Intensive Care Unit.
Gastroenterology Division and Digestive Endoscopy Centre, Jiangsu Provincial People's Hospital Affiliated to Nanjing Medical University, Nanjing, China.
J Clin Gastroenterol. 2019 Aug;53(7):e276-e283. doi: 10.1097/MCG.0000000000001079.
Computed tomography-measured visceral adipose tissue (VAT) and the distribution of VAT are highly correlated with the severity and prognosis of acute pancreatitis (AP). To date, all available data are from the overall AP patient population; no subgroup analysis has been conducted to evaluate patients with moderately severe AP or patients with hyperlipidemia acute pancreatitis (HLAP) as independent populations. Currently, studies on the relationship between VAT and HLAP are lacking.
A total of 235 patients with moderately severe AP or severe acute pancreatitis were divided into 2 groups according to whether hyperlipidemia was present: the HLAP group and the non-HLAP group. The general inpatient information was collected, and computed tomography was used to measure VAT, subcutaneous adipose tissue (SAT), total adipose tissue, and VAT/SAT (V/S). The data were subjected to t test, χ test, matrix scatter plot, logistic regression, and receiver operating characteristic analyses to evaluate the relationship between VAT and HLAP severity.
Significant differences were observed in VAT, SAT, total adipose tissue, and triglycerides (TGs) between the HLAP group and the non-HLAP group (P<0.001). Significant correlations were observed between VAT and body mass index (r=0.425, P=0.017) and between VAT and TG (r=0.367, P=0.042). In the HLAP group, VAT, V/S, TG, and local complications may have significant effects on disease severity. The receiver operating characteristic curves showed that VAT and V/S were more reliable than TGs in evaluating disease severity [area under the curve (AUC) of VAT: 0.819, P<0.001; AUC of V/S: 0.855, P<0.001; AUC of TG: 0.671, P=0.04]. Disease severity was reliably evaluated at 139 cm, the cut-off value of VAT. The cut-off value of V/S was 1.145; high V/S was associated with extended intensive care unit stay. VAT and its distribution had no significant effects on mortality.
For patients with moderately severe to severe HLAP, VAT was correlated with body mass index and TG. VAT and V/S were valuable factors for evaluating disease severity and prognosis. However, VAT had no effect on mortality, and VAT could not be used to evaluate patients with moderately severe to severe non-HLAP.
计算机断层扫描测量的内脏脂肪组织（VAT）及其分布与急性胰腺炎（AP）的严重程度和预后高度相关。迄今为止，所有可用数据均来自总体 AP 患者人群；没有进行亚组分析来评估中度重症 AP 患者或高脂血症性急性胰腺炎（HLAP）患者作为独立人群。目前，关于 VAT 与 HLAP 之间关系的研究尚缺乏。
根据是否存在高脂血症，将 235 例中度重症 AP 或重症急性胰腺炎患者分为 2 组：HLAP 组和非 HLAP 组。收集一般住院信息，并使用计算机断层扫描测量 VAT、皮下脂肪组织（SAT）、总脂肪组织和 VAT/SAT（V/S）。对数据进行 t 检验、卡方检验、矩阵散点图、逻辑回归和受试者工作特征分析，以评估 VAT 与 HLAP 严重程度的关系。
HLAP 组和非 HLAP 组之间在 VAT、SAT、总脂肪组织和甘油三酯（TGs）方面存在显著差异（P<0.001）。VAT 与体重指数（r=0.425，P=0.017）和 VAT 与 TG（r=0.367，P=0.042）之间存在显著相关性。在 HLAP 组中，VAT、V/S、TG 和局部并发症可能对疾病严重程度有显著影响。受试者工作特征曲线显示，VAT 和 V/S 在评估疾病严重程度方面比 TGs 更可靠[VAT 的曲线下面积（AUC）：0.819，P<0.001；V/S 的 AUC：0.855，P<0.001；TG 的 AUC：0.671，P=0.04]。VAT 为 139cm 时，可可靠评估疾病严重程度，这是 VAT 的截断值。V/S 的截断值为 1.145；高 V/S 与延长重症监护病房住院时间有关。VAT 及其分布对死亡率没有显著影响。
对于中度重症至重症 HLAP 患者，VAT 与体重指数和 TG 相关。VAT 和 V/S 是评估疾病严重程度和预后的有价值因素。然而，VAT 对死亡率没有影响，并且不能用于评估中度重症至重症非 HLAP 患者。
