| Objective:Acute pancreatitis(AP)is an inflammatory disease of the pancreas and one of the most common acute abdomens in the digestive field.The prevalence of AP is growing year after year.The clinical course of most AP is self-limiting,while a small number of patients can develop into severe acute pancreatitis(SAP)with poor prognosis and high mortality.People’s diet structure and lifestyle have gradually changed in recent years as the economy has progressed.At the moment,hyperlipidemic acute pancreatitis(HLAP)is on track to overtake alcoholic AP as the second leading cause of AP in China.As the two common causes of AP in China,the detailed differences between biliary acute pancreatitis(BAP)and HLAP are still uncertain,especially in the severity and complications of the two causes of AP.In addition,hypertriglyceridemia is considered to be an important factor in the development of HLAP,but the relationship between serum triglycerides(TG)levels and the severity of HLAP is still controversial.Therefore,this study aims to compare and analyze the differences between BAP and HLAP from many aspects,and further explore the relationship between serum TG concentration and the severity of HLAP,so as to improve clinicians’ understanding of AP with two causes.Methods:From January 2014 to April 2022,718 AP patients were admitted to the Department of Gastroenterology at Baoding First Central Hospital and divided into groups based on etiology,including 426 BAP patients and 292 HLAP patients.To summarize the changes in the constituent ratio of causes of HLAP and BAP in AP from 2014 to 2022.The differences in general information,laboratory results,clinical features and complications between BAP and HLAP groups were statistically analyzed.Multivariate logistic regression was used to identify the independent risk factors for systemic inflammatory response syndrome and organ failure.Spearman correlation analysis was used to further explore the relationship between serum TG concentration and the severity of HLAP.Results:1.From 2014 to 2022,the constituent ratio of causes of HLAP in AP was 30.2%,43.9%,41.5%,43.4%,37.1%,43.9%,38.8%,39.7% and 48.8%,respectively.The constituent ratio of etiology of BAP was 69.8%,56.1%,58.5%,56.6%,62.9%,56.1%,61.2%,60.3% and 51.2%,respectively.2.Comparison of general data between the two groups:HLAP patients were younger [38(33,44)years vs 65(52,74)years,P<0.001],had a higher proportion of males(74.0% vs 49.1%,P<0.001),and had a higher BMI [26.7(25.4,28.7)vs 24.3(22.5,25.8),P<0.001] than BAP patients.Compared with the BAP group,the HLAP group had higher rates of smoking(45.2% vs 23.5%,P<0.001),drinking(49.0% vs 24.2%,P<0.001),diabetes(50.3% vs 16.9%,P<0.001)and fatty liver(90.1% vs 31.7%,P<0.001),and lower rates of hypertension(23.6% vs 43.4%,P<0.001)and coronary heart disease(3.4% vs 16.2%,P<0.001).3.Comparison of clinical characteristics between the two groups:Compared with BAP patients,HLAP patients had lower BISAP scores(P<0.001),higher MCTSI scores(P<0.001),while there were no significant differences between the two groups in the time from symptom onset to admission,the length of hospital stay,and the rate of ICU admission(all P values>0.05).The proportions of mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP),and SAP in BAP group were 49.5%,36.4%,and 14.1%,respectively,and those in HLAP group were 23.3%,62.7%,and 14.0%,respectively.The constituent ratio of AP severity differed significantly between the two groups(P<0.001).4.Comparison of laboratory results between the two groups:Hemoglobin,hematocrit,white blood cell,fibrinogen,platelet,potassium,blood glucose,albumin,uric acid,and C-reactive protein levels were lower in the BAP group than in the HLAP group,while red blood cell distribution width,prothrombin time,plasma D-dimer,blood sodium,and blood urea nitrogen levels were higher in the BAP group than in the HLAP group(all P values<0.05).In terms of liver function,BAP patients had significantly higher levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin(P<0.001).There were no significant differences in serum calcium(P=0.881),lactate dehydrogenase(P=0.381),and serum creatinine(P=0.064)between the two groups.In addition,the serum TG level of HLAP patients was significantly higher than that of BAP patients,while the serum amylase and lipase levels were significantly lower than those of BAP patients(all P values<0.001).5.Comparison of complications between the two groups:In terms of local complications,the incidence of acute peripancreatic fluid collections(21.2%vs11.5%,P<0.001)and acute necrosis collection(29.5% vs 14.8%,P<0.001)in the HLAP group was higher than that in the BAP group.Among the systemic complications,the incidences of systemic inflammatory response syndrome(60.3% vs 34.0,P<0.001),organ failure(34.6% vs 27.5%,P=0.041)and pleural effusion(54.8% vs 47.2%,P=0.045)in HLAP group were higher than those in BAP group,while the BAP group was more likely to be complicated with deep venous thrombosis of the lower extremity(3.8% vs 0.7%,P=0.01).There were no significant differences in pericardial effusion and abdominal and pelvic effusion between the two groups(All P values>0.05).6.Multivariate logistic regression results showed that:Systemic inflammatory response syndrome is independently associated with HLAP and fatty liver,respectively.HLAP,hypertension,and age are all risk factors for organ failure on their own.7.Spearman correlation analysis showed that:The serum TG level of HLAP patients was positively correlated with the severity of HLAP(correlation coefficient =0.186,P=0.001).Conclusions:1.The etiological constituent ratio of HLAP in AP showed an upward trend,while that of BAP showed a downward trend.Therefore,we must raise awareness of HLAP.2.Young and middle-aged obese men are more likely to have HLAP.In contrast to patients with BAP,HLAP patients are more likely to have local complications such as acute peripancreatic fluid collections and acute necrosis collection,and systemic complications such as systemic inflammatory response syndrome,organ failure,and pleural effusion.Compared with HLAP patients,BAP patients are more likely to develop deep venous thrombosis of the lower extremity.3.The clinical course of HLAP patients is more serious.And the higher the serum TG level is,the more severe the condition of HLAP is.Therefore,early identification of HLAP and rapid reduction of serum TG level are the key to improve the prognosis of HLAP. |
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