Dutta S K, Ting C D, Lai L L
Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Maryland, USA.
Am J Gastroenterol. 1997 Nov;92(11):2044-8.
Patients with the human immunodeficiency virus (HIV) disease can develop pancreatic gland inflammation from HIV infection and related causes, or from factors totally independent of it. The incidence and severity acute pancreatitis in patients with HIV diseases and the frequency of associated etiological factors have not been examined in any detail. The purpose of this study was to (a) determine the prevalence of acute pancreatitis, (b) evaluate severity of pancreatic gland inflammation, (c) identify commonly associated etiological factors with acute pancreatitis, and (d) examine the relationship between CD4 lymphocyte counts and serum pancreatic enzyme levels (amylase and lipase) in patients with HIV disease.
We examined the medical records of 321 patients with HIV disease seen at Sinai Hospital of Baltimore between July of 1993 to June of 1994. Data collected from these records included clinical, laboratory, and radiologic features of pancreatitis, staging of HIV disease, risk factors, CD4 lymphocyte counts, medications associated with the presence of opportunistic infections, Kaposi's sarcoma, and lymphoma.
From 321 patients with HIV disease, 45 patients developed at least one episode of acute pancreatitis as defined by clinical and laboratory criteria during the 1-yr period. A statistically significant negative correlation was found between serum pancreatic enzyme level and the number of CD4 lymphocytes (r = -0.15, p < 0.05 for serum amylase; r = -0.2, p < 0.05 for serum lipase). Furthermore, patients with asymptomatic HIV infection or CD4 lymphocyte count >500 mm3 did not develop asymptomatic hyperamylasemia or acute pancreatitis. Furthermore, the presence of gallstones, active injection drug use, pentamidine therapy, Pneumocystis carinii, Mycobacterium avium intracellulare correlated significantly (p < 0.001) with the diagnosis of acute pancreatitis.
A detailed review of medical records of patients with HIV disease seen in a community hospital in 1 yr (1993-1994) suggests a high incidence (14%) of mild to moderately severe acute pancreatitis. In this group of patients, pancreatic gland inflammation is commonly associated with gallstones, intravenous drug abuse, pentamidine intake, and Pneumocystis carinii and Mycobacterium avium intracellulare infections. In addition, marked reduction in CD4 lymphocyte count is associated with increase in serum pancreatic enzyme levels (amylase, lipase activity) suggesting pancreatic gland inflammation or altered pancreatic enzyme turnover.
人类免疫缺陷病毒（HIV）疾病患者可能因HIV感染及相关原因，或完全与之无关的因素而发生胰腺炎症。HIV疾病患者中急性胰腺炎的发病率、严重程度以及相关病因的发生频率尚未得到详细研究。本研究的目的是：（a）确定急性胰腺炎的患病率；（b）评估胰腺炎症的严重程度；（c）识别与急性胰腺炎常见相关的病因；（d）研究HIV疾病患者CD4淋巴细胞计数与血清胰腺酶水平（淀粉酶和脂肪酶）之间的关系。
我们检查了1993年7月至1994年6月在巴尔的摩西奈医院就诊的321例HIV疾病患者的病历。从这些病历中收集的数据包括胰腺炎的临床、实验室和放射学特征、HIV疾病分期、危险因素、CD4淋巴细胞计数、与机会性感染、卡波西肉瘤和淋巴瘤存在相关的药物。
在321例HIV疾病患者中，45例在1年期间至少发生了1次符合临床和实验室标准定义的急性胰腺炎发作。血清胰腺酶水平与CD4淋巴细胞数量之间存在统计学上显著的负相关（血清淀粉酶r = -0.15，p < 0.05；血清脂肪酶r = -0.2，p < 0.05）。此外，无症状HIV感染或CD4淋巴细胞计数>500 mm3的患者未发生无症状高淀粉酶血症或急性胰腺炎。此外，胆结石、活跃的注射吸毒、喷他脒治疗、卡氏肺孢子虫、鸟分枝杆菌与急性胰腺炎的诊断显著相关（p < 0.001）。
对一家社区医院1993 - 1994年1年间就诊的HIV疾病患者病历的详细回顾表明，轻度至中度严重急性胰腺炎的发病率较高（14%）。在这组患者中，胰腺炎症通常与胆结石、静脉药物滥用、喷他脒摄入以及卡氏肺孢子虫和鸟分枝杆菌感染有关。此外，CD4淋巴细胞计数显著降低与血清胰腺酶水平（淀粉酶、脂肪酶活性）升高有关，提示胰腺炎症或胰腺酶周转改变。
