Analysis of clinical characteristics of biliary hyperlipidemic pancreatitis

doi:10.16138/j.1673-6087.2022.01.011

Abstract

Abstract:

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.

Key words: Biliary acute pancreatitis, Hyperlipidemic acute pancreatitis, Biliary-hyperlipidemic acute pancreatitis, Clinical characteristics

CLC Number:

R576

CHE Zaiqian, ZHAO Bing, WANG Yihui, ZHU Huihui, WANG Yuming, QI Xing, LI Mengjiao, CHEN Ying, MA Li, CHEN Erzhen, MAO Enqiang. Analysis of clinical characteristics of biliary hyperlipidemic pancreatitis[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(01): 58-62.

Figures/Tables 1

References 15

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项目	BAP	HLAP	BHAP	总数	统计量	P
病例数（n）	196	35	55	286
男性[n（%）]	129（65.8）	21（60.0）	40（72.7）	190	1.660	0.436^a
年龄（岁）	52.50[39.25,64.00]	37.00[33.00,47.00]^2）	41.00[31.00,47.00]^2）	46.00[36.00,60.00]	34.706	0.000^cd
患者来源（n）
ICU	97	18	30	145	1.637	0.891^b
急诊内科	98	17	25	140
急诊外科	1	0	0	1
发病时间（d）	2[1,4]	2[1,3]	2^1）[1,3]	2[1,3]	8.868	0.012^cd
合并疾病[n（%）]
高血压	61（31.1）	8（22.9）	16（29.1）	85（29.7）	0.984	0.611^ab
糖尿病	29（14.8）	16（45.7）^2）	12（21.8）	57（19.9）	17.942	0.000^ab
吸烟	63（32.1）	10（28.6）	26（47.3）	99（34.6）	4.987	0.083^ab
饮酒	60（30.6）	10（28.6）	23（41.8）	93（32.5）	2.741	0.254^ab
脏器支持[n（%）]
机械通气	27（13.78）	3（8.57）	16（29.09）	46	9.055	0.010^b
肾脏替代	20（10.20）	2（5.71）	16（29.10）	38	12.962	0.001^b
血管活性药物	7（3.57）	0	6（10.91）	13	5.821	0.043^b
炎症因子
PCT（μg/L）	0.63[0.18,2.65]	0.44[0.05,0.68]^2）	1.62[0.48,8.03]^2）4）	0.67[0.21,2.60]	21.903	0.000^cd
CRP（mg/L）	27.21±23.28	29.57±24.87	25.04±19.87	27.08±22.82	0.431	0.651^ef
疾病危重度（分）
CTSI	3.56±1.87	3.14±1.73	4.33±2.37^1）4）	3.65±1.98	4.477	0.012^ef
Marshall评分	2[2,2]	2[2,2]	2[2,2]^1）	2[2,2]	7.216	0.027^cd
APACHEⅡ评分	7.32±5.80	4.71±3.55^2）	9.18±5.60^2）4）	7.36±5.65	6.974	0.001^ef
BISAP评分	2[1,2]	1[0,2]^1）	2[2,2]^4）	2[1,2]	14.183	0.001^cd
SOFA评分	2[1,5]	1[0,3]^2）	4[2,6]^2）4）	3[1,5]	33.765	0.000^cd
住院时间（d）	32.96±27.20	24.11±11.80	40.61±30.27^3）	33.35±26.78	4.216	0.016^ef
开腹手术[n（%）]	13（6.6）	1（2.9）	5（9.1）	19	1.177	0.532^ab
死亡[n（%）]	20（10.2）	0（0.0）	6（10.9）	26	4.559	0.109^ab