高脂血症性急性胰腺炎的临床特征及其与脂代谢的关系

目的探讨高脂血症性急性胰腺炎(HLAP)患者的临床特征,以及脂代谢谱与HLAP的关系。方法选取2017年9月-2019年9月昆明医科大学第二附属医院消化内科收治的61例HLAP患者(HLAP组)与同期77例非高脂血症性急性胰腺炎患者(NONHLAP组)。分析2组患者的临床特点,包括基线资料、实验室指标、病情分级、合并症、严重程度评分等。符合正态分布的计量资料2组间比较采用t检验;不满足正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验。采用多因素二分类logistic回归分析HLAP的独立危险因素,Z检验比较受试者工作特征曲线下面积(AUC)。结果2组间年龄(t=-6.125),BMI(t=4.125),合并感染(χ2=4.364)、脂肪肝(χ2=50.567)、糖尿病(χ2=28.408),hs-CRP(Z=-2.456),WBC(t=2.652),中性粒细胞(t=2.232),淋巴细胞(Z=-2.339),D二聚体(Z=-8.601),空腹血糖(Z=-4.416),尿酸(t=4.644),总胆固醇(Z=-8.937),甘油三酯(Z=-8.87),LDL-C(Z=-7.972),非高密度脂蛋白(Z=-9.085),载脂蛋白B(Z=-3.244),SIRS评分(Z=-2.817),MEWS评分(Z=-2.226)比较差异均有统计学意义(P值均<0.05)。甘油三酯(OR=0.675,95%CI:0.484~0.943,P=0.021)和非高密度脂蛋白(OR=0.320,95%CI:0.164~0.624,P=0.001)为HLAP的独立危险因素。非高密度脂蛋白(AUC=0.951,灵敏度=100%,特异度=88.31%,95%CI:0.901~0.981,SE=0.020,Youden指数=0.883)和甘油三酯(AUC=0.940,灵敏度=95.08%,特异度=81.82%,95%CI:0.887~0.974,SE=0.018,Youden指数=0.769)诊断能力均较高。当非高密度脂蛋白cut-off值>4.55 mmol/L时诊断价值最高。结论HLAP好发于代谢综合征人群,发病较年轻化,炎症反应较重。非高密度脂蛋白对ALAP表现出了较高的诊断价值,为临床进一步指导治疗提供了新思路。

Clinical features of hyperlipidemic acute pancreatitis and their association with lipid metabolism

Objective To investigate the clinical features of patients with hyperlipidemic acute pancreatitis(HLAP)and the association between lipid metabolism profile and HLAP.Methods A total of 61 patients with HLAP who were treated in Department of Gastroenterology,The Second Affiliated Hospital of Kunming Medical University,from September 2017 to September 2019 were enrolled as HLAP group,and 77 patients with non-hyperlipidemic acute pancreatitis were as non-HLAP group.The clinical features of the two groups were analyzed,including baseline data,laboratory markers,disease grade,comorbidities,and severity score.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The chi-square test was used to for comparison of categorical data between groups.A multivariate binary logistic regression analysis was used to investigate the independent risk factors for HLAP,and the Z test was used for comparison of the area under the ROC curve(AUC).Results There were significant differences between the two groups in age(t=-6.125,P<0.05),body mass index(t=4.125,P<0.05),infection(χ2=4.364,P<0.05),fatty liver disease(χ2=50.567,P<0.05),diabetes(χ2=28.408,P<0.05),high-sensitivity C-reactive protein(Z=-2.456,P<0.05),white blood cell count(t=2.652,P<0.05),neutrophils(t=2.232,P<0.05),lymphocytes(Z=-2.339,P<0.05),D-dimer(Z=-8.601,P<0.05),fasting blood glucose(Z=-4.416,P<0.05),uric acid(t=4.644,P<0.05),total cholesterol(Z=-8.937,P<0.05),triglyceride(Z=-8.87,P<0.05),low-density lipoprotein cholesterol(Z=-7.972,P<0.05),non-high-density lipoprotein(Z=-9.085,P<0.05),apolipoprotein B(Z=-3.244,P<0.05),systemic inflammatory response syndrome score(Z=-2.817,P<0.05),and Modified Early Warning Score(Z=-2.226,P<0.05).Triglyceride(odds ratio[OR]=0.675,95%confidence interval[CI]:0.484-0.943,P=0.021)and non-high-density lipoprotein(OR=0.320,95%CI:0.164-0.624,P=0.001)were independent risk factors for HLAP.Non-high-density lipoprotein(AUC=0.951,sensitivity=100%,specificity=88.31%,95%CI:0.901-0.981,SE=0.020,Youden index=0.883)and triglyceride(AUC=0.940,sensitivity=95.08%,specificity=81.82%,95%CI:0.887-0.974,SE=0.018,Youden index=0.769)had high diagnostic efficiency.Non-high-density lipoprotein with a cut-off value of>4.55 mmol/L had the highest diagnostic value.Conclusion HLAP often occurs in the population with metabolic syndrome,with a younger age of onset and more severe inflammatory response.Non-high-density lipoprotein has a high value in the diagnosis of HLAP,which provides a new idea for guiding clinical treatment.