外周血RLP-C、RC/HDL-C表达与高脂血症性急性胰腺炎患者病情严重程度及复发的关系

Associations of peripheral blood RLP-C and RC/HDL-C levels with disease severity and recurrence in patients with hyperlipidemic acute pancreatitis

摘要:

目的 探讨血清残粒脂蛋白胆固醇（RLP-C）、残余胆固醇/高密度脂蛋白胆固醇（RC/HDL-C）与高脂血症性急性胰腺炎（HLAP）病情严重程度及复发的关系。方法 回顾性分析2018年1月—2021年1月西安高新医院收治的92例HLAP患者的病历资料，分析不同严重程度HLAP患者的RC/HDL-C、RLP-C水平。根据2年内的复发情况分为复发组和非复发组，分析HLAP患者复发的影响因素，评估RC/HDL-C、RLP-C对HLAP患者复发的预测效能。结果 92例HLAP患者轻度26例（28.26%）、中度54例（58.70%）、重度12例（13.04%）。轻度组RC/HDL-C和RLP-C水平均低于中度组和重度组（P <0.05），中度组RC/HDL-C和RLP-C水平均低于重度组（P <0.05）。RC/HDL-C、RLP-C与HLAP严重程度呈正相关（r_s =0.472和0.459，均P =0.000）。92例HLAP患者中复发38例（41.30%）。复发组HDL-C低于非复发组（P <0.05），RC/HDL-C、RLP-C高于非复发组（P <0.05）。多因素逐步Logistic回归分析结果显示：RC/HDL-C水平高［O^R=3.899（95% CI：1.344，11.319）］、RLP-C水平高［O^R=4.491（95% CI：1.547，13.033）］是HLAP复发的危险因素（P <0.05）；HDL-C水平低［O^R=0.229（95% CI：0.079，0.665）］是HLAP复发的保护因素（P <0.05）。RC/HDL-C、RLP-C单一及联合预测HLAP复发的敏感性分别为72.15%（95% CI：0.635，0.804）、81.73%（95% CI：0.729，0.916）、87.09%（95% CI：0.764，0.931），特异性分别为71.29%（95% CI：0.628，0.815）、78.04%（95% CI：0.712，0.841）、92.31%（95% CI：0.835，0.981）。结论 RC/HDL-C、RLP-C水平与HLAP患者的病情严重程度呈正相关，可用于预测HLAP患者的复发风险，且预测效能良好。

Abstract:

Objective To explore the associations of serum remnant lipoprotein cholesterol (RLP-C) and remnant cholesterol/high-density lipoprotein cholesterol (RC/HDL-C) levels with the disease severity and recurrence of hyperlipidemic acute pancreatitis (HLAP).Methods A retrospective analysis was conducted on the medical records of 92 HLAP patients admitted to Xi'an High-tech Hospital from January 2018 to January 2021, and the levels of RC/HDL-C and RLP-C in patients with varying degrees of disease severity were analyzed. According to the recurrence outcomes within 2 years, the patients were divided into a recurrence group and a non-recurrence group. The factors affecting the HLAP recurrence were analyzed, and the predictive efficacy of RC/HDL-C and RLP-C levels for HLAP recurrence was evaluated.Results Among the 92 patients with HLAP, 26 cases (28.26%) were classified as mild, 54 cases (58.70%) as moderate, and 12 cases (13.04%) as severe. The RC/HDL-C and RLP-C levels in the mild group were lower than those in the moderate and severe groups (P < 0.05), and the RC/HDL-C and RLP-C levels in the moderate group were lower than those in the severe group (P < 0.05). The RC/HDL-C and RLP-C levels were positively correlated with the severity of HLAP (r_s = 0.472 and 0.459, both P = 0.000). Among the 92 HLAP patients, 38 (41.30%) experienced disease recurrence. The HDL-C level in the recurrence group was lower than that in the non-recurrence group, while the RC/HDL-C and RLP-C levels were higher in the recurrence group than in the non-recurrence group (P < 0.05). Multivariable Logistic regression analysis revealed that high RC/HDL-C levels [O^R = 3.899 (95% CI: 1.344, 11.319) ] and high RLP-C levels [O^R = 4.491 (95% CI: 1.547, 13.033) ] were risk factors for HLAP recurrence (P < 0.05), and that low HDL-C levels [O^R = 0.229 (95% CI: 0.079, 0.665) ] were found to be a protective factor (P < 0.05). The sensitivities of RC/HDL-C, RLP-C, and their combination in predicting HLAP recurrence were 72.15% (95% CI: 0.635, 0.804), 81.73% (95% CI: 0.729, 0.916), and 87.09% (95% CI: 0.764, 0.931), respectively. The specificities were 71.29% (95% CI: 0.628, 0.815), 78.04% (95% CI: 0.712, 0.841), and 92.31% (95% CI: 0.835, 0.981), respectively.Conclusion RC/HDL-C and RLP-C levels are positively associated with the severity of HLAP and demonstrate good predictive performance for assessing the risk of disease recurrence.