高脂血症在急性胰腺炎中作用的研究

目的探讨高脂血症在急性胰腺炎(AP)进展中的作用及对预后的影响。方法选取2009年1月~2015年6月在海军总医院消化科住院的急性胰腺炎患者365例,分为轻症急性胰腺炎(MAP)组263例和重症急性胰腺炎(SAP)组102例,观察患者腹痛、腹胀等不适症状,并检测治疗前后(第0天、第3天、第5天)血尿淀粉酶和三酰甘油(TG)、胆固醇(CHOL)水平,计算急性生理功能和慢性健康状况评分(APACHEII),比较两组患者的治疗效果和平均住院天数。结果 AP患者中合并高脂血症者占AP的44.9%,高脂血症患者体质量指数(BMI)指数(26.7±4.6)明显高于血脂正常者(24.7±6.9);APACHE-II和改良CT严重指数(MCTSI)评分为(7.3±2.8)分和(3.9±3.8)分也高于血脂正常组(6.8±2.0)分和(3.2±3.0)分,两组比较差异均有统计学意义(P<0.001)。AP患者中高脂血症主要见于饱食和饮酒为诱因。MAP和SAP两组患者治疗前血、尿淀粉酶及CHOL水平均无明显差异,而SAP组TG为(3.4±3.2)mmol/L,明显高于MAP组(2.4±1.9)mmol/L(P<0.05)。同组患者治疗后第5天血脂TG、CHOL均随APACHEII评分下降明显降低(P<0.05)。观察患者治疗效果,SAP组高脂血症者治疗有效率为74.2%明显低于同组血脂正常者83.3%,且平均住院时间为(25.7±13.4)d,明显多于血脂正常者的(21.3±12.9)d,两组比较差异有统计学意义(P<0.05)。而MAP组高脂血症患者和血脂正常者治疗有效率均在95%以上,且住院天数无明显差异。结论高脂血症是AP的重要致病因素之一,血脂中TG水平与AP患者病情严重程度、治疗效果和预后密切相关,可能成为判断AP病情和预后的重要指标。

The effect of hyperlipidemia on the pathogenesis of acute pancreatitis

Objective To explore the effect of hyperlipidemia on the pathogenesis and prognosis of acute pancreatitis. Methods 365 inpatients with acute pancreatitis (AP) were enrolled in the study from January 2009 to June 2015. These patients were divided two groups, 263 patients in the mild acute pancreatitis group(MAP) and 102 patients in severe acute pancreatitis(SAP). Standard therapy was given to each patient. The complaints, serum and urine amylase, serum triglyceride and cholesterol were all recorded before and after treatment (day o,3 and 5 days) were recorded. Finally,curative effect and average hospitalized time was analyzed. Results 44.9% AP patients had hyperlipidemia. more common in satiation and drinking as an incentive. BMI、MCTSI and APACHE-II scores of patients with hyperlipidemia were respectively 26.7 ± 4.6,7.3 ± 2.8 and 3.9 ± 3.8,and these scores were higher than those of patients with normal serum lipid (respectively 24.7 ± 6.9,6.8 ± 2.0 and 3.2 ± 3.0)(P < 0.001). Before treatment, the base level of triglyceride in SAP was higher than in MAP (P < 0.05). And the level of serum amylase, urine amylase and cholesterol was no difference between two groups.The serum lipid level and APACHEII were decreased dramatically at 5 days after treatment. The effective rate was 74.2% in SAP, that was lower than the effective rate in MAP (83.3%).Moreover, the average hospitalized time in SAP was (25.7 ± 13.4) days, that was longer than that in MAP (21.3 ± 12.9 days) (P < 0.05). Conclusion Hyperlipidemia is one of the most important pathogenic factors of AP. Serum triglyceride might be an important marker on evaluating conditions and prognosis of acute pancreatitis.