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非酒精性脂肪性肝病与高脂血症性急性胰腺炎严重程度的相关性分析
DOI: 10.3969/j.issn.1001-5256.2021.01.019
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突，特此声明。
作者贡献声明：梅佩参与收集数据，资料分析和撰写论文；张正乐负责课题设计和拟定写作思路；陶京负责修改论文，指导撰写文章并最后定稿。
Association of nonalcoholic fatty liver disease with the severity of hyperlipidemic acute pancreatitis
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摘要:
目的 探讨非酒精性脂肪性肝病(NAFLD)与高脂血症性急性胰腺炎(HLAP)严重程度的相关性。 方法 回顾性选取2018年2月20日—2020年1月20日武汉大学人民医院胰腺外科收治的895例急性胰腺炎患者，从中筛选出101例HLAP患者。根据患者是否合并NAFLD，将患者分为非脂肪肝组(41例)和脂肪肝组(60例)。收集患者的临床资料，包括一般资料(性别、年龄、BMI、糖尿病、高血压)、生化指标(淀粉酶、脂肪酶、ALT、AST、Alb、TBil、血尿素、血肌酐、血糖、血钠、血钙、胆固醇、TG、乳酸脱氢酶、超敏C反应蛋白)水平、WBC水平、AP严重度、CT扫描下的局部并发症、系统性炎症反应综合征、菌血症、器官衰竭情况及患者住院和HLAP复发情况(住院时间、ICU入住率、HLAP的1年内复发率及HLAP的1年内发病次数)。符合正态分布的计量资料两组间比较采用独立样本t检验；不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验；计数资料两组间比较采用χ2检验或Fisher检验。 结果 脂肪肝组患者入院时血糖、WBC水平高于与非脂肪肝组，血钠水平低于非脂肪肝组，差异有统计学意义(Z=-2.241、t=2.187、t=-2.533，P值均＜0.05)。脂肪肝组患者与非脂肪肝组相比中重症AP比例更高，差异有统计学意义(75.0% vs 53.7%，χ2=4.968，P＜0.05)，且脂肪肝组患者的局部并发症、系统性炎症反应综合征、菌血症和呼吸衰竭的发生率较高，差异均有统计学意义(χ2值分别为6.059、4.611、4.056、4.568，P值均＜0.05)。两组患者住院时间差异无统计学意义(P＞0.05)，而脂肪组患者的ICU入住率较高(7.3% vs 23.3%，χ2=4.463，P＜0.05)。此外，两组患者HLAP的1年内复发率及HLAP的1年内发病次数差异均无统计学意义(P值均＞0.05)。 结论 NAFLD与HLAP严重程度具有明显的相关性。NAFLD可能在HLAP的早期病情评估、疾病进展及预测预后中具有重要的作用。 Abstract:Objective To investigate the association of nonalcoholic fatty liver disease (NAFLD) with the severity of hyperlipidemic acute pancreatitis (HLAP). Methods A retrospective analysis was performed for 895 patients with acute pancreatitis (AP) who were admitted to Department of Pancreatic Surgery in Renmin Hospital of Wuhan University from February 20, 2018 to January 20, 2020, among whom 101 patients with HLAP were screened out. According to the presence or absence of NAFLD, the 101 patients with HLAP were divided into non-NAFLD group with 41 patients and NAFLD group with 60 patients. Related clinical data were collected, including general information (sex, age, body mass index, diabetes, and hypertension), biochemical parameters (amylase, lipase, alanine aminotransferase, aspartate aminotransferase, albumin, total bilirubin, blood urea, serum creatinine, blood glucose, blood sodium, blood calcium, cholesterol, triglyceride, lactate dehydrogenase, and high-sensitivity C-reactive protein), white blood cell count (WBC), severity of AP, local complications under CT scan, systemic inflammatory response syndrome, bacteremia, organ failure, hospitalization, and recurrence of HLAP [length of hospital stay, rate of admission to the intensive care unit (ICU), 1-year recurrence rate of HLAP, and number of HLAP attacks within 1 year]. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher blood glucose and WBC and a significantly lower blood sodium level on admission (Z=-2.241, t=2.187, t=-2.533, all P < 0.05). Compared with the non-NAFLD group, the NAFLD group had a significantly higher proportion of patients with severe AP (75.0% vs 53.7%, χ2= 4.968, P < 0.05), as well as significantly higher incidence rates of local complications, systemic inflammatory response syndrome, bacteremia, and respiratory failure (χ2=6.059, 4.611, 4.056, and 4.568, all P < 0.05). There was no significant difference in length of hospital stay between the two groups (P > 0.05), and the NAFLD group had a significantly higher rate of admission to the ICU than the non-NAFLD group (23.3% vs 7.3%, χ2= 4.463, P < 0.05). In addition, there were no significant differences in 1-year recurrence rate of HLAP and number of HLAP attacks within 1 year between the two groups (both P > 0.05). Conclusion NAFLD is significantly associated with the severity of HLAP, and furthermore, NAFLD may play an important role in the early severity assessment, disease progression, and prognosis prediction of HLAP. -
Key words:
- Non-alcoholic Fatty Liver Disease /
- Pancreatitis /
- Patient Acuity /
- Recurrence
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表 1 两组患者一般资料及实验室指标比较
项目 非脂肪肝组(n=41) 脂肪肝组(n=60) 统计值 P值 男[例(%)] 24(58.5) 44(73.3) χ2=2.424 0.119 年龄(岁) 43.02±11.41 40.70±9.96 t=1.085 0.280 BMI(kg/m2) 26.43±1.09 26.74±1.18 t=-0.984 0.236 糖尿病[例(%)] 9(22.0) 13(21.7) χ2=0.001 0.973 高血压[例(%)] 7(17.1) 12(20.0) χ2=0.137 0.712 淀粉酶(U/L) 252.0(94.0~530.5) 227.0(88.5~545.5) Z=0.104 0.917 脂肪酶(U/L) 1243.00(473.00~4678.00) 1640.00(449.75~4657.00) Z=-0.332 0.740 ALT(U/L) 19.0(14.0~29.5) 24.0(15.0~35.0) Z=-1.097 0.273 AST(U/L) 25.00(19.00~36.00) 25.00(18.00~36.25) Z=0.488 0.626 Alb(g/L) 38.73±6.53 40.17±5.90 t=-1.146 0.254 TBil(μmol/L) 12.80(10.32~19.64) 13.97(10.65~19.02) Z=-0.322 0.748 尿素(mmol/L) 4.25(3.21~5.43) 4.15(3.20~5.63) Z=0.508 0.611 肌酐(μmol/L) 60.0(46.5~75.5) 54.5(44.0~72.0) Z=0.747 0.455 血糖(mmol/L) 8.90(6.93~14.35) 12.34(8.07~16.10) Z=-2.241 0.025 血钠(mmol/L) 137.050±5.579 134.830±4.542 t=2.187 0.031 血钙(mmol/L) 2.10(1.95~2.24) 2.14(1.99~2.27) Z=-0.668 0.504 胆固醇(mmol/L) 7.05(5.46~10.99) 7.70(6.20~11.45) Z=-0.861 0.389 TG (mmol/L) 13.43±5.19 14.24±5.13 t=-0.767 0.445 乳酸脱氢酶(U/L) 289.50(195.50~572.25) 271.75(242.75~313.25) Z=0.574 0.566 超敏C反应蛋白(mg/L) 54.01(11.14~181.00) 128.57(39.74~174.38) Z=-1.010 0.313 WBC(109/L) 11.07±4.76 13.36±4.21 t=-2.533 0.013 
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表 2 两组患者AP分型及并发症发生情况比较[例(%)]
项目 非脂肪肝组(n=41) 脂肪肝组(n=60) χ2值 P值 AP分型[例(%)] 4.968 0.026 轻症 19(46.3) 15(25.0) 中重症 22(53.7) 45(75.0) 并发症[例(%)] 局部并发症 6.059 0.048 急性坏死物积聚 5(12.2) 16(26.7) 感染性胰腺坏死 2(4.9) 8(13.3) SIRS 13(31.7) 32(53.3) 4.611 0.032 菌血症 8(19.5) 23(38.3) 4.056 0.044 弥漫性血管内凝血 6(14.6) 10(16.7) 0.075 0.784 呼吸衰竭 7(17.1) 22(36.7) 4.568 0.033 循环衰竭 4(9.8) 8(13.3) 0.054 0.816 肾衰竭 2(4.9) 1(1.7) 0.113 0.736 器官衰竭＞48 h 3(7.3) 9(15.0) 0.737 0.390
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表 3 两组患者住院及复发情况对比
项目 非脂肪肝组(n=41) 脂肪肝组(n=60) 统计值 P值 住院时间(d) 15.0(10.5~27.0) 19.5(13.0~30.5) Z=-1.308 0.191 ICU入住率[例(%)] 3(7.3) 14(23.3) χ2=4.463 0.035 HLAP的1年内复发率[例(%)] 16(39.0) 20(33.3) χ2=0.344 0.558 HLAP的1年内发病次数(次) 1(1~2) 1(1~2) Z=0.611 0.541
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