高三酰甘油血症对急性胆源性胰腺炎病情影响的一项队列研究

摘要

目的 本文旨在研究对于急性胆源性胰腺炎的患者,合并不同水平的高三酰甘油血症时对胰腺炎病程和严重度的影响.方法 回顾性分析了本院急性胆源性胰腺炎病例共334例.根据美国国家胆固醇教育计划成人治疗专家组的第三次指南分级标准,把不同的血清三酰甘油水平分为四组,即三酰甘油正常组、轻度升高组、中度升高组和重度升高组.观察患者的病情严重度、Ranson评分、并发症情况.计算相关的OR值和危险因子.运用Logistic回归分析影响病情转归的危险因子.结果 与三酰甘油正常组相比,中度和重度升高的三酰甘油水平组发生重症胰腺炎的风险增加(中度:OR:11.136,95%CI:4.808-25.794;重度:OR:15.375,95%CI:6.556-36.058).发生全身器官衰竭危险性明显增高(中度:OR:7.977,95%CI:2.927-21.742;重度:OR:6.750,95%CI:2.510-18.150),发生呼吸衰竭的数量差异有统计学意义(中度:P=0.000;重度:P=0.002).重度三酰甘油水平升高组发生局部并发症,如胰腺假性囊肿和胰腺脓肿的危险性增加(OR:5.835,95%CI:2.302-14.792),发生胰腺坏死的危险性增加(OR:5.247,95%CI:1.403-19.627).患者升高的血清三酰甘油水平是发生急性重症胰腺炎的独立预示因子(P=0.000).结论 在急性胆源性胰腺炎患者中,升高的血清三酰甘油水平(≥2.26 mmol/L)是发生重症化和全身局部并发症的危险因素.%Objective To explore the impact of hypertriglyceridemia on the outcome of acute biliary pancreatitis. Methods Total 334 patients with acute biliary pancreatitis enrolled the study were divided into mild, moderate, severe hypertriglyceridemia group. The severity of disease, Ranson's score, complications were compared with normal triglyceridemia. Logistic regression analysis was performed to find factors that predicted severe outcome. Results When compared with normal triglyceridemia patients, moderate and severe hypertriglyceridemia had an increased risk of developing the severe form of acute pancreatitis [moderate: odds ratio (OR) : 11.136, 95% confidence interval (CI) : 4.808-25.794; severe: OR: 15.375, 95% CI: 6.556-36.058]. They also developed significantly more organ failure (moderate: OR: 7. 977, 95%CJ: 2. 927-21. 742; severe: OR: 6. 750, 95% CI: 2. 510-18. 150). There was a statistically difference in respiration failure (moderate: P = 0. 000; severe:P= 0. 002). Severe hypertriglyceridemia had an increased risk of developing local implications, such as pancreatic pseudocyst abscess (OR: 5. 835, 95%CJ: 2. 302-14. 792), pancreatic necrosis (OR: 5. 247, 95%CI: 1. 403-19. 627). Increasing hypertriglyceridemia as an independent predictor of severe outcome in acute biliary pancreatitis (P = 0. 000). Conclusion In acute biliary pancreatitis,hypertriglyceridemia (≥2. 26 mmol/L) represent a risk of severe disease and number and type of complications.