Mentula Panu, Kylänpää Marja-Leena, Kemppainen Esko, Repo Heikki, Puolakkainen Pauli
Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Scand J Gastroenterol. 2007 Nov;42(11):1362-8. doi: 10.1080/00365520701427086.
Obesity is a known risk factor for severe acute pancreatitis (AP), but the mechanism by which it affects the severity of AP is not fully understood. The main objective of this study was to investigate the relationship between obesity and inflammatory markers in AP.
Thirty patients with AP who developed organ failure (Group I) and 87 patients with AP who survived without organ failure (Group II) were studied. Patients' height and weight were measured at admission for calculation of body mass index (BMI). Blood samples were taken at admission for measurement of plasma interleukin (IL)-1beta, IL-6, IL-10, IL-1 receptor antagonist, procalcitonin, C-reactive protein (CRP) and monocyte human leucocyte antigen (HLA)-DR expression.
Group I patients had higher BMI values (median 26.2 kg/m2) than Group II patients (25.2 kg/m2), p =0.033. Both CRP values and monocyte HLA-DR expression showed a significant correlation with BMI (Spearman's rank correlation r=0.32, p =0.003 and r= -0.33, p = 0.002, respectively). The correlation between BMI and monocyte HLA-DR expression was significant in Group II patients (r = -0.34, p =0.002) but not in Group I patients (r = -0.02, p >0.05). There was no correlation between BMI and IL-1beta, IL-6, IL-10, IL-1 receptor antagonist or procalcitonin.
BMI did not affect either proinflammatory or anti-inflammatory cytokine levels in early AP. However, in patients with mild AP, BMI correlated positively with CRP levels and inversely with monocyte HLA-DR expression, which might reflect an amplified inflammatory response in these patients. Taken together, acute inflammatory response in AP, which ultimately determines the severity of AP, was little affected by BMI.
肥胖是重症急性胰腺炎（AP）的已知危险因素，但其影响AP严重程度的机制尚未完全明确。本研究的主要目的是探讨肥胖与AP炎症标志物之间的关系。
对30例发生器官功能衰竭的AP患者（第一组）和87例未发生器官功能衰竭而存活的AP患者（第二组）进行研究。入院时测量患者的身高和体重以计算体重指数（BMI）。入院时采集血样，检测血浆白细胞介素（IL）-1β、IL-6、IL-10、IL-1受体拮抗剂、降钙素原、C反应蛋白（CRP）以及单核细胞人类白细胞抗原（HLA）-DR表达。
第一组患者的BMI值（中位数26.2kg/m²）高于第二组患者（25.2kg/m²），p =0.033。CRP值和单核细胞HLA-DR表达均与BMI显著相关（Spearman等级相关系数r分别为0.32，p =0.003和r = -0.33，p =0.002）。BMI与单核细胞HLA-DR表达之间的相关性在第二组患者中显著（r = -0.34，p =0.002），而在第一组患者中不显著（r = -0.02，p>0.05）。BMI与IL-1β、IL-6、IL-10、IL-1受体拮抗剂或降钙素原之间无相关性。
BMI在AP早期不影响促炎或抗炎细胞因子水平。然而，在轻症AP患者中，BMI与CRP水平呈正相关，与单核细胞HLA-DR表达呈负相关，这可能反映了这些患者炎症反应的增强。总体而言，最终决定AP严重程度的急性炎症反应受BMI的影响较小。
