44例高脂血癥性急性胰腺炎的臨床特點分析
發(fā)布時間：2018-10-05 16:11
【摘要】：目的 通過對高脂血癥性急性胰腺炎(Hyperlipidemic acute pancreatitis,HLAP)和膽源性急性胰腺炎(Acute biliary pancreatitis,ABP)的臨床資料的對比分析,總結(jié)HLAP的臨床特點,為其診斷、嚴重程度評估、治療方案確定及預(yù)后判斷提供指導(dǎo)。方法 收集寧夏醫(yī)科大學(xué)總醫(yī)院2013年1月-2016年1月明確診斷為急性胰腺炎(Acute pancreatitis,AP)并住院治療的患者完整資料,按納入標準和排除標準,最后確定135例病例資料入選。將研究對象按病因分為ABP組91例和HLAP組44例,將HLAP患者按病情嚴重程度分為輕度(MAP)和重度(SAP),記為HL-MAP組25例和HL-SAP組19例。收集所有患者入院時間與發(fā)病時間間隔在24小時之內(nèi),且未經(jīng)治療患者的一般資料、實驗室指標、影像學(xué)檢查、改良CT嚴重指數(shù)評分、合并癥、并發(fā)癥及病情嚴重程度等方面的數(shù)據(jù)信息,對兩組資料進行統(tǒng)計學(xué)分析。結(jié)果 (1)與ABP組比較,HLAP組中男性患者比例及體重指數(shù)(BMI)明顯升高,差異具有顯著性(P0.05);HLAP組發(fā)病年齡明顯低于ABP組,差異具有極顯著性(P=0.000);HLAP組中平均住院日均高于ABP組,但差異無統(tǒng)計學(xué)意義(P0.05);(2)HLAP組的AMY、TBIL、ALT、AST水平均明顯低于ABP組,差異具有極顯著性(P=0.000);HLAP組的PBLC、TG、TC及Glu水平明顯高于ABP組,差異有顯著性(P0.05);(3)HLAP組中伴隨糖尿病、脂肪肝、肥胖與并發(fā)胸腔積液、肺部感染者比例明顯高于ABP組,差異具有顯著性(P0.05)。而HLAP組伴隨高血壓者比例明顯低于ABP組,差異具有顯著性(P0.05);兩組比較,在并發(fā)胰腺壞死、多臟器功能不全、膿毒癥、胰腺假性囊腫、腹腔積液、盆腔積液等并發(fā)癥方面,差異無統(tǒng)計學(xué)意義(P0.05);(4)治療后與治療前比較:HLAP組:TG水平明顯降低,差異具有極顯著性(P=0.000),而ALT水平、AST水平無顯著改變(P0.05);ABP組:治療后ALT水平、AST水平明顯降低,差異具有顯著性(P0.05),而TG水平無顯著改變(P0.05);(5)HL-SAP組伴隨糖尿病、并發(fā)胸腔積液、腹腔積液及肺部感染的比例明顯高于HL-MAP組,差異具有顯著性(P0.05),而在伴隨高血壓、脂肪肝和肥胖者方面差異無顯著性(P0.05);(6)將HLAP患者的胸腔積液數(shù)據(jù)形成ROC曲線,其預(yù)測HL-SAP的AUC為0.729(95%CI:0.571-0.888,P=0.010),提示胸腔積液對預(yù)測SAP有較好的能力。結(jié)論 (1)HLAP好發(fā)于中青年男性,血淀粉酶升高不明顯。(2)HLAP患者大多存在嚴重的脂代謝及糖代謝紊亂,常合并糖尿病、脂肪肝、肥胖等疾病,病情較重,易出現(xiàn)多種并發(fā)癥。(3)ABP組更易并發(fā)肝功能損害,且治療后肝功能較易恢復(fù)。(4)胸腔積液有較好預(yù)測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.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576
本文編號：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.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576
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