Analysis Of Clinical Features Of Hyperlipidemic Acute Pancreatitis

The first part A comparative analysis of the clinical characteristics of hyperlipidemic acute pancreatitis and biliary acute pancreatitisObjective:To compare the clinical characteristics of hypertriglyceridemia acute pancreatitis(HTG-AP)and acute gallstone pancreatitis(ABP),and to explore the value of critical illness score in distinguishing the severity of acute pancreatitis(AP).Methods:Clinical data of hospitalized patients diagnosed as AP from January 2013 to June 2018 in China-Japan Friendship Hospital were collected.Ranson,BISAP and Apache-? scores were calculated based on the worst parameters on the day of admission and 48h after admission.The differences between HTG-AP and ABP in each index were compared.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of Ranson,BISAP and APACHE-II scores on SAP.Results:A total of 142 cases of HTG-AP and 516 cases of ABP were collected.The prevalence of HTG-AP was mainly male(73.9%vs.26.1%)and younger(39 years vs.61 years,P<0.001).In terms of comorbidities,a higher proportion of patients with HTG-AP had diabetes(45.1%vs 14.5%,P<0.001);However,the levels of amylase,lipase and serum calcium in ABP patients were significantly higher than those in HTG-AP(P<0.001).In terms of complications,HTG-AP patients had higher incidence of acute respiratory distress syndrome,acute kidney injury,and gastrointestinal bleeding(P<0.05).The ROC curve showed that:?The area under the curve of Ranson score to differentiate severe from non-severe AP,MSAP and SAP was 0.965 and 0.888,respectively.The best cutoff value was 3.5 and 4.5,and the sensitivity and specificity were 96.7%and 82.9%,86.9%and 74.3%,respectively.?The area under the curve of BISAP score for distinguishing severe from non-severe AP,MSAP from SAP was 0.929 and 0.792,the best cutoff value was 1.5 and 1.5,the sensitivity and specificity were 96.7%and 84.1%,96.7%and 50.0%,respectively.?The area under the curve of APACHE-? score for distinguishing severe from non-severe AP,MSAP and SAP was 0.968 and 0.892,respectively.The best cutoff value was 9.5 and 10.5,respectively.The sensitivity and specificity were 90.2%and 89.6%,85.2%and 78.1%,respectively.Conclusion:HTG-AP is more common in young men and has a high prevalence of diabetes.The incidence of acute respiratory distress syndrome,acute kidney injury and gastrointestinal bleeding was higher than that of ABP group.Ranson,BISAP,and APACHE-? scores have high predictive value in differentiating SAP.The second part analyses the clinical characteristics of hyperlipidemic acute pancreatitisObjective:Through the comparative analysis of the clinical data of hyperlipidemic acute pancreatitis,the clinical characteristics of HTG-AP were discussed,and the severity assessment and prognosis of the disease were analyzed,so as to improve the understanding of HTG-AP.Methods:Data of patients admitted to China-Japan Friendship Hospital and diagnosed as HTG-AP from January 2013 to June 2018 were collected.Parameters of patients on the day of admission and within 48 hours were collected,and Ranson,BISAP and Apache-?scores were calculated respectively.Whether there are differences in the biochemical examination results and critical disease scores between mild,moderate and severe syndromes HTG-AP;The differences of each index between the complication group and the non-complication group were compared.Receivers operating characteristic(ROC)curve and linear regression were used to analyze the predictive efficacy of Ranson,BISAP and APACHE-? scores on complications.Results:A total of 142 cases of HTG-AP were collected.Among them,105(73.9%)were males,37(26.1%)were females,68(47.9%)had hyperlipidemia,64(45.1%)had diabetes,and 58(40.8%)had a history of pancreatitis.And often combined with diabetes,hyperlipidemia,etc.,more prone to relapse.There was no difference in serum amylase level between MAP,MSAP and SAP patients(P>0.05).LDH,serum creatinine,Ranson score,BISAP score and APACHE-? score were significantly increased in SAP patients,but serum calcium was significantly decreased(P<0.001).Serum lipase,aspartate transferase and triglyceride levels were higher than those of non-severe HTG-AP(P<0.05).In terms of complications(ARDS,infection,pseudocyst,pancreatic abscess,acute kidney injury,gastrointestinal bleeding),the incidence of SAP is significantly increased.Serum levels of amylase,aspartate transferase,serum urea nitrogen,lactate dehydrogenase,pancreatic necrosis rate,Ranson,BISAP,APACHE-? scores were higher than those in the non-complication group,while serum calcium level was the opposite(P<0.05).On imaging,CT grades were significantly higher in the group with complications(P<0.001).The ROC curve showed that:?The area below the suite was 0.848,the best cutoff value was 3.5,the sensitivity and specificity were 78.2%,78.2%,PPV69.4%,NPV85.0%,and Youden index 0.564.?The area under the curve was 0.797,the best cutoff value was 1.5,the sensitivity and specificity were 63.6%,86.2%,PPV74.5%,NPV78.9%,and Youden index 0.498.?The APACHE-? score was used to differentiate the suite between the complication group and the non-complication group.The area below line was 0.850,the best cutoff value was 10.5 points,the sensitivity and specificity were 63.6%,92.0%,PPV83.3%,NPV80.0%,and Youden index 0.556.Conclusion:HTG-AP tends to occur in young male patients and is usually associated with diabetes.The levels of serum TG,LDH,serum creatinine and serum lipase in severe HTG-AP patients were higher than those in non-severe HTG-AP patients.Serum calcium was significantly lower than non-severe HTG-AP;Ranson score,BISAP score and APACHE-? score were significantly increased in SAP patients.Complications such as ARDS,infection,pseudocyst,pancreatic abscess,acute kidney injury,and gastrointestinal bleeding are significantly higher in patients with SAP.Using ROC curve analysis and linear regression analysis,Ranson,BISAP,and APACHE-? scores had high predictive value in terms of complications.