發(fā)布時間：2018-05-10 11:11

  本文選題：高脂血癥 + 急性胰腺炎��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:本文旨在通過對臨床病例的回顧性總結(jié),對比高脂血癥性急性胰腺炎與急性膽源性胰腺炎的臨床特征,提高臨床工作對HLAP的診斷、治療水平。方法:收集蘭州大學(xué)第一醫(yī)院自2013年1月至2016年11月收治的57例明確診斷,且病例資料完整的高脂血癥性急性胰腺炎(Hyperlipidmia acute pancreatitis,HLAP)的患者資料,同時用隨機抽樣的方法抽取同時期60例明確診斷為急性膽源性胰腺炎(Acute biliary pancreatitis,ABP),且病例資料完整的患者為對照組。收集兩組患者的一般情況、實驗室檢查、影像學(xué)檢查、病情嚴(yán)重程度、伴隨疾病、并發(fā)癥、治療及效果等數(shù)據(jù)資料,對所得的數(shù)據(jù)采用Excel表及SPSS21.0軟件進行數(shù)據(jù)記錄及統(tǒng)計分析。結(jié)果:(1)基本情況:HLAP組患者年齡較ABP組低,但體質(zhì)指數(shù)(BMI)相對較高,差異具有統(tǒng)計學(xué)意義(P0.05),而住院日期、性別無明顯統(tǒng)計學(xué)意義(P0.05);(2)血脂:HLAP組患者甘油三酯(TG)、總膽固醇(CHOL)水平顯著高于ABP組,差異具有統(tǒng)計學(xué)意義(P0.05),而高密度脂蛋白膽固醇(HDL-C)及低密度脂蛋白膽固醇(LDH-C)則無明顯統(tǒng)計學(xué)意義(P0.05);(3)生化及血常規(guī):ABP組患者天冬氨酸氨基轉(zhuǎn)移酶(AST)、谷丙氨酸轉(zhuǎn)氨酶(ALT)、總膽紅素(TBIL)、堿性磷酸酶(ALP)、谷氨酰轉(zhuǎn)肽酶(GGT)及尿素氮(BUN)水平均顯著高于HLAP組,差異具有統(tǒng)計學(xué)意義(P0.05);HLAP組葡萄糖(GLU)、膽堿酯酶(CHE)、鈣離子(Ca2+)水平及白細胞(WBC)水平均高于ABP組,差異具有統(tǒng)計學(xué)意義(P0.05),其余血淀粉酶(AMY)、尿淀粉酶(UAMY)、乳酸脫氫酶(LDH)、血肌酐(Crea)水平及中性粒細胞百分比(NEUT%)則無統(tǒng)計學(xué)意義(P0.05);(4)臨床癥狀的對比中,HLAP組伴隨糖尿病、脂肪肝的患者比ABP組多,但臨床表現(xiàn)為黃疸、發(fā)熱以及并發(fā)胰腺壞死及肝功能異常的較ABP組少,差異具有統(tǒng)計學(xué)意義(P0.05);(5)HLAP組患者表現(xiàn)為重癥急性胰腺炎(SAP)的顯著高于ABP組,與MCTSI評分結(jié)果一致,差異具有統(tǒng)計學(xué)意義(P0.05)。HLAP組患者手術(shù)率明顯低于ABP組,差異具有統(tǒng)計學(xué)意義(P0.05);而兩組在死亡率、復(fù)發(fā)率進行比較,差異無統(tǒng)計學(xué)意義(P0.05);(6)將HLAP組患者分為非重癥組及重癥組進行對比,重癥組患者GLU水平、MCTSI評分以及BISAP評分明顯高于非重癥組,差異具有統(tǒng)計學(xué)意義(P0.05)。而在一般情況、血脂、生化、伴隨糖尿病、脂肪肝、治療效果等方面的比較兩組患者無明顯統(tǒng)計學(xué)差異(P0.05)。結(jié)論:(1)HLAP組發(fā)病多為中青年患者,其中男性患者較多;(2)HLAP患者TG顯著升高,治療中應(yīng)積極降脂治療;(3)HLAP組患者伴隨糖尿病、脂肪肝的較多;(4)ALT、AST、ALP、GGT等肝功等指標(biāo)可以輔助ABP的診斷肝功等指標(biāo)可以輔助ABP的診斷。
[Abstract]:Objective: to compare the clinical features of hyperlipidemic acute pancreatitis and acute biliary pancreatitis by reviewing the clinical cases and to improve the clinical diagnosis and treatment of HLAP. Methods: from January 2013 to November 2016, 57 patients with hyperlipidmia and hyperlipidemia acute were collected from the first Hospital of Lanzhou University from January 2013 to November 2016. At the same time, 60 cases of acute biliary pancreatitis with complete data were selected as control group by random sampling in the same period. The data of two groups of patients were collected, such as general condition, laboratory examination, imaging examination, severity of the disease, concomitant disease, complications, treatment and effect. The data were recorded and analyzed by Excel table and SPSS21.0 software. Results the age of HLAP group was lower than that of ABP group, but the body mass index (BMI) was higher, the difference was statistically significant (P 0.05). There was no significant difference in sex (P 0.05). The serum levels of triglyceride and total cholesterol in HLAP group were significantly higher than those in ABP group. The difference was statistically significant (P 0.05), but high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDH-C) had no statistical significance. The levels of total bilirubin, alkaline phosphatase, glutamyl transpeptidase (GGTT) and urea nitrogen bun were significantly higher than those in HLAP group. There were significant differences in the levels of GLU, che, Ca 2 + and WBC in HLAP group compared with those in ABP group. The difference was statistically significant (P 0.05). There was no significant difference in the levels of serum amylase, urine amylase, lactate dehydrogenase (LDH), creatinine (crea) and neutrophilic granulocyte (n = 4). There was no significant difference in the clinical symptoms of HLAP with diabetes mellitus. There were more patients with fatty liver than those with ABP, but there were fewer patients with jaundice, fever, complicated pancreatic necrosis and abnormal liver function than those with ABP. The difference was statistically significant (P 0.05). The number of patients with severe acute pancreatitis (ABP) was significantly higher than that of ABP. In accordance with the MCTSI score, the operative rate of patients in the group of P0.05 + HLAP was significantly lower than that in the group of ABP, and the difference was statistically significant (P 0.05), and the mortality rate and recurrence rate were compared between the two groups. There was no significant difference (P 0.05). The HLAP group was divided into non-severe group and severe group for comparison. The GLU level and BISAP score of severe group were significantly higher than that of non-severe group, the difference was statistically significant (P 0.05). But in the general situation, blood lipid, biochemistry, concomitant diabetes mellitus, fatty liver, curative effect and so on aspect comparison two groups patient not to have the obvious statistical difference (P 0.05). Conclusion the incidence of HLAP group is mostly middle and young patients, among which the TG of male patients is higher than that of male patients, so it is necessary to treat the patients with diabetes mellitus by reducing blood lipid actively. The indexes of liver function, such as liver function of fatty liver such as alt, ALP, GGT and so on, can be used to assist the diagnosis of ABP and other indexes of liver function, which can assist in the diagnosis of ABP.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576;R589.2

【參考文獻】

相關(guān)期刊論文 前10條

1 何欽緣;付文廣;李秋;;急性重癥胰腺炎的發(fā)病原因及發(fā)病機制研究進展[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年21期

2 Mohammad S Khuroo;Ajaz A Rather;Naira S Khuroo;Mehnaaz S Khuroo;;Hepatobiliary and pancreatic ascariasis[J];World Journal of Gastroenterology;2016年33期

3 劉偉;宋曉彪;劉超;胡江;;高脂血癥性胰腺炎的研究進展[J];臨床薈萃;2016年08期

4 阮繼剛;孫金玲;臧媛;;急性胰腺炎的病因及臨床特征分析[J];寧夏醫(yī)科大學(xué)學(xué)報;2016年07期

5 石廣東;;156例膽源性胰腺炎外科治療體會[J];實用臨床醫(yī)藥雜志;2016年13期

6 王春友;李非;趙玉沛;苗毅;楊尹默;;急性胰腺炎診治指南(2014)[J];中國實用外科雜志;2015年01期

7 Pier Alberto Testoni;;Acute recurrent pancreatitis:Etiopathogenesis, diagnosis and treatment[J];World Journal of Gastroenterology;2014年45期

8 孫俊峰;湯親青;張劍林;方茂勇;;高脂血癥性急性胰腺炎的發(fā)病機制及治療的研究進展[J];肝膽外科雜志;2014年05期

9 譚超超;趙亞欄;黃瑩;譚黎明;彭劍橋;曹友德;;血清生化指標(biāo)在膽源性重癥急性胰腺炎診治中的臨床價值[J];實用預(yù)防醫(yī)學(xué);2014年09期

10 陳幼祥;;急性膽源性胰腺炎的診斷和治療[J];中國實用內(nèi)科雜志;2014年09期

相關(guān)碩士學(xué)位論文 前1條

1 張娜;近10年急性胰腺炎病因變化特點的Meta分析[D];山西醫(yī)科大學(xué);2016年

，

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