本文選題：C反應蛋白　切入點：高脂血癥　出處：《蘇州大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的研究分析高脂血癥性急性胰腺炎及非高脂血癥性急性胰腺炎的臨床特點，評價C反應蛋白(CRP)評估兩組疾病嚴重程度的意義，提高臨床診治水平。 方法收集2009年7月至2013年6月兩所三級甲等醫(yī)院收治的1073例急性胰腺炎患者的臨床資料，回顧分析高脂血癥性急性胰腺炎（hyperlipidemic acutepancreatitis，HLAP）與非高脂血癥性急性胰腺炎（non hyperlipidemic acute pancreatitis，NHLAP）的臨床特點，比較兩組在年齡、性別、住院天數(shù)、復發(fā)率、合并癥（糖尿病、高血壓及脂肪肝）、嚴重程度、并發(fā)癥及血清C反應蛋白濃度等有無差異，受試者工作曲線（receiver operating characteristic curve，ROC curve）分析C反應蛋白在評估高脂血癥性急性胰腺炎與非高脂血癥性急性胰腺炎嚴重程度最佳診斷閾值，多元線性回歸分析影響高脂血癥性急性胰腺炎患者血清C反應蛋白濃度的危險因素。 結果共計1073例急性胰腺炎，高脂血癥性急性胰腺炎208例，非高脂血癥性急性胰腺炎865例，平均年齡51.74±17.55歲。兩組在年齡、性別比例、合并癥（糖尿病、高血壓、脂肪肝）、局部并發(fā)癥、假性囊腫發(fā)生率、復發(fā)率、重度急性胰腺炎（Balthazar CT分類標準）、中度急性胰腺炎及重度急性胰腺炎（2012亞特蘭大分類標準）差異具有統(tǒng)計學意義(P0.05)。在腹痛至入院間隔時間（P=0.970），腹痛持續(xù)時間（P=0.809）及重度急性胰腺炎（P=0.266）(2012亞特蘭大分類標準）上無統(tǒng)計學差異（P0.05）。高脂血癥性急性胰腺炎發(fā)病1周血清C反應蛋白濃度高于非高脂血癥性急性胰腺炎，差異有統(tǒng)計學意義（P0.05）。無論Balthazar CT分級標準還是2012年修訂亞特蘭大分類標準評判重度急性胰腺炎，高脂血癥性急性胰腺炎患者第2、3天的血清C反應蛋白濃度均高于非高脂血癥性急性胰腺炎患者血清C反應蛋白濃度。Balthazar CT分級標準分為重度急性胰腺炎中，非高脂血癥性急性胰腺炎患者第3天約登指數(shù)最高，對應血清C反應蛋白最佳閾值為142.50mg/L（靈敏度69%，特異度85%），而高脂血癥性急性胰腺炎患者第2天約登指數(shù)最高，C反應蛋白最佳閾值為162.75mg/L（靈敏度81%，特異度84%）。根據(jù)2012亞特蘭大新分類標準分為重度急性胰腺炎的患者中，高脂血癥性急性胰腺炎患者第2天約登指數(shù)最高，對應的血清C反應蛋白最佳閾值為172.95mg/L（靈敏度100%，特異度73%），而非高脂血癥性急性胰腺炎患者第3天約登指數(shù)最高，血清C反應蛋白最佳閾值為197mg/L（靈敏度60%，特異度89%）。在合并有糖尿病、脂肪肝和極低密度脂蛋白升高的高脂血癥性急性胰腺炎患者其C反應蛋白濃度明顯增高，而女性、高密度脂蛋白升高的患者血清C反應蛋白濃度較低。 結論高脂血癥性急性胰腺炎具有發(fā)病率高，發(fā)病年齡輕，病情嚴重，復發(fā)率高，，并發(fā)癥多，多合并糖尿病、脂肪肝的特點。高脂血癥性急性胰腺炎病程中血清C反應蛋白濃度明顯高于非高脂血癥性急性胰腺炎，C反應蛋白評判高脂血癥性急性胰腺炎嚴重程度的診斷閾值不同于非高脂血癥性急性胰腺炎。高脂血癥性急性胰腺炎患者血清C反應蛋白濃度升高的危險因素有：男性、糖尿病、脂肪肝、低水平高密度脂蛋白及高水平極低密度脂蛋白。
[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.

【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R657.51

【參考文獻】

相關期刊論文 前8條

1 周建華;C-反應蛋白檢測的臨床價值[J];國外醫(yī)學.臨床生物化學與檢驗學分冊;2004年02期

2 王曉輝;崔立紅;;C-反應蛋白測定對重癥急性胰腺炎早期預測的臨床意義[J];海軍總醫(yī)院學報;2009年03期

3 王中秋;急性胰腺炎CT評價及進展[J];醫(yī)學研究生學報;2002年05期

4 朱壯春;血沉與C-反應蛋白檢測結果相關性研究[J];華北煤炭醫(yī)學院學報;2005年01期

5 王興鵬;加強重癥急性胰腺炎臨床若干問題的研究[J];中華消化雜志;2003年12期

6 George W Browne;CS Pitchumoni;;Pathophysiology of pulmonary complications of acute pancreatitis[J];World Journal of Gastroenterology;2006年44期

7 胡偉明,田伯樂,張肇達;急性胰腺炎時C-反應蛋白變化及臨床意義[J];職業(yè)衛(wèi)生與病傷;2002年01期

8 萬美華;唐文富;夏慶;朱林;;高甘油三酯血癥與急性胰腺炎[J];職業(yè)衛(wèi)生與病傷;2007年02期

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