高甘油三酯腰围表型与急性胰腺炎病情程度及预后的相关性分析

目的探讨高甘油三酯腰围表型(HTGW)与急性胰腺炎(AP)病情程度及预后的相关性。方法选取西南医科大学附属医院2018年9月-2019年8月收治的356例AP患者为研究对象,将患者分为甘油三酯和腰围正常组(NWNT)、单纯高甘油三酯组(NWET)、单纯腹型肥胖组(EWNT)、高甘油三酯腰围表型组(HTGW)4个组,对比4组患者的临床特点,包括年龄、性别、实验室指标、病情分级、并发症等。符合正态分布的计量资料组间比较采用one-way ANOVA检验,组内两两比较采用LSD-t检验;不符合正态分布的计量资料组间及组内两两比较均采用Kruskal-Wallis H检验。计数资料二分类变量组间及组内两两比较均采用χ2检验,有序多分类变量组间比较采用Kruskal-Wallis H检验,组内两两比较采用Mann-Whitney U检验。患者发生器官衰竭和胰腺感染坏死的影响因素采用单因素及多因素logistic回归分析。结果HTGW组中性粒细胞计数水平高于NWNT组,CRP水平高于NWNT、NWET组,肌酐水平高于NWNT组,总胆固醇、TG、低密度脂蛋白水平高于NWNT、EWNT组,高密度脂蛋白水平低于NWNT、EWNT组,血糖水平高于NWNT组,差异均有统计学意义(P值均<0.05)。HTGW组重型急性胰腺炎发生率高于其他3组,差异有统计学意义(χ2=189.519,P<0.001)。HTGW组感染性胰腺坏死和器官衰竭并发症比例均高于其他3组,差异均有统计学意义(χ2值分别为11.770、19.457,P值分别为0.008、<0.001)。单因素logistic回归分析显示性别、复发史是感染性胰腺坏死的危险因素,校正危险因素后,HTGW组发生感染性胰腺坏死的风险为NWNT的3.347倍95%可信区间(95%CI):1.538~7.283,P=0.002];BMI、腰围甘油三酯指数、吸烟、糖尿病、HTGW是器官衰竭的危险因素(P<0.05),校正危险因素后,HTGW组发生器官衰竭的风险为NWNT的4.143倍(95%CI:1.299~13.219,P=0.016)。结论HTGW是重型急性胰腺炎发生的独立危险因素,影响患者的病情程度及并发症的发生,应早期识别和诊断此型患者,积极改善脂代谢紊乱,改善患者的病情及预后。

Association of hypertriglyceridemic waist phenotype with the severity and prognosis of acute pancreatitis

Objective To investigate the association of hypertriglyceridemic waist(HTGW)phenotype with the severity and prognosis of acute pancreatitis(AP).Methods A total of 356 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from September 2018 to August 2019 were enrolled as subjects and were divided into normal-waist-normal-triglyceride(NWNT)group,normal-waist-elevated-triglyceride(NWET)group,enlarged-waist-normal-triglyceride(EWNT)group,and HTGW group.The four groups were compared in terms of the clinical features including age sex,laboratory markers,disease grade,and complications.A one-way ANOVA was used for comparison of normally distributed continuous data between groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and between any two groups.The chi-square test was used for comparison of dichotomous variables between multiple groups and between any two groups;the Kruskal-Wallis H test was used for comparison of ordered polytomous variables between multiple groups,and the Mann-Whitney U rank sum test was used for comparison between two groups.Univariate and multivariate logistic regression analyses were performed to investigate the influencing factors for organ failure and pancreatic infection and necrosis.Results The HTGW group had a significantly higher neutrophil count than the NWNT group,a significantly higher C-reactive protein level than the NWNT group and the NWET group,a significantly higher creatinine level than the NWNT group,significantly higher levels of total cholesterol,triglyceride,and low-density lipoprotein than the NWNT group and the EWNT group,a significantly lower level of high-density lipoprotein than the NWNT group and the EWNT group,and a significantly higher level of blood glucose than the NWNT group(all P<0.05).The HTGW group had a significantly higher incidence rate of severe AP(SAP)than the other three groups(χ2=189.519,P<0.001),as well as significantly higher incidence rates of infectious pancreatic necrosis and organ failure than the other three groups(χ2=11.770 and 19.457,P=0.008 and P<0.001).The univariate logistic regression analysis showed that sex,recurrence history were the risk factors for infectious pancreatic necrosis,and after the adjustment for these risk factors,the risk of infectious pancreatic necrosis in the HTGW group was 3.347 times that in the NWNT group(95%confidence intervalCI]:1.538-7.283,P=0.002;body mass index,WTI,smoking,diabetes mellitus,and HTGW were the risk factors for organ failure(P<0.05),and after the adjustment for these risk factors,the risk of organ failure in the HTGW group was 4.143 times that in the NWNT group(95%CI:1.299-13.219,P=0.016).Conclusion HTGW is an independent risk factor for the development of SAP and may affect patients’disease severity and complications.Such patients should be identified and diagnosed as early as possible,and improvement of dyslipidemia should be performed to improve patients’conditions and prognosis.