Evaluation On Clinical Characteristics And Therapeutic Effect Of Varying Degrees Of Hypertriglyceridemia Acute Pancreatitis

Aims:The aims of this study were to enhance understanding of hypertriglyceridemia acute pancreatitis(HTG-AP)and improve its level of clinical treatment by analyzing the clinical manifestation and therapeutic effect of HTG-AP.Methods:We enrolled 112 well-characterized HTG-AP patients who admitted to the first hospital of Jilin University from January 2012 to December 2019.The clinical data of 112 patients included age,gender,duration of hospitalization,clinical manifestation,past history,height,body weight,laboratory data,imaging presentations,local and systemic complications,therapeutic process and outcome.The clinical characteristics and treatment effect of HTG-AP were analyzed from the following aspects:(1)analyzing the age and gender distribution of 112 patients with HTG-AP according to the age segmentation proposed by the World Health Organization(WHO);(2)112 cases of HTG-AP were divided into mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)according to the 2012: revision of the Atlanta classification and definitions standards and the clinical data of the three groups at 24 hours after admission was analyzed;(3)hypolipidemic therapies of the three groups were compared;(4)to compare the efficacy of hemoperfusion(HP)on MSAP and SAP,these patients were divided into MSAP without HP treatment,MSAP with HP treatment and SAP with HP treatment respectively;(5)to compare the efficacy of low calorie on MAP,MAP was divided into low calorie group and normal calorie group according to intravenous heat supplement.Results:(1)112 patients with HTG-AP admitted to our hospital were mostly aged between 18 and 44 years old(69.6%),and mainly in male(60.25%).(2)Of 112 HTG-AP patients,MSAP accounted for 48.2% which was higher than MAP(31.3%)and SAP(20.5%),respectively.(3)According to clinical data analysis of 112 HTG-AP at 24-hours after admission,there was no significant difference in gender and age distribution among MAP,MSAP and SAP groups.The median hospitalization stay in SAP group was 17 days,which was higher than that in MAP(8 days)or MSAP group(13 days)(P = 0.001).The incidences of abdominal pain and distention in the three groups were similar.There were higher coincidences of diabetes / high glucose(73.5%,68.6% and 78.2%),overweight / obesity(68.5%,66.7% and 65.2%)and metabolic syndrome(65.7%,66.7% and 69.5%)in MAP,MSAP and SAP respectively,however,they were no significant differences in incidence among the three groups(P>0.05).The coincidence of hypertension in SAP group(43.5%)were significantly higher than that in MAP group(35.3%)or MSAP group(31.5%)(P<0.05).By comparing the results obtained from laboratory test items including serum triglycerides(TG),albumin(ALB),creatinine(Cr),amylase(AMY),lipase(LIP)and C reactive protein(CRP),the results of the comparision showed that TG,Cr,AMY,LIP and CRP levels in SAP group were significantly higher than those in MSAP group and that TG,Cr,AMY,LIP and CRP levels in MSAP group were significantly higher than those in MAP group(P<0.05).On the contrary,the serum ALB levels was the lowest in SAP group and was the highest in MAP group(P<0.05).The serum aspartic transferase(AST),urea nitrogen(BUN)and cholesterol(CHO)levels of the SAP group were significantly higher than those of the MAP group and the MSAP group,respectively(P<0.05),whereas there was no significant difference between MAP and MSAP groups.The values of white blood cell(WBC),aminotransferase(ALT),international normalized ratio(INR),glucose(GLU),High density liptein cholesterol(HDL-C)and low density liptein cholesterol(LDL-C)were no significant difference among the three types of HTG-AP patients(P>0.05).(4)The analysis results obtained from various hypolipidemic therapies showed that insulin was used for all patients in three types of HTG-AP,Small molecule heparin was used in 1 case(2.9%)of MAP,9 cases(16.7%)of MSAP,and 3 cases(13.0%)of SAP respecteively,without significant difference among these three groups(P>0.05).Enofibrate and Rosuvastatin were used only in a few cases in each group of HTG-AP,without significant difference in the number of treated cases with Enofibrate or Rosuvastatin(P<0.05).21(91.3%)of 23 SAP patients were treated with HP,13(24.1%)of 54 MSAP patients were treated with HP,and none of MAP was treated with HP.Additionally,26(74.3%)of 35 MAP patients were treated with intravenous hypocaloric therapy,36(66.7%)of 54 MSAP patients were treated with hypocaloric therapy,and 4(17.4%)of 23 SAP patients were treated with hypocaloric therapy.The number of SAP patients received hypocaloric therapy was significantly lower than that of MAP or MSAP received hypocaloric therapy(P < 0.01),whereas,there was no significant difference in the number of patients receiving low calorie therapy between MAP and MSAP groups.(5)The comparison results from 21 cases of SAP who had treated with HP(median 3.89 times)and 13 cases of MSAP with HP(median 2.66 times)and 41 cases of MSAP without HP showed that the average levels of serum TG in SAP plus HP,MSAP plus HP and MSAP without HP were 16.4 mmol/L,14.1 mmol/L and 11.7 mmol/L,respectively,with significant difference among them and the lowest level in MSAP without HP at 24 hour after admission(P<0.05).The serum levels of TG in these three groups were significantly decreased on the 7th day of admission,however,the decreased TG levels didn’t make difference among them anymore(P>0.05).Additionally,the degrees of reduction in serum CHO and C reaction protein(CRP)of MSAP plus HP and SAP plus HP treatment were more obvious than that of MSAP without HP treatment,suggesting that HP treatment after admission could decrease TG and CHO levels and inflammatory mediator concentration in MSAP and SAP patients.However,HP treatment could not shorten the average hospitalization days in MSAP patients.(6)The serum levels of TG,CHO and fasting blood glucose in 9 MAP patients receiving normal calorie and 26 MAP patients receiving low calorie at 24 hour after admission were 11.1 mmol/L and 11.2 mmol/L,8.7 mmol/L and 8.6 mmol/L,and 12.3 mmol/L and 12.5 mmol/L,respectively,without significant difference between two MAP groups(P < 0.05),however,TG(4.9 mmol/L)and CHO(6.3 mmol/L)levels of MAP plus low calorie were significantly lower than TG(7.3 mmol/L)and CHO(8.6 mmol/L)of MAP plus normol calorie on the 7th day of admission,indicating that low calorie could significantly reduce the serum levels of TG and CHO in MAP(P<0.01,P<0.05).In addition,intravenous low calorie could significantly reduce the level of fasting blood glucose in MAP patients(P < 0.05).However,compared with normal calorie group,the low calorie could not shorten the hospitalization days.Conclusions:HTG-AP is more common in young men,and most of the clinical inpatients are MSAP.The incidences of diabetes/high glucose,overweight/obesity and metabolic syndrome in all types of HTG-AP are about 2/3.The higher the serum level of TG,Cr,AMY and LIP is,the worse the HTG-AP is,and the lower the serum level of ALB is,the worse the disease is.Insulin is widely used in the treatment of HTG-AP,while the application of small molecule heparin is very limited.HP has the ability to rapidly reduce the serum TG,CHO and CRP levels of MSAP and SAP,and intravenous low calorie can effectively reduce the serum TG,CHO and fasting blood glucose levels of MAP patients,however,HP and low calorie treatment can’t shorten the hospitalization days of MSAP and MAP.