高脂血症性急性胰腺炎病人的临床特点及C反应蛋白对其严重程度的评估价值

郭兰; 柯希权; 陈玲玲

doi:10.13898/j.cnki.issn.1000-2200.2019.07.019

高脂血症性急性胰腺炎病人的临床特点及C反应蛋白对其严重程度的评估价值

Characteristics of patients with hyperlipidemic acute pancreatitis, and the value of c-reactive protein in assessing disease severity

摘要

摘要:
目的探讨高脂血症性急性胰腺炎（HLAP）的临床特点以及C反应蛋白（CRP）在HLAP严重程度和预后评估中的作用。
方法回顾性分析103例急性胰腺炎病人的临床资料，其中高脂血症病人32例（HLAP组），非高脂血症病人71例（非HLAP组）。比较2组病人的临床特征。其中HLAP病人又根据病情轻、重，分为HLAP1组（轻症，22例）和HLAP2组（重症，10例），比较HLAP1组与HLAP2组病人入院第1、3、5、7天血清CRP水平的变化；采用ROC曲线评估血清CRP在HLAP严重程度中的价值。
结果HLAP组与非HLAP组比较，空腹血糖、三酰甘油（TG）水平均较高（P < 0.01），CRP、年龄、血清AMY、Ranson评分和APACHEⅡ评分均较低（P < 0.05~P < 0.01）。入院第1、3、5、7天HLAP1组的血清CRP水平均明显低于HLAP2组（P < 0.05~P < 0.01）；2组在第3天血清CRP水平增加到最高水平（P < 0.01），之后又逐渐降低（P < 0.01）。HLAP组脂肪肝的发生率28.1%高于非HLAP组的11.3%（P < 0.05）。ROC曲线分析表明，CRP在HLAP严重程度评估中的AUC为0.905，P < 0.01，95%CI为0.782~1.000。
结论HLAP发病年龄趋于年轻化，脂肪肝的发生率高；血清CRP可作为HLAP严重程度的评价指标，其对HLAP预后评估具有经济、方便、可行等临床价值。

Abstract:
ObjectiveTo explore the clinical features of hyperlipemic acute pancreatitis(HLAP), and value of C reactive protein(CRP) in the evaluation of severity and prognosis of HLAP.
MethodsThe clinical data of 103 patients with acute pancreatitis were retrospectively analyzed, the patients were divided into the HLAP group(32 cases) and non-HLAP group(71 cases), and the clinical features between two groups were compared.The HLAP group was subdivided into the HLAP1 group(mild disease, 22 cases) and HLAP2 group(severe disease, 10 cases) according to the severity of disease.The serum levels of CRP in HLAP1 and HLAP2 groups on the 1st, 3rd, 5th and 7th day of admission were detected.The value of CRP level in the evaluation of severity of HLAP was investigated using ROC curve.
ResultsCompared with the non-HLAP group, the fasting blood glucose and triglyceride(TG) were higher(P < 0.01), and the levels of CRP, mean age and serum AMY, Ranson score, and Apache Ⅱ score were lower in HLAP group(P < 0.05 to P < 0.01).On the 1st, 3rd, 5th and 7th day of admission, the serum levels of CRP in HLAP1 group were lower than that in HLAP2 group(P < 0.05 to P < 0.01).The serum CRP levels in two groups on the 3rd day of admission were the highest(P < 0.01), and then gradually decreased(P < 0.01).The incidence rate of fatty liver in HLAP group(28.1%) was higher than that in non-HLAP group(11.3%)(P < 0.05).The ROC curve evaluation indicated that the AUC area of CRP in the evaluation of HLAP severity was 0.905(P < 0.01), and the 95% CI was 0.782~1.000.
ConclusionsThe onset age of HLAP tends to be younger, and the incidence rate of fatty liver is high.CRP can be used as the evaluation index of the severity of HLAP, and has economy, convenience and feasibility in evaluating the prognosis of HLAP.

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