| Objective: To analyze the etiology composition of acute pancreatitis,and compare the clinical characteristics of various causes of acute pancreatitis(AP)and recurrence factors.To explore the influencing factors of disease outcome,and in order to improve early clinical diagnosis rate,guide the treatment and prevent relapse.Methods: Retrospective analysis for 127 patients with AP treated in Yijishan hospital from October 2011 to October 2015.The generally information,clinical manifestations,laboratory and imaging data of AP patients were recorded.The patients were divided into five groups,biliary group,hyperlipidemia group,alcohol group,diet group and other etiology groups.General data,laboratory parameters,comorbidities and complications proportion,rate of mild acute pancreatitis(MAP)and severe acute pancreatitis(SAP)and the etiology composition of recurrent pancreatitis rate were compared in each group.In addition,serum albumin and TG/HDL-C ratio were compared between the MAP and SAP patients.Results:(1)In 127 patients with AP,59 cases(46.5%)were men,68 cases(53.5%)were women.The male to female ratio was 0.87: 1.Patients with AP aged from 17-87 years,mean age was 56.39±14.94 years.Average age of 70 patients(55.12%)with biliogenic was 59.04±15.90 years,the male to female ratio was 1: 1.59.Average age of 12 patients(9.45%)with hyperlipidemia was 47.67±5.29 years,the male to female ratio was 1: 0.71.Average age of 6 patients(4.72%)with alcoholic was 54.67±11.97 years,the male to female ratio was 6: 0.Average age of 20 patients(15.75%)with diet was 59.55±11.12 years,the male to female ratio was 1: 1.50.Average age the other causes AP was 19 cases(14.96%)51.21±15.67 years,the male to female ratio was 1: 0.73.The patients in biliogenic group was significantly older than the group with hyperlipidemia(p<0.01),the highest incidence of AP was at the ages of 45-59 and 60-74 years in these two groups.The patients in diet group was significantly older than the group with hyperlipidemia(p<0.01),the highest incidence rates of AP was at the ages of 60-74 years.(2)The increase of plasma amylase level was different in each group.The amylase level was normal in some AP patients in hyperlipidemia group.However,the amylase level was obvious increasd in biliogenic group compared to hyperlipidemia group(p<0.05).The level of alanine transaminase and aspartate aminotransferase values in biliogenic were higher than hyperlipidemia group(p<0.01).The plasma glucose values in hyperlipidemia group was higher than that in biliogenic group(p<0.05).Difference of glucose level between hyperlipidemia group and the other causes group was significant(p<0.01).The difference between groups of serum sodium was also significant.The serum sodium of alcohol group was apparently higher than the other group,and obvious lower than biliogenic and diet groups(p<0.01).The serum sodium in hyperlipidemia group was significantly higher than that in biliogenic and diet groups(p<0.01).The difference of triglyceride level in hyperlipidemia and alcohol groups was no significant,but the difference of triglyceride content was significant between hyperlipidemia and the other cause group(p<0.01).The high-density lipoprotein cholesterol level in alcohol group was lower than the other groups(p<0.05),and was obviously higher in hyperlipidemia group than biliogenic group(p<0.01).(3)There was significant difference of the causes distribution in groups with different triglyceride level(p<0.01).The group with hyperlipidemia(41.4%)was obviously higher than the other groups under the condition of elevated blood lipids.The incidence rate of biliogenic was highest in normal group.(4)There was significant difference of the causes distribution in groups with different elevated triglyceride level(p<0.01).The incidence rate of hyperlipidemia was highest(84.6%)in severe group.(5)There was no significant difference of the causes distribution in groups with different plasma glucose.The incidence rate of biliogenic was highest in each group.(6)The incidence rate of SAP was difference.Biliogenic group had fifteen cases,and the incidence rate was 21%,over 11.81%.Hyperlipemia group had three cases,and the incidence rate was 25%,over 2.36%.Alcohol group had two cases,and the incidence rate was 33.33%,over 1.57%.Diet group had nine cases,and the incidence rate was 45%,over 7.09%.The other cause group had two cases,and the incidence rate was 10.53%,over 1.57%.There was no significant difference between each group.The incidence rate was highest in diet group,lowest in the other group.Biliogenic group was the highest in all.(7)The incidence rate in biliogenic group with high blood pressure,coronary heart disease,hypocalcemia and liver dysfunction was higher than the other groups(p<0.05).The incidence rate of hyperlipidemia with fatty liver was higher than the other groups.(8)The plasma albumin of difference of MAP and SAP was significant(p<0.01),and the plasma albumin of MAP and SAP was significantly lower than the compared group(p<0.01).TG/HDL-C of SAP was higher than the compared group(p<0.01).The difference of MAP and the compared group was no significant.(9)There were 23 patients to relapse,and the recurrence rate was 18.11%.Gallstone pancreatitis was eight cases,and the recurrence rate was 11.43%,and hyperlipidemia was five cases,and the recurrence rate was 41.66%.Alcoholic was 0 cases,and the recurrence rate was 0%.Food was eight cases,and the recurrence rate was 40%,and the other was two cases,and the recurrence rate was 10.52%.The difference of the recurrence rate was no significant,but the recurrence rate of hyperlipidemia and diet group was relatively increased.Biliogenic and diet were the main cause in the relapse cases.Conclusion:(1)Biliary tract disease is still the main cause of AP,and the rate of AP resulted from hyperlipidemia and diet is increasing gradually.The patients with gallstone pancreatitis,food pancreatitis and alcoholic pancreatitis are older,and hyperlipidemia pancreatitis are younger.(2)Because plasma amylase and lipase levels are normal in some hyperlipidemia AP patients,the diagnosis should be noted to avoid misdiagnosis.The damage of liver function in gallstone pancreatitis is markedly severe than that of hyperlipidemia.Endocrine function of acute pancreatitis should be noted,and secondary diabetes mellitus also should be discovered and treated.CA199 needs to be examined in aged patients.(3)The proportion of SAP is higher in biliogenic group,followed by is hyperlipidemia group.The rate of SAP is also high in diet group.So we might pay attention to patients with hyperlipidemia,gallstone and diet pancreatitis,and avoid its further development as SAP.(4)The number of gallstone pancreatitis with high blood pressure,coronary heart disease,hypocalcemia and liver dysfunction is markedly increased.(5)Albumin level and TG/HDL-C ratio are associated with AP progression,probably used as evaluation indexes.(6)The number of the relapse of AP is most in hyperlipidemia and diet groups,so more attention should be payed to these patients. |
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