The Analysis Of Clinical Features And Prognosis Of Hyperlipidemic Acute Pancreatitis

Objective:To analyze the clinical features and prognosis of hyperlipidemic acute pancreatitis(HLAP).Methods: A retrospective study was conducted in a consecutive cohort of 57 hyperlipidemic acute pancreatitis patients admitted in Fujian Provincial hospital from January 2000 to December 2009. 68 patients with acute biliary pancreatitis (ABP) diagnosed over the same period were served as control group. Detailed clinical data of both groups including age, sex, time of visiting hospital, hospital stay, medical history, laboratory test, imaging manifestation, drug therapy, concomitant disease, local and systemic complications as well as prognosis were recorded. The Ranson score(within 48 hours of admission), APACHEII score(within 48 hours of admission), Balthazar CT score and clinical data were compared between the two groups. The correlation between serum triglyceride levels and disease severity of HLAP was assessed.Results: The age and serum amylase levels of the HLAP group were remarkably lower than those of the ABP group (Age: 40.8±l1.3 vs.59.4±17.5 years; Median serum amylase: 254.0 vs. 1083.5U, both P<0.05), whereas the serum triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) levels of the HLAP group were significantly higher than those of the ABP group (TG:13.7±8.6 vs.1.2±0.9mmol/L; LDL-C:3.1±2.5 vs.2.3±0.9mmol/L, both P<0.05). The serum TG levels showed no significant correlation with Ronson score, APACHE-Ⅱscore and Balthazar CT score values (all P>0.05). The value of serum direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase(AST),γ-glutamyl transferase (GGT), alkaline phosphatase (ALP) of HLAP group was strikingly lower than those of ABP group (all P<0.05). Patients with HLAP had a significantly increased prevalence of fatty liver and diabetes compared with those with ABP(Fatty liver: 63.2% vs.32.4%;Diabetes:36.8% vs.14.7%,both P<0.05), but no difference of incident hypertension was found (P>0.05). The Ranson score, APACHE-Ⅱscore, and Balthazar CT score were comparable between the two groups (all P>0.05). The incidence rate of severe acute pancreatitis was significantly higher in HLAP group than that in ABP group (38.6% vs. 26.4%, P<0.05). The percentage of complications in HLAP group, including acute respiratory distress syndrome( ARDS), renal failure, pancreatic pseudocyst and multiple organ failure, were significantly higher than those in ABP group (all P<0.05). The recurrence risk of HLAP group was strikingly higher than that of ABP group (47.4% vs. 23.5%, P<0.05), whereas the surgical operation and mortality rates were not significantly different between the two groups (P> 0.05).Conclusion: Hyperlipidemia acute pancreatitis(HLAP) mainly occurs in young to middle-aged people. The admission serum amylase values of HLAP increased midly. Patients with HLAP are often accompanied by fatty liver and diabetes, predisposed to more serious condition, and subjected to greater complications (such as ARDS, renal failure, pancreatic pseudocyst and multiple organ failure ) and recurrence risk.