入院早期甘油三酯达标对高脂血症性急性胰腺炎患者住院期间终点事件的影响  

The impact of early triglyceride target achievement on hospitalization outcomes in the patients with hyperlipidemic acute pancreatitis

作　　者：黄晓东 徐志鸿 刘斯瑶 刘雄 郑清柳 胡俊 黄贤伟[2,3] 蔺际䶮 Huang Xiaodong;Xu Zhihong;Liu Siyao;Liu Xiong;Zheng Qingliu;Hu Jun;Huang Xianwei;Lin Jiyan(The School of Clinical Medicine,Fujian Medical University,Fuzhou 350122,China)

机构地区：[1]福建医科大学临床医学部,福建福州350122 [2]厦门大学附属第一医院急诊科,福建厦门360003 [3]厦门市中医药疗效证据研究重点实验室,福建厦门360003

出　　处：《中国急救医学》2024年第10期871-877,共7页Chinese Journal of Critical Care Medicine

基　　金：厦门市医疗卫生指导性项目(3502Z20244ZD1049);厦门市科技计划项目(3502Z202374002);福建中医药大学校管课题(XB2023155)。

摘　　要：目的探讨入院早期甘油三酯(TG)水平达标对高脂血症性急性胰腺炎(HLAP)患者住院期间终点事件(器官功能衰竭、死亡及局部并发症)的影响。方法本研究为回顾性队列研究,纳入2018年1月1日至2023年12月31日期间在厦门大学附属第一医院收治的401例HLAP患者资料。根据入院48 h内TG水平是否降至<5.65 mmol/L将患者分为未达标组(109例)和达标组(292例)。收集并比较两组患者的基本信息、实验室指标及终点事件发生情况。应用单因素及多因素Cox回归分析评估早期TG达标及其他因素对终点事件风险的影响。此外,采用倾向性评分匹配(PSM)策略平衡两组间基线差异,进一步验证比较结果,并通过Kaplan-Meier曲线进行生存分析。结果PSM调整前,达标组患者的初始血糖和TG水平低于未达标组(P<0.05)。临床结局方面,达标组患者住院期间肾损伤和局部并发症发生率低于未达标组(P<0.05),而其余器官衰竭、进展为重症急性胰腺炎及病死率两组之间差异无统计学意义(P>0.05)。单因素Cox分析显示,早期TG达标、年龄、心率、系统性炎症反应综合征、白细胞计数、C反应蛋白、血糖和D-二聚体水平与HLAP患者发生局部并发症相关(P<0.05)。多因素Cox分析显示,早期TG达标是减少局部并发症风险的独立保护因素,而D-二聚体水平升高则为独立危险因素(P<0.05)。PSM调整后,91例TG达标组患者中17例发生局部并发症,91例未达标组患者中30例发生局部并发症。Kaplan-Meier曲线显示,达标组患者累积局部并发症发生率低于未达标组(P<0.05)。而其他终点事件的发生率在两组间差异无统计学意义。结论入院早期TG达标可能有效降低HLAP患者住院期间局部并发症发生风险,临床应关注HLAP患者入院早期TG水平及达标率。Objective To investigate the effect of early triglyceride(TG)target achievement on hospitalization outcomes,including organ failure,death and local complications,in hyperlipidemic acute pancreatitis(HLAP)patients.Methods This retrospective cohort study included the data from 401 HLAP patients admitted to the First Affiliated Hospital of Xiamen University from January 1,2018 to December 31,2023.Patients were divided into two groups based on whether their TG levels had dropped below 5.65 mmol/L within 48 h of admission:the non-target group(109 cases)and the target group(292 cases).Basic demographics,laboratory data and endpoint events were collected and compared between the two groups.Univariate and multivariate Cox regression analyses evaluated the impact of early TG target achievement and other factors on the risk of endpoint events.Additionally,a propensity score matching(PSM)strategy was used to balance baseline differences between the two groups for further validation of the comparison results.Survival analysis was conducted by using Kaplan-Meier curves.Results Before PSM adjustment,initial blood glucose and TG levels were lower in the target group than in the non-target group(P<0.05).The incidence of renal impairment and local complications during hospitalization was lower in the target group compared to the non-target group(P<0.05).There were no significant differences in other organ failures,further development to severe acute pancreatitis and mortality rates(P>0.05).Univariate Cox analysis showed that early TG target achievement,age,heart rate,systemic inflammatory response syndrome,white blood cell count,C-reactive protein,blood glucose and D-dimer levels were associated with local complications in HLAP patients(P<0.05).Multivariate Cox analysis revealed that early TG target achievement was an independent protective factor for reducing the risk of local complications,while elevated D-dimer levels were an independent risk factor(P<0.05).After PSM adjustment,17 of 91 patients in the target group and 30 of 9

关 键 词：急性胰腺炎 甘油三酯 局部并发症 预后 D-二聚体 

分 类 号：R576[医药卫生—消化系统]