摘要目的:探讨重症高三酰甘油血症性胰腺炎(HTGP)的危险因素。方法:回顾性分析2012年9月至2018年12月间首都医科大学宣武医院收治的169例HTGP患者临床资料。根据病情严重程度将患者分为重症HTGP组(63例)和轻症及中度重症HTGP组(106例)，比较两组患者的一般资料，将两组间差异有统计学意义且具有临床意义的变量进行二元logistic回归分析，探究重症HTGP的独立危险因素。结果:除重症HTGP组患者心律和呼吸频次显著高于轻症及中度重症HTGP组患者，既往有胰腺炎病史的患者比例显著低于轻症及中度重症HTGP患者，差异有统计学意义外，两组其他基线资料及既往史的差异均无统计学意义。重症HTGP患者WBC、血小板平均体积、红细胞沉降率、总蛋白，第1天及第3天的C反应蛋白(CRP)、淀粉酶、脂肪酶、三酰甘油，凝血酶原时间、D-二聚体、纤维蛋白原，CTSI、APACHEⅡ、Ranson评分均显著高于轻症及中度重症HTGP患者；淋巴细胞计数、白球蛋白比、尿酸、载脂蛋白-A1、血钙、凝血酶原活动度均显著低于轻症及中度重症HTGP患者，差异均有统计学意义。将第1天和第3天的三酰甘油和CRP水平及CTSI、APACHEⅡ、Ranson评分纳入二元logistic回归模型，分析结果显示，第1天三酰甘油水平( OR＝1.08，95% CI 1.02～1.14， P＝0.01)、第3天CRP水平( OR＝1.01，95% CI 1.00～1.01， P<0.01)、CTSI评分( OR＝1.51，95% CI 1.06～2.13， P＝0.02)、APACHEⅡ评分( OR＝1.22，95% CI 1.07～1.40， P<0.01)为重症HTGP的危险因素，第3天三酰甘油水平为重症HTGP的保护因素( OR＝0.8，95% CI 0.69～0.91， P＝0.00)。 结论:第1天三酰甘油水平和第3天CRP水平、CTSI评分、APACHEⅡ评分为重症HTGP的危险因素，需特别重视。

abstractsObjective:To explore the risk factors for hyperlipidemic acute pancreatitis (HTGP).Methods:The clincial data of 169 HTGP cases admitted in Capital Medical University Attached Xuanwu Hospital from September 2012 to December 2018 were retrospectively analyzed. Patients were divided into severe HTGP group ( n=63) and mild or moderately severe HTGP group ( n=106). Clinical data were compared between two groups and variables with statistically significance and clinical values were chosen and included for binary logistic regression to explore the independent risk factors for severe HTGP. Results:Severe HTGP patients′ heart beat and respiratory rate were significantly higher than moderately severe or mild HTGP cases, while the percentage of patients with previous AP history in severe HTGP group was obviously lower than moderately severe or mild HTGP cases. There were no statistically significant differences on other baseline data and previous history. Severe HTGP patients had significantly higher white blood cell, mean platelet volume, erythrocyte sedimentation rate, total protein, C-reaction protein on first day, C-reaction protein on third day, amylase, lipase, triacylglycerol, prothrombin time, D-dimer, fibrinogen, CTSI, APACHEⅡ score and Ranson score than those in moderately severe or mild HTGP cases; the lymphocyte count, albumin-globulin ratio, uric acid, apolipoprotein-A1, blood calcium, prothrombin activity were obviously lower than those in moderately severe or mild HTGP cases; and all the differences were statistically significant. Triglyceride and CRP on the first and third day, CTSI, APACHEⅡ score and Ranson score were included for binary logistic regression model, and the results showed that triglyceride on the first day ( OR=1.08, 95% CI 1.02-1.14, P=0.01), C-reaction protein on the third day ( OR=1.01, 95% CI 1.00-1.01, P<0.01), CTSI score( OR=1.51, 95% CI 1.06-2.13, P=0.02), APACHEⅡ score( OR=1.22, 95% CI 1.07-1.40, P<0.01)were the risk factors of severe HTGP, while triglyceride on the third day ( OR=0.8, 95% CI 0.69-0.91, P=0.00)was the protective factor of severe HTGP. Conclusions:Triglyceride on the first day, C-reaction protein on the third day, CTSI score and APACHEⅡ score were the risk factors of severe HTGP, which deserve special attention.