| Objective To enhance the level of diagnosis and treatment of hyperlipidemic severe acute pancreatitis(HL-SAP) by analyzing its clinical features.Methods A retrospective analysis of clinical data of 120 cases with SAP from 2003 to 2008 in the First Affiliated Hospital of Guangxi Medical University,which were divided into four groups hyperlipemia group(29 cases), lithiasic group(38 cases),alcoholic group(25 cases) and other causal group(28 cases) according to their etiological factors.29 cases with HL-SAP were divided into high TG group(12 cases) and very high TG group(17 cases).Clinical manifestation,clinical data,lab examination,imaging outcome,local and systemic complications,treatment and turnover were recorded.Four groups were compared in the aspects of their related indexes of average age,consulting hours,fasting time,hospitalization periods,SIRS scores,Ranson scores, APACHEⅡscores,CTSI,serum lipid,hemodiastase,calcium,glucose,lactate dehydrogenase,hematocrit,rates of recurrence,operabilities and case fatalities. The association of CTSI,multiple organ dysfunction syndrome(MODS) and lipid level were analyzed as well.Results①Compared with the other three groups:The 75.9%patients of hyperlipemia group were men.The patients were averagely 41.15±11.45 years old,younger than those of lithiasic group(52.12±16.59 years) and the other causal group(50.28±19.40 years)(p＜0.05);consulting hours were 31.72±19.09 hours,earlier than that of lithiasic group(61.58±46.46 hours) and alcoholic group(83.04±51.63 hours)(p＜0.05);Hospitalization period was 40.57±21.46 days,statistically longer than that of other three groups(p＜0.05);the level of serum lipid of hyperlipemia group—among which TG is especially high(p＜0.01)—was significantly higher than that of other groups;The level of hemodiastase and urine amylase were lower than that of the lithiasic group; serum calcium was obviously lower but glucose was higher than other three groups(p＜0.05);the values of lactate dehydrogenase and hematocrit were higher than those of alcoholic group and lithiasic group respectively(p＜0.05); SIRS score was 3.53±0.72 and rate of recurrence was as high as 34.5%, significantly higher than that of the other three groups(p＜0.05);There were no significant differences in APACHEⅡscores,Ranson scores,CTSI scores, operabilities and case fatalities between hyperlipemia group and other three groups(p＞0.05);②In hyperlipemia group:cases of MODS and CTSI≥Ⅱin very high TG group and high TG group were 11 and 3,16 and 7,respectively. There were statistic differences between the two groups(p＜0.05).Conclusions HL-SAP's on-set peak usually happens in the young and middle-aged male.Its clinical symptom and patient's condition are more serious;It has a lipid metabolic disorder.The level of TG is very high; Hemodiastase and urinary amylase are not very high and they can be normally or lightly high;There is obvious relationship between the level of TG and desease severity:the higher the level of TG is,the more serious the pancreatic necrosis and MODS are.HL-SAP patients may be given with more serious conditions,more complications,higher rate of recurrence,compared with other SAP patients.
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