摘要
目的探讨2型糖尿病(T2DM)合并高甘油三酯血症性急性胰腺炎(HTGP)患者的临床特点及危险因素。方法回顾性收集2015年1月至2020年12月于北京积水潭医院急诊科就诊并确诊为T2DM合并急性胰腺炎(AP)患者的临床资料,根据是否为高甘油三酯血症引起的AP分为HTGP组和非HTGP组并进行比较。结果共纳入136例患者,HTGP组66例,非HTGP组70例。HTGP组患者与非HTGP组比较男性更多,年龄更低[岁:33.0(27.8,42.5)vs.66.0(49.5,75.5),P<0.001],体重指数(BMI)更高[kg/m^(2):26.7(24.2,30.8)vs.24.2(23.0,26.2),P<0.001]。实验室检查显示,HTGP组患者血糖[mmol/L:19.9(15.1,24.3)vs.11.3(9.0,13.7),P<0.001]、尿酸[mmol/L:486.0(367.0,587.0)vs.362.0(290.3,424.5),P<0.001]、甘油三酯[mmol/L:23.6(13.1,31.1)vs.1.5(1.1,2.6),P<0.001]、胆固醇[mmol/L:10.4(7.4,13.3)vs.4.7(3.7,6.0),P<0.001]及糖化血红蛋白[%:9.5(8.2,11.0)vs.7.5(7.0,8.8),P<0.001]高于非HTGP组,而血淀粉酶[U/L:160.5(75.6,465.3)vs.466.0(216.0,1414.0),P<0.001]低于非HTGP组。HTGP组患者更易合并糖尿病酮症酸中毒(DKA,%:36.4 vs.4.3,P<0.001)。HTGP组患者急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分[分:6.0(3.0,8.0)vs.2.0(1.0,4.0),P<0.001]及序贯器官衰竭评分[SOFA,分:1.5(0.0,3.0)vs.0(0.0,2.0),P<0.001]高于非HTGP组,更多的HTGP患者需要收入重症监护室(ICU,%:15.2 vs.2.9,P=0.026)进一步治疗。根据受试者工作特征(ROC)曲线,以血清甘油三酯5.965 mmol/L、胆固醇7.365 mmol/L、血糖13.650 mmol/L和糖化血红蛋白8.150%为临界值时,预测T2DM患者出现HTGP诊断的敏感度分别为87.9%、78.8%、88.3%和77.3%,特异度分别为94.3%、91.4%、75.7%和71.4%,阳性预测值分别为93.5%、89.7%、76.3%和71.8%,阴性预测值分别为89.2%、82.1%、82.8%和76.9%。结论年龄低、病情重、血糖控制不佳及高脂血症等,都是T2DM患者发生HTGP的危险因素。
Objective To investigate the clinical characteristics of hypertriglyceridemic pancreatitis(HTGP)in the patients with type 2 diabetes mellitus(T2DM),and to identify risk factors for HTGP in T2DM patients.Methods Clinical data of the patients suffered from acute pancreatitis(AP)and T2DM from January 2015 to December 2020 were retrospectively reviewed in this study.They were divided into HTGP group and non-HTGP group according to whether AP was caused by HTGP.Results 136 patients were enrolled in our study,66 patients in HTGP group and 70 patients in non-HTGP group.Compared with non-HTGP group,the patients in HTGP group were significantly linked to more male gender,younger age[years:33.0(27.8,42.5)vs.66.0(49.5,75.5),P<0.001]and the higher levels of BMI[kg/m^(2):26.7(24.2,30.8)vs.24.2(23.0,26.2),P<0.001],serum glucose[mmol/L:19.9(15.1,24.3)vs.11.3(9.0,13.7),P<0.001],uric acid[mmol/L:486.0(367.0,587.0)vs.362.0(290.3,424.5),P<0.001],triglycerides[mmol/L:23.6(13.1,31.1)vs.1.5(1.1,2.6),P<0.001],cholesterol[mmol/L:10.4(7.4,13.3)vs.4.7(3.7,6.0),P<0.001]and hemoglobin A1c[9.5(8.2,11.0)%vs.7.5(7.0,8.8)%,P<0.001],the lower level of hemodiastase[U/L:160.5(75.6,465.3)vs.466.0(216.0,1414.0),P<0.001].As regards the severity,the patients in HTGP group were associated with a significantly higher APACHEⅡscore[scores:6.0(3.0,8.0)vs.2.0(1.0,4.0),P<0.001]and SOFA[scores:1.5(0.0,3.0)vs.0(0.0,2.0),P<0.001]score.More patients in HTGP group were concomitant with diabetic ketoacidosis(DKA,36.4%vs.4.3%,P<0.001).They were more likely to be admitted to intensive care unit(15.2%vs.2.9%,P=0.026).When cut-off value of serum triglycerides(5.965 mmol/L),cholesterol(7.365 mmol/L),serum glucose(13.650 mmol/L)and hemoglobin A1c(8.150%)were used for the diagnosis of HTGP,sensitivity was 87.9%,78.8%,88.3%and 77.3%and specificity was 94.3%,91.4%,75.7%and 71.4%.Positive predictive value was 93.5%,89.7%,76.3%and 71.8%,respectively.Negative predictive value was 89.2%,82.1%,82.8%and 76.9%,respectively.Conclusions For T2DM patients with HTGP,the younger the patients are,the worse the patient′s condition is.Poorly controlled diabetes mellitus and hypertriglyceridemia are risk factors for HTGP in T2DM patients.
作者
付燕
刘雪
崔北辰
王聪
赵斌
Fu Yan;Liu Xue;Cui Bei-chen;Wang Cong;Zhao Bin(Emergency Department,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中国急救医学》
CAS
CSCD
2022年第2期149-153,共5页
Chinese Journal of Critical Care Medicine
