of TG had no significant change (P0.05); (5). The incidence of diabetes, pleural effusion, celiac effusion and pulmonary infection in HL-SAP group was significantly higher than that in HL-MAP group (P0.05). There was no significant difference between fatty liver and obese patients (P0.05); (6). The pleural effusion data of HLAP patients formed ROC curve, and the AUC of predicting HL-SAP was 0.729 (95CI: 0.571-0.888P0.010), which suggested that pleural effusion had a better ability to predict SAP. Conclusion (1) HLAP is more common in young and middle-aged men, and the increase of serum amylase is not obvious. (2) most of the patients with HLAP have serious disorder of lipid metabolism and glucose metabolism, and are often complicated with diabetes, fatty liver, obesity and other diseases. (3) ABP group was more prone to complicated liver function damage, and the liver function recovered easily after treatment. (4) pleural effusion had a good predictive effect on HL-SAP.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
本文编号：2254028
[Abstract]:Objective to compare and analyze the clinical data of hyperlipidemic acute pancreatitis (Hyperlipidemic acute pancreatitis,HLAP) and biliary acute pancreatitis (Acute biliary pancreatitis,ABP), and to summarize the clinical features of HLAP, and to evaluate the severity of HLAP. The determination of treatment plan and the judgment of prognosis provide guidance. Methods the complete data of patients with acute pancreatitis (Acute pancreatitis,AP) diagnosed and hospitalized in Ningxia Medical University General Hospital from January 2013 to January 2016 were collected and selected according to the inclusion criteria and exclusion criteria. The subjects were divided into ABP group (n = 91) and HLAP group (n = 44) according to the etiology. Patients with HLAP were divided into mild (MAP) group (n = 25), severe (SAP), group (n = 25) and HL-SAP group (n = 19). The general data, laboratory indexes, imaging examination, modified CT severity index score, complications were collected from all patients within 24 hours of hospitalization and onset. The complications and severity of the disease were analyzed statistically. Results (1) compared with ABP group, the percentage of male patients and body mass index (BMI) in HLAP group were significantly higher than those in ABP group (P0.05). The mean hospitalization days in HLAP group were significantly higher than those in ABP group. But there was no significant difference (P0.05); (2) AMY,TBIL,ALT,AST levels in HLAP group were significantly lower than those in ABP group. The PBLC,TG,TC and Glu levels in HLAP group were significantly higher than those in ABP group (P0.05). The difference was significant (P0.05) in HLAP group with diabetes, fatty liver, obesity and complicated with pleural effusion. The proportion of pulmonary infection was significantly higher than that of ABP group (P0.05). However, the proportion of patients with hypertension in HLAP group was significantly lower than that in ABP group (P0.05). The complications of complicated pancreatic necrosis, multiple organ dysfunction, sepsis, pancreatic pseudocyst, peritoneal effusion and pelvic effusion were compared between the two groups. There was no significant difference between the two groups (P0.05); (4). After treatment, the level of ALT decreased significantly (P0. 000), but the level of ALT was not significantly changed (P0.05). After treatment, the levels of ALT and AST decreased significantly in the control group, and there was no significant difference between the two groups (P0.05) after treatment, the level of ALT was significantly decreased in the control group (P < 0. 05), but no significant change was found in the level of ALT. The difference was significant (P0.05), but the level of TG had no significant change (P0.05); (5). The incidence of diabetes, pleural effusion, celiac effusion and pulmonary infection in HL-SAP group was significantly higher than that in HL-MAP group (P0.05). There was no significant difference between fatty liver and obese patients (P0.05); (6). The pleural effusion data of HLAP patients formed ROC curve, and the AUC of predicting HL-SAP was 0.729 (95CI: 0.571-0.888P0.010), which suggested that pleural effusion had a better ability to predict SAP. Conclusion (1) HLAP is more common in young and middle-aged men, and the increase of serum amylase is not obvious. (2) most of the patients with HLAP have serious disorder of lipid metabolism and glucose metabolism, and are often complicated with diabetes, fatty liver, obesity and other diseases. (3) ABP group was more prone to complicated liver function damage, and the liver function recovered easily after treatment. (4) pleural effusion had a good predictive effect on HL-SAP.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
【参考文献】
相关期刊论文 前10条
1 黄忠;李智;;胸腔积液及高脂血症对重症急性胰腺炎发生的预测作用[J];华西医学;2016年01期
2 张冬磊;郝建宇;杨宁;;高脂血症性急性胰腺炎患者D-二聚体和凝血指标的变化及其与血钙的关系[J];中国病案;2015年10期
3 徐贤刚;石承先;汤可立;钟浩丽;张德林;张帅民;罗丹;;豚鼠不全性胆道梗阻早期Oddi括约肌功能的变化[J];中国普通外科杂志;2015年02期
4 王晶;任丽梅;孟宪梅;张静洁;;急性胰腺炎合并急性肺损伤与血清中IL-6变化的关联性研究[J];中国临床新医学;2014年12期
5 黄晓丽;王国品;王平;于成功;;不同发病原因急性胰腺炎严重程度及并发症、死亡率的比较[J];世界华人消化杂志;2014年27期
6 李文科;王东;;高脂血症性胰腺炎研究进展[J];中国全科医学;2013年30期
7 吴红军;李荣霞;李毅;于学忠;;重症急性胰腺炎血浆D-二聚体变化的临床研究[J];中国危重病急救医学;2012年11期
8 黄玲;徐萍;史先芳;朱佳莉;杨小娟;李清华;徐凯;;三种评分标准对急性胰腺炎病情和预后的评估作用[J];中华消化杂志;2012年06期
9 张瑜红;唐国都;;134例重症急性胰腺炎回顾性分析[J];广西医科大学学报;2011年04期
10 张瑜红;唐国都;;高脂血症性胰腺炎的临床研究[J];中华临床医师杂志(电子版);2011年09期
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