Clinical Observation Of The Effect Of Hyperlipemia On The Diagnosis Of Acute Pancreatitis

Acute pancreatitis(AP) is the chemical propertiesinflammation of the pancreas enzyme activated causes thepancreatic gland own digestion.It's usually acute development,progresses quickly and appearance acute abdomen on the clinical.About 15%-20% patient may develop severe acute pancreatitis(SAP),induce multi-internal organs function failure,even died.General acute pancreatitis can be diagnosed by complaint,serumamylase (AMY) ,urinary amylase(UAMY),B supersound, CT andso on.AMY is the common laboratory index ,it wound step up after6-12 hours.48 hours decrease, to recover in 3-5 days.When theAMY is the 2-3 times of normal that have diagnostic value. TheUAMY advanced late, it will get up after the patient gets sick12-14 hour, and continues 1-2 week.Hyperlipemia(HL) is disease of the metabolic disturbancethat often seen in clinical practice.As early as in 1952,Klaskin firstreported primary hyperlipemia causes the pancreatitis to recurrentattacks[2].Toouli etc.reported that the frequency of HTG-inducedAP ranges from 1.3% to 3.8%[3],and 12%-38% acute pancreatitispatient is accompanied with HL[4].So HL is not only the cause ofAP,but also the common complications of AP[5,6].This kind ofpancreatitis is called "hyperlipidemic pancreatitis(HLP)".Based onthe experiment and the clinical research indicated that HLP closelyrelated with the level of TG but less related with the level of theblood serum cholesterol [7].So also call it as "hypertriglyceridemicpancreatitis (HAP)".Berger etc.research result indicated thatHyperlipidemic pancreatitis is an acute and potentiallylife-threatening complication of hypertriglyceridemia that can beprovoked when triglyceride levels (TGL) exceed 11.3 mmol/L[8,9].Nair thought that declining the level of blood serumtriglycerin below to 5.65mmol/L is a key step of alleviate thebelly ache of HLP [10,11].The pathogenesis of HL causes AP possiblly sum up asfollows: (1)HL can make the pancreatic gland blood to be condense,and blood serum lipid granule comes together to stop the pancreascapillaries,that both induce the microcirculation disturbance ofpancreas.(2)HL activates the blood platelets,releasing largequantity thromboxaneA2 (TXA2) that can intensity shrink theblood vessel.At the same time HL hurts pancreatic vascularendothelial cell,then causes prostacyclin2 (PGI2) that can mightilyexpand the blood vessel secreted decreased,cause TXA2/ PGI2been out of balance,aggravate the pancreatic microcirculationdisturbance.(3)The high chylomicra fill in become the fibroma andthe chylemia serum can cause pancreatic microcirculationdisturbance.(4)Pancreas and peri-pancreas have high density TGthat can be hydrolyzed by the pancreatic lipase,part create largequantity liberation fatty acid(FFA),inducing the sourpoisoned,activating the protrypsin,aggravate the pancreas owndigest.(5)FFA can produce the direct cell toxicity function with thepancreatic acinar cell and capillary endothelium cell,and throughenhance the toxicity effect that tumor necrosis factor ect. cell factorcause the biological membrane damaged,permeability increased,that cause the chondriosome engorge , deform,aggravate thepancreas keep on ischemic and necrosis.It is reported thatpregnancy femme who developed AP and HL closely related to theblood viscosity increase.Hyperlipidaemia less accompany with AMY significantheighten[12],according to the report,approximately 3.7%-47% HLaccompany with AP patient's blood serum amylase level in thenormal scope [13].Especial TG>11.3mmol/L,the serum has beenmilky,but serum amylase within the normal scope or goes upgently.This research collected 342 acute pancreatitis cases in2003.1-2005.10 years in the China-Japan Union Hospital.Amongthem companion with hyperlipidaemia have 60(24.8%)patients,male 41(68.3%),female 19(31.7%),the age from18 to 64years old,the average age is 46.7±10.66.At same time selectrandomly the acute pancreatitis that not company withhyperlipdaemia patients 60 as control group,male38(63.3%),female 21(36.7%),the age from 22 to 63 years old,theaverage age is 42.6±11.60 years old.The data received statisticslyanylasis,the measuring data was showed as ,adopting the ttesting.Comparing AMY and UAMY of two groups the statisticdifference or not.And according to the degree of triglycerinelevating divided into light,inside and heavy three sets.Analysestatistics difference of the AMY and UAMY of three groups.Tostudy the effect of hyperlipdaemia on the diagnosis of acutepancreatitis.The result is serum amylase and urine amylase of the controlgroup advanced more obviously than that of the AP companionHTG group(P<0.01). The groups of different degree TG,determination of AMY and UAMY is different obviously(P<0.05).The light group is highest than other grops,the heavygroup is lowest than other groups.So HL,especially HTG,canrepress the AMY and UAMY goes up.HTG would effect theAMY,UAMY to the diagnosis of acute pancreatitis.The reason maybe exists a factor that can blanket the active of hemodiastase,thiskind of non lipide represses the factor still pass the kidney andenter urine liquid,repress the activity of UAMY.Diagnosis of acutepancreatitis companion HTG should to attention.This text result manifested AP patient should examine TG.Avoid misdiagnosis caused by the AMY and UAMY not stepped upobviously.Depleting the obstruction of biliary tract etc.factorinduce AP, the serum of mostly HAP patient is chylus,TGcustomarily more than 11.3mmol/L;When the TG is from 5.65mmol/L to 11.3mmol/L and the serum is milky also can diagnosedHAP;When the TG is from 5.65mmol/L to 1.7mmol/L,even itshigher than normal scope,also can't diagnosed HAP.The key of treatment of HAP is quickly removal the factorthat induce TG advanced.The mild case can be recovered by afterabsolute diet,insulin usage and transfuse.TG will quickly belowto less 5.65 mmol/L.The severe case mostly exsits dyslipidosis,after absolute diet and intralipid but the blood serum also bechyle.TG is usually>11.3mmol/L.There is literature report thatHTG induced AP which were successfully treated byplasmapheresis.Yangtixiong etc. experiment demonstrate,thegroup of HAP big rats, inputs fat milk to the vein,discoverpancreas pathology injuring more heavy[18].So HAP patient shouldlimit the importation of the fat milk. At the same time we mustcontrol the factors that can cause the HAP,then can obviouselyimprove the prognosis.After the symptom of AP iscontrolled,we must control the TG less 5.65mmol/L that willrelease the palindromia of AP.