Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients.MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups.ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001).ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.     

Medications for weight reduction

Comparatively few drugs are available for the treatment of overweight patients, and their effectiveness is limited to palliation of the chronic disease of obesity. Nevertheless, drug development that is now underway is more rapid than in the past, and we anticipate the discovery of safe and effective pharmacologic strategies for the management of obesity and its serious complications.     

4种脂肪酶检测系统的性能评价

目的评估4种脂肪酶(Lipase,LPS)检测系统的分析性能。方法方法学评价研究。应用美国临床和实验室标准化协会(CLSI)EP5-A2、EP15-A2、EP7-A2、EP6-A、EP9-A2方法验证4种脂肪酶检测系统的精密度、正确度、抗干扰性、分析测量范围(AMR)、相关及偏差。采用美国病理学家协会(CAP)发放的室间质评物(C-A和C-B)验证不同系统检测LPS正确度。回归分析采用Passing-Bablok检验,回归线性检测采用Cusum方法,相关分析采用Pearson检验,偏差分析应用Bland-Altman曲线。结果 LPS在25-240U/L时,4种检测系统的批内CV均TEa的1/4(9.47%),批间CV均TEa的1/3(12.63%)。正确度验证测定美国CAP室间质评物显示仅A、C系统较为理想,其95%验证区间包含了指定均值,且符合生物学变异设定的总允许误差(TEa:37.88%);回收试验显示除B系统高回收标本外,其它系统均未超出±10%。抗干扰性评估显示Hb≥5g/L时,对B、C系统低水平有10%的正干扰,在15g/L时,对D系统低水平有10%的正干扰;Bil≤600μmol/L时对4种系统均无明显干扰现象;TG≥8mmol/L时,对A、C系统均有10%的负干扰。4种系统AMR上限分别为341、494、529、379U/L。相关分析以选取上述性能较为理想的C系统为参考对象,A、B、D与C系统比较相关性较好,r均0.975(P0.01),Bland-Altman偏差分析显示平均绝对偏差分别为-9.7、-21.7、-21.1U/L,平均相对偏差分别为-10.12%、-11.96%、-13.51%,计算医学决定水平(Xc)时的预期偏差显示在Xc=60U/L时,A、B、D系统均符合生物学变异设定的1/3总允许误差(12.63%),在Xc=180U/L时,B、D系统的允许偏差不在预期偏差的可信区间内且小于可信区间下限,证实B、D系统在Xc=180U/L时与C系统的性能不相当,结果可比性差,不可接受。结论 4种检测系统的性能之间存在差异。     

Non-linearity and gaps in results distribution over successive Roche Lipase method applications: improvement but persistence

Abstract

Non-linearity within the primary measurement range of a lipase assay (<300?U/L) has been shown on Cobas^® Roche analyzers, causing gaps in results distribution between 300 and 400?U/L. Since, new lipase method applications (LMAs) have been used. The purpose is to retrospectively evaluate their impact on relative frequencies of lipase results (RFLs).

Plasma lipase results from two hospital laboratories, assayed over 7.2?years, were collected. Over this period, three successive LMAs, characterized by automated repeat-on-dilution (1/11, 1/2, or 1/10), were applied for lipase results >300?U/L: LMA1 and LMA2 on the Modular^®P800, Cobas^®c501 and Cobas^®C701 analyzers, and LMA3 on the Cobas^®C701. RFLs were determined, linearity tests were performed, and inter-agreements between lipase results corrected and uncorrected for nonlinear biases were assessed, using 180?U/L as a decisional cut-off for acute pancreatitis.

Overall, RFL gaps narrowed from LMA1 (300 to ～380?U/L) to LMA3 (300 to ～330?U/L). For a lipase activity fixed at 300?U/L, non-linearity biases were determined at ?11.2% on the Modular^®P800 (LMA1), ?20.8% on the Cobas^®c501 (LMA1), and ?3.5% (LMA2) and ?2.2% (LM3) on the Cobas^®C701. Diagnostically, a maximum of 0.48% lipase results were misclassified as negative (LMA1 on the Cobas^®c501), and a minimum of 0.01% misclassified as negative (LMA3 on the Cobas^®C701). In conclusion, successive Roche lipase method applications improved linearity within the primary measurement range. While persisting, gaps in lipase results distribution narrowed with the evolution of the methods, with a minor impact in terms of diagnostic of acute pancreatitis.     

Bilateral vagotomy attenuates the severity of secretagogue-induced acute pancreatitis in the rat

PurposeWe assessed the effect of bilateral vagotomy (BV) on the course of acute caerulein-induced pancreatitis (AP) in the rat.Material/methodsThe study was performed on Wistar rats surgically prepared by subdiaphragmatic BV. Control group underwent sham operation. Four days later, AP was induced by subcutaneous injection of caerulein (25 μg/kg/5 h) to the conscious animals with or without BV. After administration of caerulein the blood samples were taken for determination of serum lipase activity and interleukin-10 (IL-10) concentration. Pancreatic tissue samples were subjected to histological examinations and to the measurement of lipid peroxidation products (MDA + 4-HNE) concentration and the activity of an antioxidant enzyme – glutathione peroxidase (GPx). After application of caerulein pancreatic blood flow was measured by laser Doppler flowmetry.ResultsAP was manifested by oedema and neutrophil infiltration of the pancreatic tissue and accompanied by significant increases of serum lipase activity, serum concentration of IL-10 and pancreatic concentration of MDA + 4HNE (ca. 50×, 2× and 4× respectively p ≥ 0.05). Pancreatic activity of GPx and pancreatic blood flow were decreased (both by 60%). In vagotomised rats with AP serum lipase activity and pancreatic concentration of MDA + 4-HNE were lower whereas Il-10 concentration and pancreatic activity of GPx, as well as pancreatic blood flow were significantly higher as compared to AP rats with intact vagal nerves. In AP rats with vagotomy all histological signs of pancreatitis were significantly reduced.ConclusionsBilateral vagotomy resulted in the significant attenuation of caerulein-induced pancreatitis in the rat.     

脂蛋白脂酶基因多态性与飞行员血脂水平的关系

目的了解脂蛋白脂酶（LPL）基因多态性与飞行员血脂水平的关系,为飞行员高脂血症的防治提供依据。方法采用聚合酶链反应-限制性片断长度多态性方法检测106例飞行员和98例健康对照者LPL基因HindⅢ、PvuⅡ和Ser447Ter位点多态性,并用常规方法测定其血脂水平。结果飞行员LPL基因HindⅢ、PvuⅡ和Ser447Ter位点多态性的基因型频率和等位基因频率与健康对照人群相比差异无统计学意义。飞行员的高脂血症患病率（52.83%）明显高于对照人群（29.59%）。LPL基因HindⅢ和Ser447Ter位点的不同基因型与飞行员血清TG和HDL-C水平相关,而PvuⅡ位点不同基因型与血清TG、TC和HDL-C水平相关。结论 LPL基因多态性影响飞行员不同个体间血脂水平,环境因素是引起飞行员高脂血症的重要作用因子。     

Acute pancreatitis and amiodarone： A case report

Amiodarone, a class Ⅲ antiarrhythmic drug, is one of the most effective drugs used in the treatment of ventricular and paroxysmal supraventricular tachyarrhythmia. Adverse effects of amiodarone including pulmonary toxicity, hepatotoxicity, aggravation of arrhythmia, and thyroid diseases are well understood. A 66-year old woman with acute pancreatitis was admitted to our hospital with the complaint of epigastralgia radiating to both flanks for two months. Her symptoms and elevation of pancreatic enzymes did not respond to conventional medical treatment of pancreatitis for 18 d. No known causal factors for pancreatitis such as biliary tract stone, hypertriglyceridemia and alcohol consumption could be identified. Under the suspicion of amiodarone-induced acute pancreatitis, amiodarone was substituted by propafenone. Her symptoms soon alleviated and serum lipase level declined. Three months after hospital discharge, the abdominal pain did not recur. Amiodarone was approved to treat recurrent ventricular fibrillation or sustained ventricular tachyarrhythmia that has been resistant to other medications since 1986. Pancreatitis is a very rare adverse effect associated with the use of amiodarone, and only four cases of amiodarone-induced pancreatitis have been reported in literature. We report a patient who developed acute pancreatitis during amiodarone therapy.     

内皮脂肪酶与高密度脂蛋白及动脉粥样硬化的关系

高密度脂蛋白具有一定的抗动脉粥样硬化的作用,而内皮脂肪酶可水解高密度脂蛋白,进而影响动脉粥样硬化的进展,故深入探讨三者关系,可能为动脉粥样硬化相关疾病的防治提供崭新的靶点.     

血清脂肪甘油三酯脂肪酶水平与肥胖和糖尿病的相关性

目的通过检测肥胖和新诊断2型糖尿病患者的血清脂肪甘油三酯脂肪酶（adiposetfiglycefidelipase,ATGL）水平,探讨ATGL与糖、脂代谢的相关性。方法选取2006年8月至2009年4月在江苏大学附属医院门诊和内分泌科住院患者114例,其中男54例,女60例,年龄38-70岁。分为2型糖尿病患者66例和正常糖调节者48例,再按体质指数（BMI）是否≥25kg／m^2分为4组：2型糖尿病-超重组、正常糖调节-超重组、2型糖尿病．正常体重组和正常糖调节．正常体重组,检测空腹血糖、血脂和空腹胰岛素（FINS）、ATGL水平,并计算BMI、腰臀比、体脂含量和胰岛素抵抗指数（HOMA-IR）。分别进行t检验、直线相关分析、多元逐步回归分析。结果（1）血清ATGL水平在2型糖尿病-超重组为（239±61）μg／L,与2型糖尿病-正常体重组[（355±54）μg／L]相比,差异有统计学意义（t=22．53,P〈0．05）;而正常糖调节-超重组[（242±60）μg/L]与正常糖调节-正常体重组[（383±58）μg/L]相比,差异也有统计学意义（t=8．23,P〈0．05）。（2）简单相关分析发现,血清ATGL浓度与体脂含量、BMI、腰臀比、甘油三酯、HOMA．IR等呈负相关（r值分别为-0．271、-0．238、-0．375、-O．313、-0．164,均P〈0．05）。多元逐步回归分析发现腰臀比、体脂含量为血清ATGL的独立相关因素。结论肥胖者的血清ATGL水平明显低于正常体重者,ATGL与腰臀比、体脂含量呈独立相关,而与血糖无明显相关。