第一临床医学院知识库

目的：本文旨在通过对临床病例的回顾性总结，对比高脂血症性急性胰腺炎与急性胆源性胰腺炎的临床特征，提高临床工作对HLAP的诊断、治疗水平。

方法：收集兰州大学第一医院自2013年1月至2016年11月收治的57例明确诊断，且病例资料完整的高脂血症性急性胰腺炎（Hyperlipidmia acute pancreatitis，HLAP）的患者资料，同时用随机抽样的方法抽取同时期60例明确诊断为急性胆源性胰腺炎（Acute biliary pancreatitis ，ABP），且病例资料完整的患者为对照组。收集两组患者的一般情况、实验室检查、影像学检查、病情严重程度、伴随疾病、并发症、治疗及效果等数据资料，对所得的数据采用Excel表及SPSS21.0软件进行数据记录及统计分析。

结果：（1）基本情况：HLAP组患者年龄较ABP组低，但体质指数（BMI）相对较高，差异具有统计学意义（P<0.05），而住院日期、性别无明显统计学意义（P>0.05）；（2）血脂：HLAP组患者甘油三酯（TG）、总胆固醇（CHOL）水平显著高于ABP组，差异具有统计学意义（P<0.05），而高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇（LDH-C）则无明显统计学意义（P>0.05）；（3）生化及血常规：ABP组患者天冬氨酸氨基转移酶（AST）、谷丙氨酸转氨酶（ALT）、总胆红素（TBIL）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）及尿素氮（BUN）水平均显著高于HLAP组，差异具有统计学意义（P<0.05）；HLAP组葡萄糖（GLU）、胆碱酯酶（CHE）、钙离子（Ca²⁺）水平及白细胞（WBC）水平均高于ABP组，差异具有统计学意义（P<0.05），其余血淀粉酶（AMY）、尿淀粉酶（UAMY）、乳酸脱氢酶（LDH）、血肌酐（Crea）水平及中性粒细胞百分比（NEUT%）则无统计学意义（P>0.05）；（4）临床症状的对比中，HLAP组伴随糖尿病、脂肪肝的患者比ABP组多，但临床表现为黄疸、发热以及并发胰腺坏死及肝功能异常的较ABP组少，差异具有统计学意义（P<0.05）；（5）HLAP组患者表现为重症急性胰腺炎（SAP）的显著高于ABP组，与MCTSI评分结果一致，差异具有统计学意义（P<0.05）。HLAP组患者手术率明显低于ABP组，差异具有统计学意义（P<0.05）；而两组在死亡率、复发率进行比较，差异无统计学意义（P>0.05）；（6）将HLAP组患者分为非重症组及重症组进行对比，重症组患者GLU水平、MCTSI评分以及BISAP评分明显高于非重症组，差异具有统计学意义（P<0.05）。而在一般情况、血脂、生化、伴随糖尿病、脂肪肝、治疗效果等方面的比较两组患者无明显统计学差异（P>0.05）。

结论：（1）HLAP组发病多为中青年患者，其中男性患者较多；（2）HLAP患者TG显著升高，治疗中应积极降脂治疗；（3）HLAP组患者伴随糖尿病、脂肪肝的较多；（4）ALT、AST、ALP、GGT等肝功等指标可以辅助ABP的诊断肝功等指标可以辅助ABP的诊断。

Objective: The purpose of this paper is to summarize the clinical features of hyperlipidemic acute pancreatitis and acute biliary pancreatitis, and to improve the diagnosis and treatment of HLAP.

Method：the date of 57 patients with HLAP（hyperlipidemia acute pancreatitis），in Lanzhou University First Hospital ,from January 2013 to November 2016 were analyzed retrospectively. At the same time, 60 cases of patients with acute biliary pancreatitis who were diagnosed as acute gallstone pancreatitis were selected by random sampling. Collected the data of general conditions, laboratory and imaging examinations, severity of disease, concomitant disease, complications, treatment and prognosis. The data were recorded and analyzed by Excel and SPSS21.0 software.

Result：(1)The basic situation:The age of HLAP group was significantly lower, while the BMI was higher than that of ABP group，the difference was statistically significant(P<0.05).There was no difference between the length of hospitalization and gender（P>0.05）.（2）Hyperlipidemia：The TG and CHOL levels in HLAP group were significantly higher than those in ABP group (P<0.05).High density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDH-C) were not statistically significant（P>0.05）.(3)Biochemistry index and Routine blood test：HLAP group of AST、ALT、TBIL、ALP、GGT and BUN levels were significantly lower than those of ABP group ;while the GLu、CHE、Ca²⁺ and WBC levels in HLAP group were higher than ABP group, the difference were statistically significant (P<0.05); but there was no difference in the AMY、UAMY、LDH、Crea and NEUT% level between the two groups (P>0.05);(4)Clinical symptom：HLAP group with diabetes, fatty liver patients more than ABP group, but the clinical manifestations of jaundice, fever and pancreatic necrosis and abnormal liver function were less, the difference were statistical significance (P<0.05);（5）The HLAP group showed in patients with SAP was more than ABP group，which was consistent with the MCTSI score，and the operation rate of HLAP group was less than ABP group (P<0.05)，while between the two groups in mortality and recurrence rate was no difference.(6)To divided the group HLAP into non severe group and severe group，The GLU level、MCTSI score and BISAP score was significantly higher in the severe group，However, there was no difference between the two groups in the general situation, blood lipids, biochemistry, accompanied by diabetes, fatty liver, treatment effect and so on.

Conclusion: (1) most of the patients in group HLAP were young and middle-aged patients, among which there were more male patients；(2)TG significantly increased in HLAP patients,Active lipid-lowering therapy was necessary；(3)The number of patients with diabetes and fatty liver in HLAP group was more；（4）Liver function indexes like ALT、AST、ALP、GGT can assist in the diagnosis of ABP.