目的 研究高血脂症性急性胰腺炎患者血清细胞因子水平及其与病情严重程度的相关性.方法 回顾性分析200例急性胰腺炎(AP)患者资料,按照患者发病原因分成2组,观察组为高血脂症性急性胰腺炎(HLAP)患者,对照组为非高血脂症性急性胰腺炎(NHLAP)患者.观察2组三酰甘油(TG)、总胆固醇(TC)、谷草转氨酶(AST)、血淀粉酶、内毒素、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)、C反应蛋白(CRP)水平情况及其与患者病情严重程度的相关性.结果 2组年龄、性别、高血压、糖尿病、脂肪肝比较差异有统计学意义(P均＜0.05),2组腹痛持续时间及腹痛至入院时间比较差异无统计学意义(P均＞0.05);2组血清CRP水平均呈先升后降的动态变化,在发病第3天达到最高值,然后下降,但观察组各时间点血清CRP水平均明显高于对照组(P均＜0.05);轻型急性胰腺炎患者中,第1天与第7天2组间血清CRP水平比较差异无统计学意义(P＞0.05),在第2-6天观察组均显著高于对照组(P均＜0.05);中型急性胰腺炎患者中,第1-4天2组间血清CRP水平比较差异有统计学意义(P均＜0.05),第5-7天2组间比较差异无统计学意义(P均＞0.05);重型急性胰腺炎患者中,第2-4天2组间血清CRP比较差异有统计学意义(P均＜0.05),在第1天与第5-7天2组间比较差异无统计学意义(P均＞0.05);观察组TG、TC、AST、内毒素、TNF-α、IL-6、PCT水平均明显高于对照组(P均＜0.05),血淀粉酶值显著低于对照组(P＜0.05);ROC曲线分析,观察组第2天的约登指数明显高于第1,3天,对应的CRP临界值为173.12 mg/L,而对照组在第3天的约登指数明显高于第1,2天,血清CRP临界值为198.00mg/L.结论 高血脂症性急性胰腺炎患者血清CRP及血脂水平均明显高于其他原因引起的急性胰腺炎,并且血清CRP会随着病情加重而变化,可为临床上早期诊断高血脂症性急性胰腺炎提供依据.

Objective:To compare the efficacy of hydration combined with 60 mg/day or 40 mg/day atorvastatin on prevention of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods:172 AMI patients were randomly divided into high dose group (88 cases) and low dose group (84 cases).Based on the conventional treatment of PCI,the patients in high dose group after admission to 72 h after PCI were given 60 mg/day atorvastatin orally,and those in low dose group given 40 mg/day atorvastatin orally,at the same time two groups in the perioperative period were given intravenous saline water treatment.The operation associated indexes,variations on biological markers and renal function before and after operation were recorded,and the incidence of CIN and clinical adverse events were noted and compared between the two groups.Results:There was no significant difference in contrast agent dosage,contact time,hydration volume and coronary atherectomy ratio,and mean number of stent implantation per patient (P ＞ 0.05).The decreased values of NT-proBNP,Hs-CRP and MMP-9 in the high dose group at 72 h after PCI as compared with the preoperative values were significantly higher than those in the low dose group [(0.5 ± 0.2) pg/mL vs (0.4±0.2) pg/mL,(7.8±2.4) mg/Lvs (6.3±1.9) mg/L and (27.5 ±9.5) μg/Lvs (23.7±7.7) μg/L] (allP＜0.05).The increased values of Scr and BUN,and the decreased values of eGFR in the high dose group at 72 h after PCI as compared with the preoperative values were significantly lower than those in the low dose group [(11.9 ± 3.5) μmol/L vs (19.6 ± 5.8) μmol/L,(1.5 ±0.5) mmol/Lvs (2.4±0.7) mmol/L,and (5.0±2.2) mL/(min · 1.73 m2) vs (9.2±3.8)mL/(min · 1.73m2)] (P＜0.05).The incidence rate of CIN and the ratio of patients accepting renal dialysis in the high dose group were significantly lower than those in the low dose group [6.8％ vs 16.7％,1.1％ vs 8.3％] (P＜0.05).Conclusion:Atorvastatin combined with conventional hydration during PCI can prevent the occurrence of CIN,and the preventive effect of 60 mg/day atorvastain is better than 40 mg/day.