| Acute pancreatitis(AP)is a common disease in the department of gastroenterology with variable severity,from being mild and self-limited to severe and fatal.The early diagnosis and accurate prediction of AP severity are of great importance.Our primary observation showed that fatty liver(FL)was frequently detected in patients with AP.In recent years,with the improvement of people’s living standard and the change of diet structure,the incidence of obesity and Fatty Liver(FL)has been increasing.AP patients are often associated with obesity or fatty liver,previous studies have shown that obesity is an easily acquired adverse prognostic factor in AP.However,there is limited research on the effect of fatty liver(FL)on the severity and clinical outcome of AP.Objective:We aimed to observe the clinical characteristics of acute pancreatitis in patients with fatty liver or obesity,and to evaluate whether it is an aggravating factors for the severity and poor prognosis of AP.Method:In this study,222 patients with acute pancreatitis were selected from January 2019 to August 2019 in the first Hospital of Jilin University by retrospective analysis.We collected the patients’ data,such as age,sex,height,weight,laboratory data(white blood cell,amylase,urine amylase,lipase,alanine transaminase,aspartate aminotransferase,creatinine,urea nitrogen,triglyceride),CT plain scan and enhanced scan data of pancreas and liver,and other past history(hypertension,diabetes mellitus).All data were collected and analysed by SPSS25.0 software.Mann-Whitney U test(in case of non-normal distribution)or T test(in case of normal distribution)was used to compare data between two groups.Chi-square test was used to assess differences in categorical variables,.Two independent sample tests in the nonparametric test were used for the comparison of multiple samples.P<0.05 was statistically significant.Result:1.A total of 222 patients were admitted in this study,including112(50.45%)patients with biliary pancreatitis,93(41.89%)patients with hyperlipidemic pancreatitis,and 17(7.66%)patients with other causes such as alcohol,drugs and infection.By definition,there were 173 cases(77.93%)of MAP,20 cases(9.01%)of MSAP,and 29 cases(13.06%)of SAP,resulting in 13 deaths(5.86%).2.There were 125 patients with fatty liver.There were significant differences between non-FL group and FL group in gender,age,etiology,obesity,white blood cell,ALT,AST,ALP,GGT,triglyceride,cholesterol,creatinine and C-reactive protein levels at admission.However,there were no statistically significant differences between the FL group and the non-FL group in smoking history,drinking history,hypertension,diabetes incidence and other aspects.The mortality rate was significantly higher in the FL group(8.80%)than in the non-FL group(2.06%)(odds ratio :4.583,95%CI: 0.991-21.189).The incidence of local and systemic complications was also higher in the FL group(41.60% and 22.40%)than in the non-fl group(21.65% and 12.37%).According to the clinical classification of AP,the incidence of MSAP and SAP in the FL group(12.80% and 15.20%)was still higher than that in the non-FL group(4.12% and 10.31%,respectively).3.We grouped the patients according to whether they are combined with obesity.AP patients with obesity had higher SAP(OR 3.384,95%CI1.260-9.091),local complications(2.307 95%CI 1.136-4.686),and systemic complications(2.042 95%CI 0.868-4.803).We subgrouped systemic complications,and the results showed that the differences in the incidence of respiratory failure,circulatory failure,and acute kidney injury between obese and non-obese AP patients were statistically significant,while the differences in AP recurrence and mortality between the two groups were not statistically significant.4.We studied the correlation between gender,age,etiology,hypertension,diabetes,fatty liver,obesity,smoking and drinking history and the occurrence of moderate to severe acute pancreatitis(MSAP+SAP),and then included variables with P< 0.1 in logistics regression.The results showed that the combination ofobesity and hypertension were independent risk factors for MSAP+SAP in AP patients.Conclusion:1.The patients with acute pancreatitis complicated with fatty liv er are mostly young obese men.2.Etiological analysis showed that t he patients with acute pancreatitis in the non-fatty liver group were mainly biliary,while the patients in the fatty liver group were mai nlyhyperlipidemia.3.Patients with acute pancreatitis complicated with fatty liver and obesity are more serious and have morecomplications.4.Logistic regression analysis showed thatobesity and hypertension w ere independent risk factors for MSAP+SAP in AP patients. |
