目的： 探讨胆源性急性胰腺炎（biliary acute pancreatitis,BAP）、高脂血症急性胰腺炎（hyperlipidemic acute pancreatitis,HLAP）和胆脂复合型急性胰腺炎（biliary-hyperlipidemic acute pancreatitis,BHAP）的临床特点。方法： 回顾性研究2013年1月6日至2017年6月17日,我院收治的急性胰腺炎患者286例。按照其发病原因进行分类,分为BAP、HLAP和BHAP组。对其年龄、性别、收治病区、发病时间、合并疾病、疾病严重程度、脏器功能支持、炎症指标进行比较,同时对各组患者的住院时间、手术率和死亡率等临床预后进行分析比较。结果： BHAP组和HLAP组较BAP组患者发病年龄更为年轻（P<0.01）。入院时的降钙素原（procalcitonin,PCT）BHAP组较HLAP组和BAP组明显升高（P<0.01）。3组患者机械通气（P<0.05）、肾脏替代治疗（P<0.01）、使用血管活性药物（P<0.05）差异有统计学意义。危重程度评估中改良Marshall评分BHAP组高于BAP组（P<0.05）;急性生理学和慢性健康状况评价Ⅱ（acute physiology and chronic health evaluation Ⅱ,APACHEⅡ）评分及序贯器官功能衰竭评分（sequential organ failure assessment,SOFA）BHAP组>BAP组>HLAP 组（均P<0.01）;急性胰腺炎严重程度床边指数（bedside index for severity in acute pancreatitis,BISAP）BHAP组>HLAP组（P<0.01）和BAP组>HLAP组（P<0.05）。CT严重指数（computed tomography severity index,CTSI） BHAP组>BAP组（P<0.05）和BHAP组>HLAP组（P<0.01）。3组患者住院时间差异有统计学意义（P<0.05）,BHAP组的住院时间长于HLAP组（P<0.01）。结论： BAP、HLAP和BHAP 3种不同病因的胰腺炎各有其临床特征,其中同时具有胆源性和高脂血症发病因素的BHAP更易发展为重症,住院时间更长。

Objective To study the clinical characteristics of biliary pancreatitis(BAP), hyperlipidemic pancreatitis (HLAP) and biliary hyperlipidemic pancreatitis(BHAP). Methods The patients diagnosed with acute pancreatitis in the emergency department of our hospital from January 2013 to June 2017 were studied retrospectively. The patients were divided into BAP, HLAP and BHAP groups according to the causes. The clinical data including age, sex, admission ward, time of onset, comorbidities, severity, organ support and inflammatory biomarkers were compared. The clinical prognosis parameters of patients in each group, such as hospitalization time, operation rate and mortality, were also analyzed. Results A total of 286 patients with acute pancreatitis were included. The clinical information of the patients in three groups were analyzed with pairwise comparison, and the results showed that the age of onset in both BHAP group and HLAP group was younger than that in BAP group(P<0.01). The comparison of procalcitonin(PCT) on admission showed that its level in BHAP group was significantly higher than that in the other two types of pancreatitis(P<0.01). In terms of organ support, the patients among three groups showed significant differences in mechanical ventilation (P<0.05), renal replacement therapy (P<0.01), and the use of vasoactive drugs (P<0.05). In terms of severity, the results of pairwise comparison among groups showed as follows: the modified Marshall score, BHAP group>BAP group (P<0.05); acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and sequential organ failure assessment (SOFA) score, BHAP group>BAP group>HLAP group (P<0.01); bedside index for severity in acute pancreatitis (BISAP), BHAP group>HLAP group (P<0.01) and BAP group>HLAP group (P<0.05); computed tomography severity index (CTSI), BHAP group>BAP group (P<0.05) and BHAP group>HLAP group(P<0.01). In terms of prognosis, the comparison of hospital stays among three groups showed that it was longer in BHAP group than that in HLAP group(P<0.01). Conclusions BAP, HLAP and BHAP have different clinical characteristics. The patients of BHAP combined with biliary tract and hyperlipidemia are more likely to develop into severe pancreatitis, and have longer hospital stays.