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ABSTRACT Objective: The study aims to explore the relationship between lipoprotein lipase (LPL) variants and hyperlipidemic acute pancreatitis (HLAP) in the southeastern Chinese population. Subjects and methods: In total, 80 participants were involved in this study (54 patients with HLAP and 26 controls). All coding regions and intron-exon boundaries of the LPL gene were sequenced. The correlations between variants and phenotypes were also analysed. Results: The rate of rare LPL variants in the HLAP group is 14.81% (8 of 54), higher than in controls. Among the detected four variants (rs3735959, rs371282890, rs761886494 and rs761265900), the most common variant was rs371282890. Further analysis demonstrated that subjects with rs371282890 "GC" genotype had a 2.843-fold higher risk for HLAP (odds ratio [OR]: 2.843, 95% confidence interval [CI]: 1.119-7.225, p = 0.028) than subjects with the "CC" genotype. After adjusting for sex, the association remained significant (adjusted OR: 3.083, 95% CI: 1.208-7.869, p = 0.018). Subjects with rs371282890 "GC" genotype also exhibited significantly elevated total cholesterol, triglyceride and non-high-density lipoprotein cholesterol levels in all the participants and the HLAP group (p < 0.05). Conclusion: Detecting rare variants in LPL might be valuable for identifying higher-risk patients with HLAP and guiding future individualised therapeutic strategies.
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Objective To explore the value of CT enhanced radiomics model in predicting severe hyperlipidemic acute pancreatitis(HLAP).Methods The data of 117 HLAP patients were analyzed retrospectively and the patients were randomly divided into a training set(93 cases)and a test set(24 cases)in the ratio of 8∶2.CT enhanced images of arterial phase and venous phase were collected,and the optimal radiomics features were extracted and screened.The arterial phase model and venous phase model were established by support vector machine(SVM).Meanwhile,the bedside index for severity in acute pancreatitis(BISAP)was scored and a BISAP model was developed for the patients based on clinical information.The area under the curve(AUC)under the receiver operating characteristic(ROC)curve was used as the evaluation criterion for the model.DeLong test was used to compare the prediction efficiency of each model.Results The training set AUC of the arterial phase model,venous phase model and BISAP model were 0.777,0.788 and 0.732,respectively.And the AUC of the test set were 0.836,0.734 and 0.695,respectively.DeLong test results showed that the training set AUC of the arterial phase model and the venous phase model was better than that of BISAP model(P＜0.05),but there was no significant difference between the AUC of the test set AUC(P＞0.05).There was no significant difference in AUC between arterial phase model and venous phase model(P＞0.05).Conclusion The radiomics model based on CT enhancement can predict the severity of HLAP at the early stage,which helps to target the treatment of HLAP patients in the early clinical stage.
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Background: Peripheral blood test is a routine clinical examination item. Granulocytes and platelets are often used to measure the severity of inflammatory response, and it is worthy to investigate the value of various inflammatory indices ratio for predicting the prognosis of disease. Aims: To compare and analyze the diagnostic efficacy of platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), red blood cell distribution width to platelet ratio (RPR), C-reactive protein to lymphocyte ratio (CLR) and C-reactive protein (CRP) in evaluating the severity of hyperlipidemic acute pancreatitis (HLAP). Methods: The clinical and laboratory data of 104 patients with HLAP from January 2018 to December 2020 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. According to the revised Atlanta classification, HLAP patients were divided into mild HLAP, moderate to severe/severe HLAP. Forty-four healthy subjects during the same period were served as the controls. PLR, NLR, MLR, RPR, CLR and CRP were compared between HLAP group and control group. The ROC curve was used to analyze the diagnostic efficacy of PLR, NLR, MLR, RPR, CLR and CRP for the diagnosis of moderate to severe/severe HLAP. Results: PLR, NLR, MLR, RPR, CLR and CRP were significantly increased in HLAP group than in control group (P<0.05); PLR, NLR, MLR, RPR, CLR and CRP were significantly increased in moderate to severe/severe HLAP group than in mild HLAP group (P<0.05). The cut-off values of PLR, NLR, MLR, RPR, CLR, CRP and combined PLR, NLR, MLR, RPR, CLR were 220.48, 10.95, 0.84, 0.12, 76.66, 87.44 mg/L, 0.37, respectively, the sensitivity for diagnosing moderate to severe/severe HLAP were 0.73, 0.45, 0.47, 0.82, 0.65, 0.65 and 0.88, respectively, the specificity were 0.85, 0.87, 0.90, 0.81, 0.83, 0.83 and 0.85, respectively, AUC were 0.84, 0.65, 0.67, 0.87, 0.77, 0.75 and 0.94, respectively. Conclusions: PLR, NLR, MLR, RPR, CLR and CRP can evaluate the severity of HLAP, and the combined PLR, NLR, MLR, RPR and CLR has higher sensitivity and diagnostic efficacy in the diagnosis of moderate to severe/severe HLAP.
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Objective To study the impact of weight loss surgery after 3 months of stable condition through intervention on patients with obese hyperlipidemic acute pancreatitis (HLAP).Methods Ten patients with obese HLAP who underwent laparoscopic sleeve gastrectomy (LSG) at the General Surgery Department of our hospital were followed-up at 1,3,6,12,24 months after surgery.Their weight,BMI,EWL,and blood parameters (TG,LDL-C,HDL-C,TC,FPG,HbA1c,UA,hs-CRP,ESR,and hemorheology indexes) were compared.The impact on postoperative obese HLAP was assessed.Results The weight,BMI,EWL and blood index (TG,LDL-C,HDL-C,TC,FPG,HbA1c,UA,hs-CRP,ESR,and hemorheology indexes) of the patients gradually decreased.The decrease was significantly different from that before surgery (P＜0.05),which became stable at 12 months and with no recurrence at 24 months after surgery.Conclusions LSG reduced body weight and improved metabolic status of the patients.It stopped the occurrence of obese HLAP.LSG can be used as an effective intervention for patients with obese HLAP.
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Objective To investigate the changes of C-reactive protein(CRP)and D-dimer in the patients with hyperlipidemic acute pancreatitis(HLAP)and biliogenic acute pancreatitis(BAP).Methods One hundred fifty-five inpatients with acute pancreati-tis in our hospital from Jan.2012 to Dec.2014 were divided into the HLAP group and BAP group by etiology.Also the patients were divided into mild acute pancreatitis(MAP)subgroup and moderately severe acute pancreatitis(MSAP)subgroup by disease se-verity.Blood routine,liver and kidney function,glucose(Glu),calcium,blood lipids,CRP and D-dimer were measured.Results Platelet,Glu and blood lipid indicators in the HLAP group were significantly higher than those in the BAP group.But alanine amin-otransferase(ALT),r-glutamyl transferase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),calci-um(Ca)and creatinine(Cr)in the HLAP group were significantly lower than those in the BAP group(P <0.05).CRP in the HLAP group was significantly higher than that in the BAP group with statistical difference(P <0.01).CRP had statistical difference be-tween the HLAP group and BAP group in the MAP and MSAP subgroups (P <0.01).CRP and D-dimer had statistical difference between in the MAP and MSAP subgroups of the HLAP group(P <0.05).Increased CRP and D-dimer in the HLAP group were the risk factors for MSAP occurrence(OR =1.121,3.716,P =0.025,0.001 ).In the BAP group,only increased D-dimer was the risk factor for MSAP occurrence(OR=2.717,P =0.002).Conclusion CRP and D-dimer in HLAP and BAP are increased with dis-ease severity aggravation,moreover CRP increase is more obvious in HLAP patients.
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Objective To discuss the clinical effects of enteral immunonutrition on patients with hyperlipidemic acute pancreatitis and its influence on levels of immunologic function and nutrition indicators.Methods 2015,100 patients with hyperlipidemic acute pancreatitis Selected from department of general surgery between January 2012 and December were randomly divided into observation group and control group,and each group had 50 cases.All patients were treated with conventional treatment,monitored for vital signs,fasting water,gastrointestinal decompression,anti-infection,acid suppression therapy and suppression of trypsin activity,balance of water electrolyte and acid-basewere included.After bowel function in patients with recovery,two groups were given enteral nutrition support,observation group were received enteral immunonutrition therapy.At the same time,we added the immune enhancement components.After treatment for 10 days,we compare two groups of patients with therapeutic effect,for APACHE-Ⅱ score,nutrition indicators (ALB,PAB),immune index(TLC,IgA,IgG,IgM) changes.Results After two groups of patients were given different enteral nutrient solution,the clinical total effective rate of observation group was obviously higher than that of control group(P ＜ 0.05).After treatment for 10 days,the indicators were obviously improved.The APACHE-Ⅱ score of the observation group were significantly fallinger than that of the control group (t =3.311,P ＜0.05).The ALB and PAB levels of the observation group were significantly higher than those of the control group (t =2.217,6.622,P ＜ 0.05).At the same time,the TLC,IgA,IgG,IgM of the observation group were improved significantly better than the control group (t =3.600,4.867,3.270,3.911,P ＜ 0.05).Conclusion Enteral immunonutrition can improve the nutrition indicators and immunological function of patients with hyperlipidemic acute pancreatitis,thus improve prognosis and promoting recovery of the patient.
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Objective To investigate the correlation and differences of serum calcium ( Ca) and intact parathyroid hormone ( i-PTH) in patients with hyperlipidemic or biliogenic acute pancreatitis ( AP) .Methods From Jan 2012 to Jan 2014 , total 80 AP patients admitted to Bejing Chaoyang Hospital were enrolled . According to the etiology , AP patients were divided into 2 groups, hyperlipidemic acute pancreatitis ( HLAP) group and biliogenic acute pancreatitis (BAP) group.Blood routine, function of liver and kidney , blood lipids, Ca, and i-PTH were measured .Differences between Ca and i-PTH in HLAP group and BAP group were analyzed, and found the correlation with disease severity of AP .Results 80 AP patients included 43 HLAP and 37 BAP patients, 55 mild acute pancreatitis(MAP) and 25 moderately severe acute pancreatitis (MSAP) patients.HLAP group had 34 male and 9 female patients, average age was 37 years, 31 MAP and 12 MSAP patients.BAP group had 17 male and 20 female patients, average age was 58 years, 24 MAP and 13 MSAP patients.proportion of males was significantly higher in HLAP group than BAP group .on the contrary, average age was significantly lower (P<0.01 and <0.01, respectively).No significantly difference was found in MAP/MSAP ration.Level of serum Ca in HLAP group was significantly decreased than BAP group (1.92 ± 0.24 mmol/L vs 2.14 ±1.99 mmol/L, P<0.05).No significantly difference was found in i-PTH between two groups.Level of serum Ca in MAP and MSAP subgroup in HLAP group were 1.98 ±0.20 mmol/L and 1.76 ± 0.27 mmol/L.Accordingly, Level of serum Ca were 2.23 ±0.15 mmol/L and 1.98 ±0.19 mmol/L in BAP group. i-PTH in MAP and MSAP subgroup in HLAP group were 43.41 ±18.40 ng/L and 56.07 ±33.61 ng/L.Accordingly, i-PTH was 39.22 ±17.19 mmol/L and 52.73 ±29.42 mmol/L in BAP group.Compared to MAP, Ca in MSAP group was significantly decreased in HLAP and BAP group ( P<0.01 and <00.5, respectively).In HLAP group, Ca was a negative correlation with low density lipoprotein cholesterol (LDLC-) and triglycerides(TG) (P<0.05 and <0.01, respectively).In BAP group, Ca was a negative correlation with i-PTH(P<0.05).Conclusions Serum Ca is decreased with severity of HLAP and BAP .Decreased Ca has correlation with increased LDL-C, TG in HLAP and increased i-PTH in BAP.
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Objective To analyze the clinical features and prognosis of hyperlipidemic acute sancreatitis (HLAP) .Methods A retrospective study was conducted in a cohort of 72 hyperlipidemic acute pancreatitis patients admitted in hospital from June 2007 to June 2012 .83 patients with acute biliary pancreatitis (ABP) diagnosed were served as control group .The clinical data of both groups were compared between the two groups .The correlation between serum triglyceride(TG) levels and disease severity of HLAP was assessed .Results The age and serum amylase levels of the HLAP group were remarkably lower than those of the ABP group (both P0 .05) .The Ranson score ,APACHE-Ⅱ score ,and Bal-thazar CT score were comparable between the two groups (all P>0 .05) .The recurrence risk of HLAP group was strikingly higher than that of ABP group(P0 .05) .The serum TG levels of HLAP showed no significant correlation with Ronson score ,APACHE-Ⅱ score and Balthazar CT score values(all P>0 .05) .Conclusion HLAP mainly occurs in young to middle-aged people .The serum amylase val-ues of HLAP increased mildly .Patients with HLAP are often accompanied by fatty liver and type 2 diabetes ,and subjected to grea-ter complications and recurrence risk .The severity of HLAP doesn′t correlate with the serum TG levels .