总胆固醇与重症急性胰腺炎的相关性：呈 U 型关系。
Association of total cholesterol with severe acute pancreatitis: A U-shaped relationship.
机构信息
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China; Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, Wenzhou, Zhejiang, People's Republic of China.
Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, 66424, Germany; Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, 66539, Germany.
出版信息
Clin Nutr. 2020 Jan;39(1):250-257. doi: 10.1016/j.clnu.2019.01.022. Epub 2019 Jan 31.
BACKGROUND & AIMS: There is no consensus on relationship between total cholesterol levels and incidence of severe acute pancreatitis (SAP). The aim of this study was to investigate the relation between total cholesterol (TC) and the disease severity of acute pancreatitis.
METHODS
We conducted a cross-sectional study on patients with acute pancreatitis between April 2012 and December 2015 in a university hospital. Fasting blood total cholesterol (TC) was assayed within 24 h of admission, as well as 3-5 days, 7-9 days and 13-15 days during hospitalization. Time interval before admission, age, gender, Body Mass Index, hypertension, diabetes mellitus, alcohol consumption, smoking, etiology and albumin were recorded as potential confounding factors. To assess the pattern of relationship of TC and SAP, we used restricted cubic spline analysis with multivariable logistic regression analysis. We also compared total cholesterol concentrations between patients with or without SAP at different time points.
RESULTS
648 patients (median age: 47.5 years; 62.4% man) were enrolled. The incidence of SAP was 10%. A U-shaped association of TC level within 24 h of admission with severity was observed in acute pancreatitis. Patients with low TC levels (<160 mg/dL) and high TC levels (>240 mg/dL) had a significantly higher incidence of SAP and protracted hospital stays when compared to moderate TC levels (160-240 mg/dL). Low total cholesterol levels (OR 2.72; 95 %eCI 1.27-5.83; P = 0.01) and high total cholesterol levels (OR 2.54; 95 %eCI 1.09-5.89; P = 0.03), were still independently associated with development of SAP after adjusting for potential confounding factors. Longitudinal cohort study indicated that patients with SAP had lower total cholesterol concentrations among 3-15 days after admission compared to patients without SAP (P < 0.001).
CONCLUSIONS
Both low TC level (<160 mg/dL) and high TC (>240 mg/dL) within 24 h of admission is independently associated with an increased risk of SAP.
背景与目的
总胆固醇水平与重症急性胰腺炎（SAP）发病率之间的关系尚未达成共识。本研究旨在探讨总胆固醇（TC）与急性胰腺炎严重程度之间的关系。
方法
我们对 2012 年 4 月至 2015 年 12 月在一所大学医院住院的急性胰腺炎患者进行了横断面研究。入院后 24 小时内测定空腹血总胆固醇（TC），并在住院期间的 3-5 天、7-9 天和 13-15 天进行测定。记录入院前时间间隔、年龄、性别、体重指数、高血压、糖尿病、饮酒、吸烟、病因和白蛋白作为潜在混杂因素。为了评估 TC 和 SAP 的关系模式，我们使用了多元逻辑回归分析的受限立方样条分析。我们还比较了不同时间点 SAP 患者和非 SAP 患者的总胆固醇浓度。
结果
共纳入 648 例患者（中位年龄：47.5 岁；62.4%为男性）。SAP 的发病率为 10%。入院 24 小时内 TC 水平与严重程度呈 U 型关联。与 TC 水平中度（160-240mg/dL）相比，低 TC 水平（<160mg/dL）和高 TC 水平（>240mg/dL）的患者 SAP 发生率和住院时间明显延长。低总胆固醇水平（OR 2.72；95%CI 1.27-5.83；P=0.01）和高总胆固醇水平（OR 2.54；95%CI 1.09-5.89；P=0.03）在调整潜在混杂因素后，仍与 SAP 的发生独立相关。纵向队列研究表明，与无 SAP 的患者相比，SAP 患者在入院后 3-15 天的总胆固醇浓度较低（P<0.001）。
结论
入院 24 小时内 TC 水平低（<160mg/dL）和高（>240mg/dL）均与 SAP 的风险增加独立相关。
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