| Objective:To investigate the relationship between serum triglyceride(TG)level and clinical features of acute pancreatitis(AP)and its effect on the diagnostic value of serum amylase.Methods:According to Pre-established criteria,the research included298 patients with acute pancreatitis who admitted to the affiliated Hospital of Southwest Medical University from July 2020 to June 2021.According to etiology and Serum triglyceride level within 24 hours of admission,patients were divided into four groups as follow:non hypertriglyceridemic-induced acute pancreatitis and normal triglyceride group(NHNT group),non hypertriglyceridemic-induced acute pancreatitis with elevated triglyceride group(NHET group),hypertriglyceridemic-induced acute pancreatitis without severe high triglyceride group(HNST group),hypertriglyceridemic-induced acute pancreatitis with severe high triglyceride group(HST group).The sex,age,onset time,past medical history,serum amylase level,serum lipase level,severity score,complications and clinical outcome of patients in each group were collected and compared with SPSS 23.0software.One-way ANOVA test was used to compare the measurement data in accordance with normal distribution,LSD-t test was used to compare between the two groups;and Kruskal-Wallis H test was used for comparison the measurement data that did not conform to normal distribution.The counting data were compared by X~2test or Fisher exact probability method;the ordered multi-classification variables were compared by Kruskal-Wallis H test,and the two groups were compared by Mann-Whitney U test.The factors with significant differences between groups were further analyzed by univariate and multivariate Logistic regression analysis.Results:(1)Sex:the proportion of males in NHET group,HNST group and HST group was higher than that in NHNT group(73.4%,81.8%,72.4%vs.52.8%,P<0.05),but there was no significant difference among NHET group,HNST group and HST group.(2)Age:the median age of NHET group,HNST group and HST group was lower than that of NHNT group(46 years old,46 years old,44 years old vs.57years old),but there was no significant difference among NHET group,HNST group and HST group.(3)Past medical history:the proportion of diabetes in NHET group,HNST group and HST group was higher than that in NHNT group(20.3%,24.2%,47.4%vs.5.7%,P<0.05).The proportion of diabetes in HST group was higher than that in NHET group and HNST group(44.4%vs.20.3%,24.2%).There was no significant difference in history of cholecystectomy among the four groups(P>0.05).(4)The proportion of recurrent acute pancreatitis(RAP):the proportion of RAP in HST group was significantly higher than that in NHNT group(48.4%vs.22.6%,P<0.05).There was no significant difference among NHET group,HNST group and HST group.(5)Degree of lipid turbidity:the proportion of patients with lipid turbidity(4+)in HST group was significantly higher than that in NHNT group,NHET group and HNST group(90.5%vs.0,7.8%,36.4%,P<0.001).(6)Serum amylase level:the level of serum amylase in NHET group,HNST group and HST group was lower than that in NHNT group(161.75U/L,299.00U/L,217.80U/L vs.836.30U/L,P<0.05),but there was no significant difference among NHET group,HNST group and HST group.The sensitivity of serum amylase in diagnosing AP:the proportion of serum amylase level exceeding three times upper limit of normal(ULN)in NHET group,HNST group and HST group was lower than that in NHNT group(34.4%,39.4%,24.2%vs.66.0%,P<0.05).(7)Serum lipase level:the level of serum lipase in NHET group,HNST group and HST group was lower than that in NHNT group(192.55U/L,733.50U/L,399.70U/L vs.11066.60U/L,P<0.05),but there was no significant difference among NHET group,HNST group and HST group.The sensitivity of serum lipase in the diagnosis of AP:there was no significant difference in the proportion of serum lipase exceeding 3*ULN among HNST group,HST group and NHNT group(69.7%,76.8%vs.84.0%,P>0.05).(8)Local complications:pancreatic parenchyma necrosis in NHNT group,NHET group,HNST group and HST group was 10.4%,7.8%,3.0%and 11.6%respectively,and there was no significant difference among the four groups(P>0.05).The proportion of pleural effusion in NHET group and HST group was lower than that in NHNT group(17.2%,16.8%vs.32.1%P<0.05).(9)Systemic complications:the proportion of SIRS in HST group was higher than that in NHNT group and NHET group(30.5%vs.9.4%,14.1%).There was no significant difference among the other groups.There was no significant difference in the proportion of ARDS and AKI among the four groups.(10)Prognosis:there was no significant difference in cure rate,improvement rate and mortality among the four groups(P>0.05).(11)The influencing factors of serum amylase lower than 3*ULN:univariate logistic regression analysis showed that the onset time was the influencing factor of serum amylase lower than 3*ULN.After adjusting for related factors,the risk of serum amylase lower than 3*ULN in NHET group was 3.754 times higher than that in NHNT group(95%CI:1.881～7.489,P<0.001).The risk of serum amylase lower than 3*ULN in HNST group was 3.745times that of NHNT group(95%CI:1.589～8.831,P=0.003).The risk of serum amylase lower than 3*ULN in HST group was 10.067 times that of NHNT group(95%CI:5.009～20.233,P<0.001).(12)The risk factors of SIRS:univariate logistic regression analysis showed that RAP was a protective factor for SIRS.After adjusting for related factors,the risk of SIRS in HST group was 5.703 times that of NHNT group(95%CI:2.513～12.943,P<0.001).Conclusion:Firstly,in patients with AP and elevated triglycerides,the levels of serum amylase and lipase don’t increase significantly,and the diagnostic sensitivity of serum amylase decrease,but the diagnostic sensitivity of serum lipase don’t decrease significantly,serum lipase has higher diagnostic value than serum amylase.Secondly,both patients with hypertriglyceridemic-induced acute pancreatitis(HTG-AP)and patients in NHET group are showed these features of younger age,higher proportion of males,higher proportion of complicated with diabetes.Thirdly,the risk of SIRS in patients with HTG-AP and TG≥11.2 mmol/L is significantly higher than that in patients with non-HTG-AP.Fourthly,the recurrence rate of patients with HTG-AP and TG≥11.2 mmol/L is significantly higher than that of AP patients with normal triglyceride. |
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