Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Rev Med Pharmacol Sci. 2021 Feb;25(3):1462-1471. doi: 10.26355/eurrev_202102_24854.
Biliary and hyperlipidemic acute pancreatitis (AP) has become the second most common AP in China. Currently, AP is exclusively diagnosed as biliary or hyperlipidemic AP. However, as suggested by some reports, biliary and hyperlipidemic AP might coexist in a single patient. Moreover, acute lipotoxicity was shown to regulate the severity of biliary AP in the mouse model. Thus, whether these two etiologies coexist in AP patients and potentially worsen the clinical course remains unclear. To elucidate the clinical feature of a new complex type of acute pancreatitis with both biliary and hyperlipidemic etiologies.
This retrospective study included AP patients who were admitted into our department within 7 days after the onset of the disease. 267 AP patients were enrolled in this study and were classified as BAP (biliary acute pancreatitis, n=153), HLAP (hyperlipidemic acute pancreatitis, n=65) and BHAP (biliary-hyperlipidemic acute pancreatitis, n=49). All the enrolled patients met the classification criteria of biliary etiology, hyperlipidemic etiology, and both etiologies, respectively. BHAP was compared with BAP and HLAP in terms of general information, inflammatory biomarkers, organ dysfunction, disease severity and clinical outcomes.
BHAP (41 vs. 53) patients were younger than BAP patients. Serum procalcitonin of BHAP patients was higher than BAP and HLAP patients. Serum CRP of BHAP patients was higher than BAP patients. BHAP patients had the highest diagnosis rate of severe acute pancreatitis (SAP) (46.9% vs. 17.6% or 21.5%) compared to BAP and HLAP. Prevalences of persistent respiratory, acute renal, and circulatory failure were highest in BHAP patients (44.9%, 28.6%, 12.2%, respectively). Requirements for mechanical ventilation, renal replacement therapy and vasoactive agents were also highest in BHAP patients (36.7%, 34.7%, 12.2%, respectively). Hospital stay was longer in BHAP patients (33 days) compared with BAP patients (24 days).
Patients with both biliary and hyperlipidemic etiologies suffer from more severe clinical course of the disease and have worse prognosis than single-etiology BAP or HLAP patients in the early stage of AP (within 7 days). It should be recognized as a new etiological type named biliary-hyperlipidemic acute pancreatitis (BHAP).
胆源性和高脂血症性急性胰腺炎（AP）已成为中国第二大常见的 AP。目前，AP 仅被诊断为胆源性或高脂血症性 AP。然而，正如一些报道所表明的，胆源性和高脂血症性 AP 可能在单个患者中同时存在。此外，在小鼠模型中，急性脂毒性被证明可以调节胆源性 AP 的严重程度。因此，这些两种病因在 AP 患者中是否共存并可能使临床病程恶化尚不清楚。为了阐明具有胆源性和高脂血症性两种病因的新的复杂类型急性胰腺炎的临床特征。
本回顾性研究纳入了发病后 7 天内入住我科的 AP 患者。共纳入 267 例 AP 患者，分为胆源性急性胰腺炎（BAP，n=153）、高脂血症性急性胰腺炎（HLAP，n=65）和胆源性-高脂血症性急性胰腺炎（BHAP，n=49）。所有纳入的患者分别符合胆源性病因、高脂血症性病因和两种病因的分类标准。BHAP 与 BAP 和 HLAP 在一般资料、炎症标志物、器官功能障碍、疾病严重程度和临床结局方面进行了比较。
BHAP（41 例）患者比 BAP 患者年轻。BHAP 患者的降钙素原血清水平高于 BAP 和 HLAP 患者。BHAP 患者的 C 反应蛋白血清水平高于 BAP 患者。与 BAP 和 HLAP 相比，BHAP 患者的重症急性胰腺炎（SAP）诊断率最高（46.9%比 17.6%或 21.5%）。BHAP 患者持续性呼吸、急性肾和循环衰竭的发生率最高（44.9%、28.6%和 12.2%）。BHAP 患者需要机械通气、肾脏替代治疗和血管活性药物的比例也最高（36.7%、34.7%和 12.2%）。BHAP 患者的住院时间也较长（33 天），与 BAP 患者（24 天）相比。
同时存在胆源性和高脂血症性病因的患者与单一病因 BAP 或 HLAP 患者相比，在 AP 的早期（发病后 7 天内），疾病的临床病程更严重，预后更差。它应被视为一种新的病因类型，命名为胆源性-高脂血症性急性胰腺炎（BHAP）。
