高脂血症性急性胰腺炎的发病机制及诊疗进展

Epidemiology and Etiology of Acute Pancreatitis in Urban and Suburban Areas in Shanghai: A Retrospective Study

Aim

To investigate the epidemiology, etiology, and severity of acute pancreatitis (AP) in urban and suburban areas of Shanghai in 2011 and 2016.

Methods

A retrospective study of patients admitted to Shanghai General Hospital (urban and suburban campuses) with AP in 2011 and 2016 was undertaken. Patients were divided into acute biliary pancreatitis (ABP), hypertriglyceridemic pancreatitis (HTGP), alcoholic pancreatitis, and pancreatitis of other causes according to etiology. Severity of AP was divided into mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP).

Results

AP patients in the suburban area increased more rapidly than those in the urban area. The mean onset age of AP in the urban area in 2016 was older than that in the suburban area (p < 0.05). The suburban patients in 2016 have significantly younger mean onset age than those in 2011 (p < 0.05). HTGP incidence in suburban patients increased from 2011 to 2016, which changed little in the urban area. Urban females were more likely to develop HTGP than suburban ones in 2011, which reversed in 2016. As to the male patients, the incidence of HTGP increased in both urban and suburban areas. Nonelderly (<60 years old) patients had higher HTGP incidence than elderly ones in both 2011 and 2016. The descending trend of SAP in the suburban area was more obvious than that in the urban area. The length of hospitalization decreased from 2011 to 2016, especially in SAP patients.

Conclusions

AP patients increased more rapidly in the suburban area of Shanghai with younger onset age. The incidence of HTGP increased significantly in the suburban area, reminding of the prevention and screening of HTG.

Role of hyperlipidimia in pathogenesis of acute pancreatitis

Recently, many studies have focused on the relationship between hyperlipidemia (HL) and acute pancreatitis (AP). HL is a significant cause of AP, but it may also be secondary to AP. Hypertriglyceridemia (HTG) and hypercholesterolemia (HTC) are two types of HL. It is generally believed that HTG may induce AP and AP could increase the incidence of HTG. However, the relationship between HTC and AP has not yet confirmed. The diagnosis of hyperlipidemic acute pancreatitis (HLAP) needs not only the evidence of AP, but also an elevated level of serum lipids. Nevertheless, there still exist some divergent opinions regarding the level of serum lipids. Since the diagnosis of HLAP is critical for the therapy and prognosis, the lack of unified diagnostic criteria poses a great challenge for clinicians.

Severity, complications and mortality of acute pancreatitis of different etiology: A comparative analysis

AIM: To compare the severity and clinical characteristics of hyperlipidemic acute pancreatitis (HLAP) and biliary acute pancreatitis (ABP).

METHODS: Clinical data for 23 patients with HLAP (HLAP group) and 84 patients with ABP (ABP group) treated at our hospital from January 2012 to December 2013 were retrospectively analyzed, and the general data, severity, complications and mortality were compared.

RESULTS: Body mass index (BMI) and time of hospitalization in the HLAP group were significantly higher than those in the ABP group (24.3 kg/m² ± 2.15 kg/m²vs 22 kg/m² ± 2.84 kg/m², 14.30 d ± 5.77 d vs 10.32 d ± 3.91 d, P < 0.01). Serum AMS levels were significantly lower in the HLAP group than in the ABP group (598.04 U/L ± 857.40 U/L vs 1200.86 U/L ± 833.64 U/L, P < 0.05). C-reactive protein (CRP) values, acute physiology and chronic health evaluation scoring system (APACHEⅡ) scores, and bedside index for severity in acute pancreatitis (BISAP) scores at admission and 48 h after admission were significantly higher in the HLAP group than in the ABP group (P < 0.05 or P < 0.01). The modified CT severity index (MCTSI) score had no significant difference between the two groups at admission, but was significantly higher 48 h after admission in the HLAP group (5.91 ± 1.41 vs 4.98 ± 1.77, P < 0.01). The incidence of intestinal paralysis and acute respiratory distress syndrome (ARDS) in the two groups had no significant difference, but that of diabetes and pancreatic cysts was significantly higher in the HLAP group (13% vs 2.4%, 21.7% vs 6%, P < 0.05). There were 1 case of pancreatic encephalopathy and 2 deaths in the HLAP group, while there was no death in the ABP group.

CONCLUSION: HLAP is characterized by serious illness and high incidence of complications and mortality, and attention should be paid to this condition.

Treatment with low-molecular-weight heparin reduces blood levels of PAF and ET-1/NO in rats with severe acute pancreatitis and hyperlipemia

AIM: To investigate the effect of treatment with low-molecular-weight heparin (LMWH) on microcirculation dysfunction in rats with severe acute pancreatitis (SAP) and hyperlipemia.

METHODS: SD rats were fed a high-fat diet for four weeks to induce hyperlipemia and randomly divided into sham operation group, control group, and experimental group. The control group and experimental group were then used to induce SAP, while the sham operation group underwent a sham operation. At 0, 6, 12 and 18 h after SAP induction, the experimental group was subcutaneouly injected with LMWH, and the control group was injected with normal saline. The concentrations of PAF and ET-1/NO in the portal vein blood were measured, and pancreatic microcirculatory structure was observed by electron microscopy.

RESULTS: The concentrations of PAF and ET-1/NO in the experimental group (5.9250 mmol/L ± 0.6113 mmol/L, 3.5368 ± 0.26) were significantly lower than those in the control group (7.4059 mmol/L ± 0.4281 mmol/L, 4.1697 ± 0.08), but were significantly higher than those in the sham operation group (4.4950 mmol/L ± 0.2628 mmol/L, 2.5133 ± 0.20). In addition, treatment with LWMH improved pancreatic microcirculation.

CONCLUSION: Treatment with LMWH improves pancreatic microcirculation in rats with SAP and hyperlipemia.