高脂血症性急性胰腺炎15例治疗体会

2001年1月～2006年6月，我们共收治急性胰腺炎（AP）患者160例，其中高脂血症性急性胰腺炎15例。现回顾性分析其临床资料，以提高其诊治水平。     

高脂血症性急性胰腺炎的临床分析

目的 探讨高脂血症性急性胰腺炎(HAP)的临床特点,以提高人们对此病的认识.方法 回顾性分析我院2005年1月～ 2010年12月收治的148例急性胰腺炎(AP)患者的临床资料,通过对HAP与非HAP的比较,探讨HAP的临床特点.结果 在148例AP患者中HAP 31例(20.95％),与其他原因的AP比较,HAP的血脂异常主要表现为三酰甘油升高(P＜0.05),HAP发病与胆固醇升高无相关性;HAP患者的糖尿病和脂肪肝发病率与其他原因所致的胰腺炎比较,差异有统计学意义(P＜0.05);HAP患者的血淀粉酶正常或略升高.结论 高三酰甘油血症和胰腺炎的发病密切相关,是AP的第3大病因.与其他原因所致胰腺炎比较,HAP组的血淀粉酶正常或轻度升高,其临床表现不典型,并发症多,易复发.     

高脂血症与急性胰腺炎临床相关性分析

目的探讨高脂血症与急性胰腺炎（AP）的临床相关性及高脂血症性急性胰腺炎（AHLP）的临床特点和治疗要点。方法对237例急性胰腺炎患者进行回顾性分析,根据病因将其分为胆源性急性胰腺炎（151例）、高脂血症性急性胰腺炎（52例）、酒精性急性胰腺炎（16例）和其他（18例）。着重对胆源性急性胰腺炎与高脂血症性急性胰腺炎的临床特点和治疗进行比较分析。结果胆源性急性胰腺炎与高脂血症性急性胰腺炎患者的甘油三酯水平、脂肪肝发生率、重症胰腺炎（SAP）发生率、复发率、手术率、糖尿病发生率、性别、年龄等比较均有显著性差异。CT严重指数、APACHEⅡ评分和Ranson评分比较差异均无显著性。结论高j舌血症性急性胰腺炎在临床特点和治疗方法上都与其它类型急性胰腺炎不同,应作为一种独特的亚型予以重视并区别对待。     

高脂血症性急性胰腺炎9例临床分析

2000年1月～2009年12月,我院收治高脂血症性胰腺炎患者9例。现将其临床特点报告如下。     

高脂血症致急性胰腺炎8例诊治分析

高脂血症为急性胰腺炎 (AP)少见病因之一 ,常致AP反复发作 ,临床表现及治疗均有其不同特点。本院近 10年来收治 8例 ,现分析如下。1　临床资料1 1　病例资料　男 5例 ,女 3例 ,年龄 32～ 4 7岁 ,平均 4 1岁。AP发作 1次 2例 ,2次 2例 ,3次 3例 ,4次 1例 ,平均发作 2 .4次 ,共发作 19例次。病程 2个月～ 4年。合并糖尿病 2例 ,糖耐量异常 4例 ,体重指数 2 6～ 37。既往高脂血症史 5例 ,均无嗜酒史。水肿型 15例次 ,坏死型 4例次。首诊误诊为溃疡病、急性胆囊炎、心绞痛各 1例 ,误诊率 37.5 % (3/ 8)。1 2　临床表现　所有病例均有持续性上…     

高脂血症性急性胰腺炎130例

目的:总结分析高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)患者的临床特点.方法:对2006-01/2012-09月住院诊治的HLAP患者进行回顾性分析,对其临床资料等进行统计分析,并选择100例胆源性急性胰腺炎(acute biliary pancreatitis,ABP)患者作为对照组进行对比.结果:共102例患者130次发生HLAP,占全部急性胰腺炎(acute pancreatitis,AP)患者的17.4%.重症患者占23.1%.HLAP患者发病年龄、血清淀粉酶>3倍正常值比例均低于均高于ABP患者(P<0.05),而糖尿病、脂肪肝、既往AP发作史比例均高于ABP组(P<0.05).甘油三酯(triglyceride,TG)≥11.30mmol/L的HLAP患者血清淀粉酶>3倍正常值比例低于TG值5.65-11.30mmol/L的患者(23.4%vs41.5%,P<0.05),而重症HLAP比例、住院时间、腹痛持续时间无统计学差异(P>0.05).结论:HLAP患者发病年龄低、男性多见,多有代谢综合症表现,具有显著的复发性趋势,血清淀粉酶增高不明显,TG水平与临床严重程度不相关.     

高脂血症性急性胰腺炎患者血脂及临床分析

目的　探讨高脂血症性急性胰腺炎患者的血脂和临床特点。方法　2001年1月～ 2003年12月共收治各种原因的急性胰腺炎146例。其中高脂血症性急性胰腺炎10例,随机以胆 源性、酒精性胰腺炎各15例为对照;记录发病8小时尿淀粉酶、血淀粉酶、血脂和血糖等指标,进 行发病48小时的临床APACHEⅡ和CT严重指数(CTSI)评分。结果　高脂血症性胰腺炎占胰腺 炎的6.85%。高脂血症性胰腺炎血脂异常7例表现为高甘油三酯(TG)血症,3例表现为以高TG 为主的混合型高血脂症,血清TG明显高于酒精性和胆源性胰腺炎(P<0.01)。高脂血症性急性胰 腺炎有2例淀粉酶(尿、血)在正常范围,其淀粉酶均值显著低于胆源性胰腺炎和酒精性胰腺炎(P <0.01)、血糖水平与酒精性胰腺炎比较差异无显著性(P>0.05),与胆源性胰腺炎比较差异有显 著性(P<0.05)。高脂血症性急性胰腺炎血清TG水平与CTSI、临床APACHEⅡ评分、血淀粉酶无 相关性(r=0.342、0.381、0.051)。与胆源性胰腺炎、酒精性胰腺炎比较,高脂血症性胰腺炎发病48 小时的CTSI、临床APACHEⅡ评分及平均住院天数无差异。结论　高脂血症性急性胰腺炎临床经 过和预后无异于其他原因的胰腺炎,病情的轻重与血脂高低无明显相关性。     

高脂血症性急性胰腺炎临床分析

目的 探讨高脂血症性急性胰腺炎的临床特点和治疗要点.方法 回顾214例急性胰腺炎患者,其中18例高脂血症性急性胰腺炎、196例其他病因急性胰腺炎的临床特点和治疗进行比较分析.结果 高脂血症胰腺炎的 TG 水平、脂肪肝发生率、SAP 患病率均明显高于其他病因胰腺炎.结论 高脂血症所致急性胰腺炎的发病率呈上升趋势.其临床表现和治疗方法均有其不同的特点.     

高脂血症性急性胰腺炎的临床特征分析

目的分析高脂血症性急性胰腺炎(HLAP)的临床特点及三酰甘油(TG)水平对HLAP病情严重程度的影响。方法选择2013年1月至2017年1月复旦大学附属华东医院消化内科收治的33例HLAP患者和163例胆源性急性胰腺炎(BAP)患者。收集患者的一般资料、伴随疾病、治疗方法、预后以及空腹血糖(FPG)、血清胆固醇(TC)、TG、淀粉酶(AMY)、尿酸(UA)、D-二聚体(D-D)水平。将HLAP患者根据血清TG水平分为TG≥11.3 mmol/L组和5.65 mmol/L≤TG11.3 mmol/L且血清呈乳糜状组,比较两组的病情严重程度。结果 HLAP组的男性、肥胖、糖尿病、脂肪肝比例以及血清TC、TG、FPG、UA、D-D水平明显高于BAP组(P0.05)。HLAP组的发病年龄、血清AMY水平低于BAP组(P0.05)。两组的外科手术率差异无统计学意义(P0.05)。HLAP组的血液净化比例、病死率与复发率明显高于BAP组(P0.05)。不同血清TG水平的HLAP患者的病情严重程度差异无统计学意义(P0.05)。结论HLAP患者发病年龄较低,男性较多,多伴有代谢综合征表现,血清AMY升高不明显,血清TG显著升高但与病情的严重程度无明显相关性,病死率高,易复发。     

高脂血症性急性胰腺炎的临床特点分析

高脂血症是急性胰腺炎（AP）的常见病因之一,高脂血症性胰腺炎（hypertri—yceridemic pancreatitis,HTGP）约占全部AP的1％～8．3％。随着我国肥胖人群及高脂血症患者的增多,HTGP的发生有所增加,有必要对其临床特点进行深入研究,以提高临床医师对HTGP的认识。     

老年高脂血症性胰腺炎的临床诊治

目的 探讨老年人高脂血症性胰腺炎的临床诊断及治疗.方法 回顾性分析我院自2000年至2007年住院的老年高脂血症性胰腺炎11例的临床资料.结果 8例保守治疗痊愈;2例行手术治疗,1例合并多器官功能衰竭死亡,治愈率72.7%.结论 老年高脂血症性胰腺炎病情复杂,应及早诊断、正确治疗以提高治愈率.     

高脂血症性重症急性胰腺炎临床特征分析

背景:目前已明确高三酰甘油血症(>11.3 mmol/L)可引起急性胰腺炎(AP)发作或复发。随着代谢综合征发病率的逐年上升,临床上高脂血症性AP病例日益增多。目的:总结高脂血症性重症急性胰腺炎(HL-SAP)的临床特征,提高对该病的认识和诊断水平。方法:收集2000年1月～2011年6月浙江中医药大学附属第一医院确诊HL-SAP和胆源性SAP(BSAP)病例,对其病史资料进行回顾性分析。结果:38例HL-SAP患者和94例BSAP患者纳入研究。HL-SAP组平均年龄显著低于BSAP组[(42.50±13.34)岁对(62.17±16.17)岁,P=0.000];血清三酰甘油水平、胆固醇水平、合并脂肪肝、糖尿病、高血压者的比例以及血清淀粉酶低于3倍正常上限者的比例(52.6%对22.3%)均显著高于BSAP组(P<0.05)。两组间胰腺局部和主要脏器并发症发生情况无明显差异。HL-SAP组血清三酰甘油水平与主要脏器并发症发生数呈正相关(r=0.382,P=0.018)。HL-SAP组出院后复发率显著高于BSAP组(42.1%对11.7%,P=0.000),两组间死亡率无明显差异。结论:本组HL-SAP患者发病年龄偏低,合并代谢综合征组分者比例较高,约半数患者血清淀粉酶正常或升高不显著,AP易复发。     

急性出血坏死性胰腺炎并发ARDS的临床研究

本文报道了急性出血环死性胰腺炎合并ARDS30例,并应用中西医结合及内、外科配合的综合治疗方法,提高了抢救成功率,降低了病死率。30例中经治疗痊愈24例(占80％),死亡6例,其中死于ARDS者2例(占6.7％),其他4例中1例死于心脏骤停,2例死于多脏器衰竭,1例因胰腺巨大囊肿继发感染于病程第七周死亡,总死亡率20％,本文还就ARDS的早期诊断等有关问题进行了讨论。     

Gut Permeability in Patients with Acute Pancreatitis

Background: The bacterial contamination of pancreatic necrosis in acute pancreatitis is supposed to occur through translocation of intestinal bacteria. Increased gut permeability may be the initial phenomenon in this process. To test the hypothesis that gut permeability is increased in acute pancreatitis a clinical study was made where gut absorption and permeability were assessed with multi-sugar probes in patients with acute pancreatitis within 2 days after admission to hospital and again after recovery of disease. Methods and Results: Twenty-three patients with acute pancreatitis and 20 healthy controls were studied. According to Atlanta classification, 15 patients had mild and 8 patients severe pancreatitis. Gut absorption, assessed as the 5-h urine excretion of L-rhamnose, D-xylose and 3-O-methylglucose, was decreased in patients with acute pancreatitis and more pronounced in patients with severe pancreatitis (L-rhamnose and D-xylose: P &lt; 0.001; 3- O -methylglucose: P     

急性胰腺炎患者血清sCD40早期检测的临床意义

背景:CD40是免疫应答中的共刺激分子,通过与其配体CD40L结合,参与介导免疫调节信号。研究显示在多种疾病状态下,外周血和体液可溶性CD40(sCD40)水平异常增高。目的:检测急性胰腺炎(AP)患者的入院早期血清sCD40水平并探讨其临床意义。方法:随机选取72例住院AP患者(MAP 44例,SAP 28例),以ELISA法检测入院24h内血清sCD40水平,21例健康体检者作为对照。以ROC曲线评价早期血清sCD40对AP以及AP相关急性肺损伤(ALI)的诊断效能。结果:AP组入院24 h内血清sCD40水平显著高于对照组(P0.01),其中SAP组又高于MAP组,并与入院24 h内血清CRP水平呈显著正相关(r=0.413,P=0.000)。血清sCD40诊断AP的ROC曲线下面积(AUC)为0.806,最佳诊断界值为≥29.45 pg/mL;预测AP相关ALI的AUC为0.808,诊断效能明显高于APACHEⅡ评分(AUC=0.733)、Ranson评分(AUC=0.648)和血清CRP(AUC=0.625),最佳诊断界值为≥47.96 pg/mL。结论:早期检测血清sCD40有助于早期识别AP、判断病情严重程度以及预测AP相关ALI的发生。     

Treatment of Hyperlipidemic Acute Pancreatitis With Plasma Exchange: A Single‐Center Experience

Of the cases of acute pancreatitis, 1–7% are caused by severe hypertriglyceridemia and can be treated with plasma exchange (PE). We report on a large series of patients with acute hyperlipidemic pancreatitis (HLP) treated with PE. In the 1992–2008 period, 50 patients (45 ± 8 years old, 92% male) with acute HLP were treated with PE, during which 1–2 plasma volumes were exchanged. Heparin was used as anticoagulant in 85% of the procedures, and citrate in the rest. Cholesterol and triglycerides were measured before and after PE. In the 2003–2008 cohort of 40 patients, we retrospectively recorded an Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the first PE session, hospital mortality, and length of hospital stay. A total of 79 PE treatments were done, 1–5 per patient. The volume exchanged was 4890 ± 1300 mL over a duration of 3.5 ± 2 h. During the first PE, the triglycerides were lowered from 58.9 ± 40.8 to 10.8 ± 10.8 mmol/L, and the total cholesterol was lowered from 20.0 ± 7.6 to 5.7 ± 4.3 mmol/L. In 10% of the procedures the plasmafilter was replaced, and in 3% the filter was clotted. Hypotension occurred in 3% of PE and there was one case of gastrointestinal bleeding after PE with heparin anticoagulation. In the 2003–2008 cohort, the median APACHE II score was 5 (range 0–15), the median overall hospital stay was 18 days (range 3–142 days) and the hospital mortality was 15%. To conclude, in acute hyperlipidemic pancreatitis, one to two plasma exchanges effectively reduce the serum triglyceride level. There is a low rate of procedure‐related complications. A mortality rate of 15% is considerable.     

大剂量维生素C对急性胰腺炎患者细胞免疫功能的影响

背景：急性胰腺炎（AP）患者存在细胞免疫功能改变和血浆维生素C（Vti C)含量降低，Vit C具有抗氧化和提高机体免疫力的作用。目的：观察大剂量Vit C对AP患者细胞免疫功能的影响。方法：将84例AP患者随机分为治疗组和对照组，40例健康志愿者作为正常对照。治疗组予Vit C 10g稀释于5％葡萄糖500ml中静脉滴注，每日1次，连用5天；对照组予Vit C1g稀释于5％葡萄糖500ml中静脉滴注，每日1次，连用5天。观察正常对照组和两组患者治疗前后血浆Vit C含量和T淋巴细胞亚群的变化。结果：AP患者CD3和CD4阳性细胞百分比较正常对照组明显下降，其中重症急性胰腺炎（SAP）组的CD4阳性细胞百分比和CD4／CD8比值较轻症急性胰腺炎（MAP）组下降更为明显（P＜0．05）。大剂量Vit C治疗后，治疗组SAP患者的CD4阳性细胞百分比和CD4／CD8比值较对照组明显升高（P＜0．05）。结论：AP患者，特别是SAP患者存在细胞免疫功能损害，静脉输入大剂量Vit C对改善SAP患者的细胞免疫功能有一定作用。     

Serum Profiles of Interleukin-18 in Different Severity Forms of Human Acute Pancreatitis

Background: Interleukin 18 (IL-18) is a new mediator and modulator of the immune response; its role in acute pancreatitis (AP), however, has not yet been fully explained. The aim of our study was to evaluate the profile IL-18 serum concentrations in the course of acute pancreatitis. Methods: The prospective study involves 30 patients with AP ( n = 15 with mild AP and n = 15 with severe AP) as well as 10 healthy subjects. AP severity was defined according to Ranson's and Balthazar's criteria, supplemented by serum CRP concentration measurements. In the course of hospitalization, 2 patients with severe AP died. Serum IL-18 and plasma polymorphonuclear leukocyte elastase (PMN-E) concentrations were measured at admission (day 1) and on days 2, 3, 5 and 10. Results: In both the mild and the severe forms of AP, serum IL-18 concentration was significantly higher than in the healthy controls. In severe AP, serum IL-18 reached the highest levels in all observed periods compared to that in patients with mild AP. Significant correlations, calculated for day 1, were found between serum IL-18 and plasma PMN-E (Rs = 0.514, P < 0.001) and between IL-18 and CRP (Rs = 0.463, P < 0.001) levels. Conclusions: Serum profile IL-18 during AP indicates that this cytokine was released early after AP onset and may play the key role in inflammatory and immune response. Positive correlation between serum IL-18 and commonly known early prognostic markers of AP severity suggest that serum IL-18 concentrations may represent another early marker indicating severe course of AP.     

短期腹腔灌洗对重症急性胰腺炎的治疗价值

背景:重症急性胰腺炎(SAP)是一种病情凶险、并发症多、死亡率高的急腹症,早期腹腔灌洗可清除渗出的炎性细胞因子等,提高SAP的治愈率。目的:观察短期腹腔灌洗对SAP的疗效。方法:选取57例SAP患者,其中26例伴有明显腹膜刺激征或穿刺腹腔有渗液的患者行腹腔灌洗,31例未行腹腔灌洗者作为对照组。腹腔灌洗在起病3天内进行,并持续约3～7天。对SAP患者腹腔灌洗前后的APACHE鄄Ⅱ积分、血清C反应蛋白(CRP)水平进行比较,并评估并发症发生和临床指标改善情况。结果:SAP患者行腹腔灌洗后,APACHE鄄Ⅱ积分由14.4±6.5降至8.1±2.4(P<0.01),血清CRP水平由272.4mg/L±51.6mg/L降至65.3mg/L±11.5mg/L(P<0.01),且较对照组基础治疗后下降更为显著(P<0.05和P<0.01)。腹腔灌洗组患者的腹痛缓解时间亦较对照组显著缩短(1.1天±0.5天对3.2天±1.4天,P<0.05)。结论:短期腹腔灌洗能明显改善SAP患者的一般情况和炎症反应,改善患者的预后,值得在临床上推广应用。     

Clinical Assessment of Hyperlipidemic Pancreatitis

Objective: This study addresses three questions: 1) What are the clinical presentations of pancreatitis secondary to hyperlipidemia? 2) What is the role of alcohol, diabetes, or known causes of hypertriglyceridemia? and 3) Does the course of pancreatitis secondary to hypertriglyceridemia differ from that of other etiologies?
Methods: We reviewed patients between 1982 and 1994 with a diagnosis of pancreatitis (577.0) and hypertriglyceridemia (272.0). Four hospitals participated. Seventy patients had a clinical presentation consistent with pancreatitis, that is elevated amylase and lipase or evidence of pancreatitis by ultrasound or CT imaging and serum triglyceride levels greater than 500 mg/dl or lactescent serum. Clinical data were derived from hospital admissions.
Results: Hypertriglyceridemia was the etiology in 1.3–3.8% of patients discharged with a diagnosis of pancreatitis. A history of diabetes mellitus was present in 72%, hypertriglyceridemia in 77%, alcohol use 23%, and gallstones in 7%. Lipemic serum was described on admission in 45%. Mean triglyceride levels were 4587 ± 3616 ml/dl. Amylase was elevated two times normal in 54%, and lipase was elevated two times normal in 67%. CT scans were abnormal in 82%, with peripancreatic fluid in 34%, pseudocyst 37%, and necrosis in 15%. Abscess occurred in 13%, death in 6%.
Conclusion: Acute pancreatitis secondary to hyperlipidemia is characterized by three presentations. AH patients present with abdominal pain, nausea, and vomiting of hours to days duration. The most common presentation is a poorly controlled diabetic with a history of hypertriglyceridemia. The second presentation is the alcoholic found to have hypertriglyceridemia or lactescent serum on admission. The third, about 15–20% of patients, is the nondiabetic, nonalcoholic, nonobese patient with drug-or diet-induced hypertriglyceridemia.