Clinical Characteristics And The Genes Associated With Hypertriglyceridemia Of Aucte Pancreatitis

Objective: To do retrospective study on the clinical characteristics of acute pancreatitis(AP)in Renji hospital,especially in the aspects of demographic characteristic,health economics,etiological distribution,severity classification and comorbidity.To explore the influence factors for the prediction for severity,the length of hospitalization days and the expenses of AP.And to explore the possible gene mutation related to HLAP patients TG metabolism.So as to further explore the pathogenesis of HLAP and predict prognosis of it.Methods: Analyze and summarize the demographic characteristics of AP medical records,From January 2010 to December 2016,total 1345 cases from all departments in the hospital.Focus on analyzing the clinical characteristics of 341 cases in emergency department(emergency observation wards and emergency intensive care unit)from January 2012 to March 2016.According to the severity,execute the Ordinal multinomial logistic regression,and draw the Receiver operator characteristic curve(ROC curves)for the diagnosis of SAP.In addition,find the significant impact factors on the length and cost of hospitalization of AP via analysis of linear regression.Collect blood samples and conduct gene sequencing after permitted by patients.According to the second generation sequencing method,choose APOA,APOB,APOC,APOE,series 3,3,LPL,APOC2 CREB3 L gene,GPIHBP1,LMF1 as purpose sequence,use the Illumina Miseq platform to sequence,and to screen and analyze the selected mutation.Results: In the last seven years,a total of 1345 cases of AP onset have been received in the hospital with average age 54.16±16.83 years old,sex ratio 1.46:1,and the overall cases fatality rate was 1.56%.The proportion of AP treatment in emergency department arose from 16%,2010 to 59%,2015.From perspective of etiological distribution,in the order,were biliogenic acute pancreatitis(BAP,74 cases,21.70%),alcohol acute pancreatitis(AAP,36 cases,10.56%),hyperlipidaemic acute pancreatitis(HLAP,14 cases,4.11%).The relapse frequency of 118 cases from the 341 cases AP accompanied with hypertriglyceridemia(HTG)was significantly higher than that of 223 cases of AP without HTG(30.51%vs.18.875%,P<0.05).There were 22 cases of SAP(5died),the proportion of SAP in HLAP was obviously higher than BAP and AAP(14.29%vs.4.05%,5.56%,P<0.05).Ranson score,prothrombin time(PT)and the serum calcium level are the influential factors of severity grades.their OR values were 2.965,2.064,and 0.42.About the ability to diagnose SAP,Ranson score has the bigger area under the curve(AUC=0.937)than other factors.At their own best cut-off value,Ranson score=2.5,the combination of Ranson score,PT and serum calcium(PRE)=2.5,PT=14.05,CRP/albumin(C/A)=4.3215,the sequence of sensitivity were Ranson score,PRE,PT and serum calcium(92.3%,61.5%,53.8%,53.8%),the specificity were PRE,PT,C/A ratio,Ranson score(98.6%,90.03%,87.6%,85.5%).Ranson score and has a significant impact on the length of hospitalization days and serum calcium has a great influence on the cost of the AP patients during their hospitalization(their partial regression coefficient=3.738,?29832.074;t=3.738,?5.892;P=0.005,0.001).Among 11 HLAP patients,there are four genes associated with TG metabolism which have mutations.Respectively,they are APOA5(c.G533 T,c.G457T),APOE(c.C526T),GPIHBP1(c.G41T)and LMF1(c.C168G?c.A746C).Conclusions: Emergency department has become the main department to undertake the treatment of AP.HLAP occurs mostly among younger population,especially males,and more serious than other causes of AP.With HTG,AP patients are more likely to relapse.The Ranson score,PT,and serum calcium levels can effectively distinguish the severity of AP.Ranson score is the most valuable indicators for diagnosis of AP.At the same time,it also has the significant impact on the length of hospitalization days.Serum calcium level of AP can be used to assess hospitalization costs.The occurrence of HTG may ascribe to the gene mutations about APOA5(c.G533T?c.G457T)?APOE(c.C526T)?GPIHBP1(c.G41T)and LMF1(c.C168G?c.A746C),then the HLAP follows.These mutations are likely appeared to be the cause of the HLAP relapse.