目的 探讨复发性高脂血症性急性胰腺炎(hyperlipidemic recurrent acute pancreatitis,HL-RAP)的临床特征,为其防治提供参考.方法 回顾性分析2019年3月—2021年4月厦门大学附属第一医院急诊科收治的97例高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HL-AP)患者的临床资料,分为复发组与初发组.收集2组患者的临床资料,并进行对比.结果 复发组C反应蛋白(C-reactive protein,CRP)、降钙素原较初发组低(P<0.01),2组甘油三酯对比差异无显著性(P>0.05);复发组病情分级低于初发组(P<0.01);复发组CT影像分级较初发组轻(P<0.05);复发组全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)发生率较初发组低(P<0.01);复发组的住院费用较初发组低,住院天数较初发组短(P<0.01).结论 HL-RAP病情较初次发生的HL-AP轻,对这部分患者应加强健康宣教,使其重视平时的血脂管理.

Objective:To explore the characteristics of T lymphocyte subsets and cytokines in hyperlipidemia-induced acute pancreatitis (HLAP) and its prognostic value.Methods:This study included 184 patients with acute pancreatitis (AP) admitted to the First Affiliated Hospital of Xiamen University from January 2018 to May 2021. Based on disease etiology, there were 92 HLAP cases and 92 non-hyperlipidemia-induced AP (NHLAP) cases. Stratified by disease severity according to 2012 Atlanta classification criteria, the patients were divided into the severe subgroup (SAP) and non-severe subgroup (NSAP). Peripheral venous blood samples were taken from all patients on day 1, 3, and 5 after admission. T lymphocyte subsets were determined by flow cytometry, and cytokines were detected by flow fluorometry. The number of CD4 +% and CD8 +% and the expression of cytokines were compared by Student’s t test or Mann-Whitney U analysis. Logistic regression analyses were performed to identify risk factors for severe AP, and a receiver operating characteristic (ROC) curve was constructed to predict severe AP. Statistical significance was taken as P<0.05. Results:Compared with the NHLAP group, patients in the HLAP group had lower CD4 +%, while higher levels of IL-2 on day 1 ( P<0.05), and had also lower CD4 +%, while higher levels of IL-4, IL-6, and IL-10 on day 3 ( P<0.05). Furthermore, IL-6 and IL-10 levels of the HLAP group were significantly increased compared to the NHLAP group on day 5 ( P<0.05). IL-10 levels in the SAP subgroup were significantly higher than those in the NSAP subgroup on day 1 ( P<0.05). Compared with the NSAP subgroup, the SAP subgroup had elevated levels of IL-2, IL-4, IL-6, IL-10 and IFN-γ on day 3 (all P<0.05), and had lower CD4 +%, while increased levels of IL-6 and IL-10 on day 5 (all P<0.05). Multivariate Logistic regression analysis showed that IL-10 was an immune indicator of independent risk factor for severe AP in the HLAP group on day 1 ( OR=1.139, 95% CI: 1.038-1.251, P<0.05). Finally, ROC analysis showed that the area under the curve of IL-10 to assess HLAP with severe AP was 0.772, and the best cut-off value for predicting severe AP was 5.6 pg/mL, with a sensitivity of 83.3% and a specificity of 68.8%. Conclusions:Changes of CD4 +% and cytokines are different between the HLAP and NHLAP groups. IL-10 can be used as a predictor of early disease severity in patients with HLAP.

Objective:To establish an early prediction model with multiple indicators to predict the risk of severe acute pancreatitis (SAP) in hyperlipidemic acute pancreatitis (HLAP).Methods:The clinical data of 92 patients with HLAP admitted to the Emergency Department of our hospital from March 2018 to February 2020 were analyzed retrospectively. Among them, 29 cases deteriorated to SAP and 63 cases did not. Univariate analysis was used to screen predictive indicators related to hyperlipidemic severe acute pancreatitis (HL-SAP), and logistic regression analysis was used to screen independent predictive indicators related to HL-SAP. Then a prediction model was established. The area under (AUC) the receiver operating curve (ROC) was used to evaluate the predictive ability of each predictive indicator and the model for HL-SAP. Bootstrap resampling technology was used to validate the predictive ability of the model.Results:Univariate analysis showed that procalcitonin, D-dimer, C-reactive protein, albumin, cholesterol and CT grade had influence on the progression of HLAP to SAP ( P<0.05). Logistic regression analysis showed that D-dimer ( OR=2.112, 95% CI: 1.022-4.366; P<0.05), CT grade ( OR=5.818, 95% CI: 2.481-13.643; P<0.01) and cholesterol ( OR=1.146, 95% CI: 1.004-1.308; P<0.05) were independent risk factor of HL-SAP. The AUC of D-dimer, CT grade, cholesterol and the model were 0.802, 0.875, 0.665 and 0.927, respectively. Internal validation of the predictive ability of the model showed that the C-index was 0.927. Conclusions:In the early phase, application of the prediction model that composes D-dimer, CT grade and cholesterol has a good predictive effect on HL-SAP.

目的 通过建立大鼠心肌缺血再灌注损伤(MIRI)模型,观察逸心汤对心肌缺血再灌注损伤的保护作用.方法 按照随机对照原则,将30只大鼠分为空白组、模型组和治疗组,各10只.模型组和治疗组分别结扎心脏左前降支45 min,空白组只穿线不结扎.模型组和空白组灌胃生理盐水4 mL,连续治疗2周.治疗组给予逸心汤,每只4 mL,每日1剂,每天灌胃给药.治疗2周后各组均取腹主动脉血检测血清丙二醛(MDA)、超氧化物歧化酶(SOD)及活性氧簇(ROS)水平;同时各组均取心肌组织进行病理苏木精-伊红(HE)染色,并采用TUNEL法检测各组大鼠心肌细胞凋亡水平.结果 模型组MDA、ROS水平明显高于空白组(P<0.05),治疗组MDA、ROS水平明显低于模型组(P<0.05),治疗组MDA水平与空白组比较差异无统计学意义(P>0.05),但ROS水平高于空白组(P<0.05).3组间SOD水平比较差异无统计学意义(P>0.05).治疗组、模型组心肌细胞凋亡水平明显高于空白组(P<0.05);模型组与治疗组心肌细胞凋亡水平比较差异均无统计学意义(P>0.05).病理组织形态学结果显示,与空白组比较,模型组、治疗组可见心肌细胞变性,心肌纤维断裂,心肌细胞间隙明显增宽,炎细胞浸润;与模型组比较,治疗组心肌细胞变性及炎细胞浸润程度较轻.结论 逸心汤可减轻大鼠MIRI,发挥心肌保护作用,且氧化应激反应是其心肌保护作用的重要机制之一.

目的 探讨盐酸小檗碱对2型糖尿病患者胃泌素、胰高血糖素及肠道菌群的影响.方法 选择我院单用胰岛素治疗的2型糖尿病患者25例为治疗组,选取同期体检中心体检健康人群10例为对照组.治疗组根据血糖情况调整胰岛素剂量,同时给予盐酸小檗碱每次500mg,tid,连续12周.分别于0、4、8、12周检测血糖、胃泌素、胰高血糖素,于0、12周采集清晨空腹粪便进行粪便菌群培养.结果 治疗组治疗前后胃泌素水平均明显高于对照组(P＜0.01);治疗组治疗后胃泌素水平高于0周水平(P＜0.01).治疗组治疗前后胰高血糖素明显高于对照组(P＜0.01),治疗前后差异无统计学意义(P＞0.05).治疗组治疗前厚壁菌门高于治疗后及对照组水平(P＜0.05);治疗组治疗前乳酸杆菌属、拟杆菌属明显低于治疗后水平(P＜0.05);治疗组治疗前拟杆菌属、柔嫩梭菌属低于对照组水平(P＜0.05).结论 2型糖尿病患者存在胃肠激素及肠道菌群失调,盐酸小檗碱有助于改善糖尿病患者胃肠激素、肠道菌群失调现象.

目的:探讨盐酸小檗碱对2型糖尿病(T2DM)胃泌素(GAS)、胰高血糖素(GLC)及肠道菌群的影响.方法:以25例口服降糖药治疗的T2 DM患者为治疗组,对照组选取健康人群10例.T2 DM患者常规治疗,同时给予盐酸小檗碱500 mg,每日3次,连续12周.分别于0、4、8、12周检测血糖、GAS、GLC,于0、12周采集清晨空腹粪便进行粪便菌群培养.结果:治疗组治疗后FPG及餐后1hPG有不同程度的下降(P<0.05).治疗前后治疗组GAS、GLC水平均明显高于对照组(P<0.05).治疗组治疗后GAS水平持续升高(P<0.05).治疗后治疗组厚壁菌门明显低于治疗前(P<0.05).治疗后治疗组大肠杆菌属明显高于治疗前(P<0.05).治疗前治疗组柔嫩梭菌属明显低于对照组(P<0.05).治疗后治疗组厚壁菌门明显低于对照组(P<0.01).治疗前后治疗组拟杆菌明显低于对照组(P<0.05).结论:小檗碱有助于改善T2 DM患者胃肠激素、肠道菌群失调现象,改善糖代谢紊乱.

小檗碱又称黄连素,是中药黄连所含的主要生物碱,具有广谱抗菌的药理作用,多用于治疗胃肠道细菌性感染.近年来大量研究显示,小檗碱具有良好的降糖、减轻胰岛素抵抗、干预胃肠道激素的作用.因此,本研究采用小檗碱进行为期12周的临床干预治疗,观察小檗碱对不同程度2型糖尿病患者胃泌素、胰高血糖素及肠道菌群的作用,为2型糖尿病患者的防治提供新思路.