Intestinal GSTpi deficiency exacerbates the severity of experimental hyperlipidemic acute pancreatitis.

Intestinal dysfunction plays a pivotal role in the development of acute pancreatitis (AP), however, the underlying mechanisms of intestinal dysfunction on severity of hyperlipidemic acute pancreatitis (HLAP) are still unclear. Herein, we explored the role of intestinal function on the severity of HLAP. We found that HLAP patients exhibit higher lipid and inflammatory response than AP patients. Hyperlipidemia significantly elevates serum lipids and worsen pancreatic damage in AP mice. In addition, significant exacerbated intestinal barrier damage and inflammation were observed in experimental HLAP mice, as evidenced by increased serum amylase and lipase levels, and pancreatic edema. Further, RNA-Seq showed that a markedly decrease of glutathione S-transferase pi (GSTpi) in colonic tissue of HLAP mice compared with AP mice, accompanied with increased serum lipopolysaccharides level. However, colonic GSTpi overexpression by adeno-associated virus significantly attenuated intestinal damage and subsequent pancreatic inflammation in HLAP mice. Mechanistically, GSTpi mitigated HLAP-mediated colonic NLRP3 inflammasome activation and barrier dysfunction. These results suggest that intestinal GSTpi deficiency exacerbates the severity of experimental HLAP, providing new insights for the clinical treatment of HLAP.

Development and Validation of a Nomogram for Predicting the Severity of the First Episode of Hyperlipidemic Acute Pancreatitis.

Purpose: Early detection of hyperlipidemic acute pancreatitis (HLAP) with exacerbation tendency is crucial for clinical decision-making and improving prognosis. The aim of this study was to establish a reliable model for the early prediction of HLAP severity. Patients and Methods: A total of 225 patients with first-episode HLAP who were admitted to Fujian Medical University Union Hospital from June 2012 to June 2023 were included. Patients were divided into mild acute pancreatitis (MAP) or moderate-severe acute pancreatitis and severe acute pancreatitis (MSAP+SAP) groups. Independent predictors for progression to MSAP or SAP were identified through univariate analysis and least absolute shrinkage and selection operator regression. A nomogram was established through multivariate logistic regression analysis to predict this progression. The calibration, receiver operating characteristic(ROC), and clinical decision curves were employed to evaluate the model's consistency, differentiation, and clinical applicability. Clinical data of 93 patients with first-episode HLAP who were admitted to the First Affiliated Hospital of Fujian Medical University from October 2015 to October 2022 were collected for external validation. Results: White blood cell count, lactate dehydrogenase, albumin, serum creatinine, serum calcium, D-Dimer were identified as independent predictors for progression to MSAP or SAP in patients with HLAP and used to establish a predictive nomogram. The internally verified Harrell consistency index (C-index) was 0.908 (95% CI 0.867-0.948) and the externally verified C-index was 0.950 (95% CI 0.910-0.990). The calibration, ROC, and clinical decision curves showed this nomogram's good predictive ability. Conclusion: We have established a nomogram that can help identify HLAP patients who are likely to develop MSAP or SAP at an early stage, with high discrimination and accuracy.

Association of lipoprotein lipase (LPL) gene variants with hyperlipidemic acute pancreatitis in southeastern Chinese population.

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.

Therapeutic plasma exchange decreases serum triglyceride level rapidly and reduces early recurrence rate but no advantages in improving outcomes for patients with hyperlipidemic acute pancreatitis: a retrospective propensity score matching analysis based on twenty year's experience.

BACKGROUND: Hyperlipidaemic acute pancreatitis (HLAP) has become the most common cause of acute pancreatitis (AP) not due to gallstones or alcohol (Mosztbacher et al, Pancreatology 20:608-616, 2020; Yin et al, Pancreas 46:504-509, 2017). Therapeutic plasma exchange (TPE) has been reported to be effective in reducing serum TG levels which is important in management of HLAP (World J Clin Cases 9:5794-803, 2021). However, studies on TPE are mostly focusing on cases reports, TPE remains poorly evaluated till date and need to be compared with conservative therapy with a well-designed study. METHODS: A retrospectively cohort study on HLAP patients between January 2003 and July 2023 was conducted. Factors correlated with efficacy of TPE were included in a propensity model to balance the confounding factors and minimize selection bias. Patients with and without TPE were matched 1:2 based on the propensity score to generate the compared groups. Lipid profiles were detected on admission and consecutive 7 days. The triglyceride (TG) level decline rates, percentage of patients to reach the target TG levels, early recurrence rate, local complications and mortality were compared between groups. RESULTS: A total of 504 HLAP patients were identified. Since TPE was scarcely performed on patients with TG < 11.3 mmol/L, 152 patients with TG level 5.65 to 11.3 mmol/L were excluded while 352 with TG ≧11.3 mmol/L were enrolled. After excluding 25 cases with incomplete data or pregnancy, 327 patients, of whom 109 treated without TPE while 218 treated with TPE, were included in data analysis. One-to-two propensity-score matching generated 78 pairs, 194 patients with well-balanced baseline characteristics. Of 194 patients enrolled after matching done, 78 were treated without while 116 with TPE. In the matched cohort (n = 194), patients treated with TPE had a higher TG decline rate in 48 h than those without TPE (70.00% vs 54.00%, P = 0.001); the early recurrence rates were 8.96% vs 1.83%, p = 0.055. If only SAP patients were analyzed, the early recurrence rates were 14.81% vs 0.00% (p = 0.026) respectively. For patients with CT severity index (CTSI) rechecked within 14 days, early CTSI improment rate were 40.90% vs 31.91%. Local complications checked 6 months after discharge were 44.12% vs 38.30%. Mortality was 1.28% vs 1.72%. No differences were found in early stage CTSI improment rate (P = .589), local complications (P = .451) or motality between two groups. CONCLUSIONS: TPE reduces TG levels more quickly in 48 h compared with those with conservative treatment, but no difference in the consecutive days. TPE tends to reduce the early recurrence rate comparing with conventional therapy, but TPE has no advantages in improving CTSI in early stage, and no improvement for outcomes including local complications and mortalty.

The pathogenic mutations of APOA5 in Chinese patients with hyperlipidemic acute pancreatitis.

BACKGROUND AND AIMS: To study the role of gene mutations in the development of severe hypertriglyceridemia (HTG) in patients with hyperlipidemic acute pancreatitis (HLAP), especially different apolipoprotein A5 (APOA5) mutations. METHODS: Whole-exome sequencing was performed on 163 patients with HLAP and 30 patients with biliary acute pancreatitis (BAP). The pathogenicity of mutations was then assessed by combining clinical information, predictions of bioinformatics programs, information from multiple gene databases, and residue location and conservation. The pathogenic mutations of APOA5 were visualized using the software. RESULTS: 1. Compared with BAP patients, pathogenic mutations of APOA5 were frequent in HLAP patients; among them, the heterozygous mutation of p.G185C was the most common. 2. All six pathogenic mutations of APOA5 identified in this study (p.S35N, p.D167V, p.G185C, p.K188I, p.R223C, and p.H182fs) were positively correlated with severe HTG; they were all in the important domains of apolipoprotein A-V (apoA-V). Residue 223 is strictly conserved in multiple mammals and is located in the lipoprotein lipase (LPL)-binding domain (Pro215-Phe261). When Arg 223 is mutated to Cys 223, the positive charge of this residue is reduced, which is potentially destructive to the binding function of apoA-V to LPL. 3. Four new APOA5 mutations were identified, namely c.563A > T, c.667C > T, c.788G > A, and c.544_545 insGGTGC. CONCLUSIONS: The pathogenic mutations of APOA5 were specific to the patients with HLAP and severe HTG in China, and identifying such mutations had clinical significance in elucidating the etiology and subsequent treatment.

Association of lipoprotein lipase (LPL) gene variants with hyperlipidemic acute pancreatitis in southeastern Chinese population

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.

Comparison of different intensive triglyceride-lowering therapies in patients with hyperlipidemic acute pancreatitis.

OBJECTIVES: The goal of this study was to investigate the clinical value of emergent triglyceride (TG)-lowering therapies for hyperlipidemic acute pancreatitis (HLAP). METHODS: 126 HLAP patients were assigned randomly to receive either conventional treatment (CT), normal saline (NS) alone, or continuous veno-venous hemofiltration (CVVH) as an intensive TG-lowering therapy. TG levels, clinical outcomes, and inflammatory biomarkers were compared among the three groups. RESULTS: Baseline characteristics did not differ significantly among the groups. CVVH removed TG from the plasma and achieved its target TG (<500 mg/dL) in approximately 25 h, compared to 40 h in the NS alone group and no targeted effect within 48 h in the CT group (P < 0.05). Although the majority of clinical outcomes did not differ significantly, an unexpectedly higher incidence of organ failure occurred in the CVVH group compared to the others. Hospital costs, severe AP patients and length of stay were significantly higher in the CVVH group compared to the other groups (P < 0.005). CONCLUSIONS: Early CVVH lowers TG levels more efficiently than NS alone or CT therapy, but is not superior in terms of clinical outcomes and costs. NS also lowers TG levels and is significantly less costly than the other two treatments. Further multicenter studies are needed to determine the feasibility of NS alone treatment for HLAP patients.

Association of Apolipoprotein A5 Gene Variants with Hyperlipidemic Acute Pancreatitis in Southeastern China.

Background: Apolipoprotein A5 (APOA5) is involved in serum triglyceride (TG) regulation. Several studies have reported that the rs651821 locus in the APOA5 gene is associated with serum TG levels in the Chinese population. However, no research has been performed regarding the association between the variants of rs651821 and the risk of hyperlipidemic acute pancreatitis (HLAP). Methods: A case-control study was conducted and is reported following the STROBE guidelines. We enrolled a total of 88 participants in this study (60 HLAP patients and 28 controls). APOA5 was genotyped using PCR and Sanger sequencing. Logistic regression models were conducted to calculate odds ratios and a 95% confidence interval. Results: The genotype distribution of the rs651821 alleles in both groups follow the Hardy-Weinberg distribution. The frequency of the "C" allele in rs651821 was increased in HLAP patients compared to controls. In the recessive model, subjects with the "CC" genotype had an 8.217-fold higher risk for HLAP (OR = 8.217, 95% CI: 1.023-66.01, p = 0.046) than subjects with the "TC+TT" genotypes. After adjusting for sex, the association remained significant (OR = 9.898, 95% CI: 1.176-83.344, p = 0.035). Additionally, the "CC" genotype was related to an increased TG/apolipoprotein B (APOB) ratio and fasting plasma glucose (FPG) levels. Conclusions: Our findings suggest that the C allele of rs651821 in APOA5 increases the risk of HLAP in persons from Southeastern China.

HIF-1α-PPARγ-mTORC1 signaling pathway-mediated autophagy induces inflammatory response in pancreatic cells in rats with hyperlipidemic acute pancreatitis.

OBJECTIVE: The incidence of hyperlipidemic acute pancreatitis (HLAP) has rapidly increased in recent years in China. Autophagy has been implicated in the inflammatory response of pancreatic cells in HLAP, but the molecular mechanisms remain unclear. METHODS: In this study, the role of HIF-1α-PPARγ-mTORC1 pathway-mediated autophagy in the inflammatory response of pancreatic cells and the underlying molecular mechanism were investigated in a rat model of HLAP using immunohistochemistry, ELISA, electron microscopy, and western blot analysis. RESULTS: The results revealed that autophagy was significantly increased and pancreatic injury was exacerbated in HLAP rats, and the inflammatory response was further exacerbated by treatment with rapamycin but relieved by treatment with 3-MA. Hyperlipidemia induced upregulation of HIF-1α and downregulation of PPARγ, which in turn led to an increase in autophagy and consequently exacerbation of the inflammatory response of pancreatic cells. CONCLUSIONS: HIF-1α-PPARγ-mTORC1 pathway-mediated autophagy plays a critical role in the inflammatory response of pancreatic cells in HLAP, and interference with the HIF-1α-PPARγ-mTOR pathway can serve as a new strategy for the prevention and treatment of HLAP.

Inhibition of TRAF6 improves hyperlipidemic acute pancreatitis by alleviating pyroptosis in vitro and in vivo rat models.

OBJECTIVE: Hypertriglyceridemia (HTG) is one of the common causes of acute pancreatitis (AP). Hyperlipidemic acute pancreatitis (HTG-AP) is associated with higher mortality owing to its tendency for greater severity and rapid progression. The purpose of this study was to explore the mechanism of involvement of tumor necrosis factor receptor-related factor 6 (TRAF6) in pyroptosis during HTG-AP. METHODS: The HTG environment was simulated with palmitic acid treatment in vitro and a high-fat diet in vivo. Cerulein was used to establish the HTG-AP model, followed by genetic and pharmacological inhibition of TRAF6. Pyroptosis activation, inflammatory reaction, and the interaction between TRAF6 and pyroptosis in HTG-AP were assessed. RESULTS: HTG was found to aggravate the development of pancreatitis, accompanied by increased pyroptosis and enhanced inflammatory response in HTG-AP models. Mechanistically, TRAF6 downregulation decreased the activation of pyroptosis in cerulein-induced HTG-AP. CONCLUSION: Collectively, inhibition of TRAF6 improved HTG-AP and the associated inflammation by alleviating pyroptosis.

TMAO promotes apoptosis and oxidative stress of pancreatic acinar cells by mediating IRE1α-XBP-1 pathway.

BACKGROUND: Acute pancreatitis caused by hyperlipidemia is a severe life-threatening condition. Therefore, it is urgent to develop new therapeutic methods to treat this disease. METHODS: Cell viability was determined by the Cell Counting Kit-8 (CCK-8) assay. Western blotting (WB) was used to detect the expression levels of apoptotic and endoribonuclease inositol-requiring enzyme 1α (IRE1α)/X-box binding protein 1 (XBP-1) pathway-associated proteins. The induction of cell apoptosis was determined using flow cytometry. The expression levels of the oxidative stress indicators were measured by an enzyme-linked immunosorbent assay. RESULTS: WB analysis and the CCK-8 assay demonstrated that trimethylamine-N-oxide (TMAO) decreased cell viability and facilitated apoptosis of MPC-83 cells in a dose-dependent manner. Furthermore, the induction of oxidative stress was assessed by evaluating the levels of specific markers, including hydrogen peroxide, reactive oxygen species, nitric oxide, and superoxide dismutase. The levels of the aforementioned markers were increased in the TMAO-treated group. Subsequently, the IRE1α/XBP-1 pathway-associated proteins were analyzed by WB analysis and the data demonstrated that the regulatory effects of TMAO on MPC-83 cells were meditated by the IRE1α/XBP-1 signaling pathway. Subsequently, rescue experiments were performed to further assess the effects of TMAO. CONCLUSION: The present study provides evidence on the application of TMAO as a potential diagnostic and therapeutic strategy for the therapeutic intervention of hyperlipidemic acute pancreatitis.

Therapeutic plasma exchange for hyperlipidemic pancreatitis: Current evidence and unmet needs.

With changes in lifestyle and diet worldwide, the prevalence of hyperlipidemic acute pancreatitis (HLAP) has greatly increased, and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol. There are many available therapies for HLAP, including oral lipid-lowering agents, intravenous insulin, heparin, and therapeutic plasmapheresis (TPE). It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides (TG), thus a rapid decrease in serum TG level is the key to the successful management of HLAP. TPE has emerged as an effective modality in rapidly reducing serum TG levels. However, due to its cost and accessibility, TPE remains poorly evaluated until now. Some studies revealed its efficacy in helping to treat and prevent the recurrence, while some studies suggested that TG levels were not correlated with disease severity, mortality, or length of hospital stay. Thus TPE might have no beneficial effect for the outcome. This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors, adverse effects of the procedure, and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis. Future direction of TPE research for HLAP is also discussed in this review.

Clinical Significance of PLR, NLR, MLR, RPR and CLR in Evaluating Severity of Hyperlipidemic Acute Pancreatitis / 胃肠病学

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.

Treatment of hyperlipidemic acute pancreatitis with modified Dachengqi decoction combining with conventional therapy based on "six-hollow-organs to be unblocked" theory.

BACKGROUND: The increase of triglyceride (TG) can induce coronary heart disease, atherosclerosis, pancreatitis and other diseases and is the most common inducing factor of acute pancreatitis (AP) second only to biliary tract disease and drinking. The pathogenesis of hyperlipidemic acute pancreatitis (HLAP) is not exactly clear, but it may be related to the toxic effect of the increase of free fatty acids produced by TG decomposition on the pancreas itself, microcirculation disorder of the pancreas, and calcium overload. At present, non-surgical therapy is the main treatment for HLAP. The key to preventing recurrence is to reduce blood lipids, change the diet structure, and reduce weight. This study aimed to treat HLAP with modified Dachengqi decoction combined with conventional therapy, based on the "six-hollow-organs to be unblocked" theory. METHODS: Forty patients with HLAP who received treatment in the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine and Puding County Hospital of Traditional Chinese Medicine from September 2016 to August 2019 were selected and divided into a control group and an intervention group, each with 20 cases, following a random number table. The control group was treated with conventional therapy while the intervention group was treated with modified Dachengqi decoction combined with conventional therapy. RESULTS: After treatment, the cure rate and the total effective rate were 60% and 95% respectively in the intervention group, and 25% and 75% respectively in the control group (P<0.05). The TG, serum amylase, leukocyte count, and neutrophil ratio of the two groups decreased significantly after treatment, and there was a greater decrease in the intervention group than that in the control group, with this being significantly different between the two groups. The gastrointestinal function score, total score of the acute physiology and chronic health evaluation II (APACHE II), and the pain score of the visual analog scale (VAS) decreased markedly in the two groups after the treatment, with scores in the intervention group being significantly lower than those in the control group (P<0.05). CONCLUSIONS: Modified Dachengqi decoction combined with conventional therapy has a better therapeutic effect on HLAP than conventional therapy.

Narrative review of the mechanisms of action of dachengqi decoction in the treatment of hyperlipidemic pancreatitis on six-hollow-organs to be unblocked theory.

The incidence rate of acute pancreatitis (AP) caused by hyperlipidemia is increasing year by year. The primary treatment goal is to reduce blood lipids rapidly. On the theory of "Six-hollow-organs to be unblocked" we used dachengqi decoction (original prescription of Zhang Zhongjing in Shanghan Lun) to block the peroxisome proliferator-activated receptor γ (PPARG) pathway and rapidly reduce blood lipid to achieve the purpose of treating hyperlipidemic acute pancreatitis (HLAP). In this review, we summarize the etiology and pathogenesis of HLAP and the progress of traditional Chinese medicine in treating HLAP. The mechanisms of action of dachengqi decoction in the treatment of HLAP and the involvement of the PPARG pathway were discussed. In brief, the dachengqi decoction has the effect of resolving phlegm and clearing waste substances and can improve intestinal function; can inhibits the production of interleukin-1, interleukin-6, and tumor necrosis factor-α, and reduces the damage of SIRS to human body; also it improves the microcirculation system by inhibiting the production of inflammatory factors, reducing, or eliminating the damage to vascular endothelial cells and microvessels, and improving vascular permeability. The clarification of the mechanisms of action of the drug is conducive to the extensive clinical application of the classical formula.

The impact of sleeve gastrectomy on recurrent obese hyperlipidemic pancreatitis / 中华肝胆外科杂志

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.

Study on changes of C-reactive protein and D-dimer in hyperlipidemic and biliogenic acute pancreatitis patients / 重庆医学

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.

Clinical Study on Effects of Enteral Immunonutrition in Patients with Hyperlipidemic Acute Pancreatitis / 医学研究杂志

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.

Changes and differences of serum calcium and intact parathyroid hormone in patients with hyperlipidemic or biliogenic acute pancreatitis / 中华胰腺病杂志

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.

A serum metabolomic investigation on lipoprotein lipase-deficient mice with hyperlipidemic pancreatitis using gas chromatography/mass spectrometry.

Hypertriglyceridemia (HTG) is often associated with acute pancreatitis. The relationship between these diseases and the role that hypertriglyceridemia plays in acute pancreatitis pathogenesis remains to be elucidated. In the present study, in order to investigate the mechanisms of hyper-lipidemic acute pancreatitis (HLP), we established an animal model using lipoprotein lipase (LPL)-deficient heterozygous mice injected with caerulein. Susceptibility to pancreatitis in LPL-deficient heterozygous mice was compared with that of wild-type mice after intraperitoneal (i.p.) injections of caerulein by determining amylase release and pancreatic pathological scores. Furthermore, serum metabolome was detected through chemical derivatization followed by gas chromatography/mass spectrometry (GC/MS). GC/MS data were analyzed by orthogonal-projection to latent structures-discriminant analysis (OPLS-DA). Caerulein induced increased levels of serum amylase and more severe pancreatic inflammation in LPL-deficient mice compared to wild-type mice. HLP was discriminated more accurately from healthy controls by the metabolites, including valine, leucine and citrate. The metabolites included valine, leucine, citrate, malic acid, proline, tetradecanoic acid (14:0), glutamine and oleic acid (18:1). Changes in energy, fat and amino acid metabolism were also evident. In conclusion, LPL-deficient heterozygous mice with hypertriglyceridemia (HTG) exhibited enhanced susceptibility to acute pancreatitis. GC/MS data revealed differences between healthy and HLP mice. Therefore, this technique is novel and a useful tool for the study of the HLP pathogenetic mechanism.