Search

胸腔积液及高脂血症对重症急性胰腺炎发生的预测作用

目的探讨胸腔积液、高脂血症与重症急性胰腺炎（SAP）早期诊断的关系。 方法2010年1月-2014年3月对入院24 h内的120例急性胰腺炎患者按2013年《中国急性胰腺炎诊治指南》的诊断标准分为SAP组（68例）和轻症急性胰腺炎（MAP）组（52例）。两组均行胸腹部CT及血脂分析检查，记录胸腔积液、高脂血症以及胸腔积液并高脂血症与SAP发病例数、病死率、腹水、肝功能不全、胰腺假性囊肿的关系。 结果SAP组与MAP组胸腔积液分别为57例（83.8%）和12例（23.1%），高脂血症分别为52例（76.5%）和17例（32.7%），胸腔积液并高脂血症分别为47例（69.1%）和7例（13.5%），差异有统计学意义（P＜0.001）。SAP组患者中，是否并发胸腔积液者病死率、胰腺假性囊肿发生率差异无统计学意义（P＞0.05），并发胸腔积液者腹水、肝功能不全发生率发生率高于无胸腔积液者（P＜0.05）；是否合并高脂血症者病死率、胰腺假性囊肿发生率差异无统计学意义（P＞0.05），合并高脂血症者腹水和肝功能不全发生率均高于未合并高脂血症者（P＜0.05）；是否同时合并胸腔积液和高脂血症者胰腺假性囊肿发生率差异无统计学意义（P＞0.05），同时合并胸腔积液和高脂血症者病死率、腹水发生率、肝功能不全发生率均高于未同时合并胸腔积液和高脂血症者（P＜0.05）。 结论胸腔积液、高脂血症与SAP发生有密切关系，同时还与部分并发症有关，检测这两项指标，对SAP早期诊断及并发症的早期干预有意义。

Progress in the treatment of hyperlipidemia acute pancreatitis

In recent years, the incidence of hyperlipidemia acute pancreatitis (HLAP) has been increasing year by year, but its pathogenesis has not been completely clear. There are many clinical treatment methods for HLAP, such as lipid-lowering drugs, low molecular weight heparin, insulin, and plasma exchange. Actively reducing serum triglyceride is the core of treatment. Plasma exchange can quickly and effectively reduce the level of triglyceride, and its application in the treatment of HLAP is gradually increasing. This article reviews the recent advances in the pathogenesis, clinical characteristics, diagnosis, and treatment of HLAP, focusing on the mechanism, indications, timing, and disadvantages of plasma exchange therapy for HLAP.

Efficacy of Electroacupuncture in Animal Hyperlipidemia Models: A Meta-analysis

ObjectiveTo systematically review the efficacy and safety of electroacupuncture in animal hyperlipidemia models. MethodsDatabases such as CNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library (Issue 12, 2013) were searched for studies concerning the efficacy and safety of electroacupuncture in animal hyperlipidemia models up to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies by using reformative CAMARADES List. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 4 studies involving 89 rats were included. The average score of CAMARADES List was 4. The results of meta-analysis showed that:there were no significant differences between electroacupuncture group and medication group in reducing the levels of TC (MD=0.06, 95%CI -0.08 to 0.20, P=0.40), TG (MD=-0.01, 95%CI -0.08 to 0.06, P=0.74), LDL-C (MD=0.01, 95%CI -0.04 to 0.03, P=0.65) and increasing the level of HDL-C (MD=-0.00, 95%CI -0.09 to 0.08, P=0.93). ConclusionCurrent evidence shows that there are no differences between electroacupuncture and medication in reducing levels of TC, TG, LDL-C and increasing the level of HDL-C in hyperlipidaemia rats. But due to the limitation of sample size of included studies, more large-scale, high quality studies are needed.

家族性高脂血症患者罹患冠状动脉粥样硬化性心脏病行冠状动脉旁路移植术一例

Effect of Sleeve Gastrectomy on LOX-1 Expression of Aortic Epithelium in Rats with High-Fat-Diet-Induced Obestiy

ObjectiveTo investigate the effect of sleeve gastrectomy on preventing adipose infiltration and LOX-1 expression in aortic epithelium of high-fat-diet-induced obese rats. MethodsTwenty-four Wistar rats were randomized into normal chow group (CO group), high-fat diet group (HD group), and high-fat diet combined with sleeve gastrectomy group (SG group). Rats of three groups before operation and CO group after operation were fed with normal diet, rats of HD and SG group were fed with high-fat diet. Body weight of all the rats were examined on day 10, 20, and 30 after operation, respectively. Animals were sacrificed on day 30 after operation and plasma HDL and LDL were detected by ELISA, LOX-1 and LOX-1 mRNA expression in aortic epithelium were measured by Western blot and real-time RT-PCR, respectively. Immunochemical histological Nile red stain was adopted in adipose infiltration examination of aorta. ResultsThe body weights in HD group were much higher than those of other groups （Plt;0.01）. The HDL in CO, HD, and SG groups was (32.9±6.2) mg/dl, (43.4± 4.0) mg/dl, and (37.5± 4.3) mg/dl, respectively. The LDL in CO, HD, and SG groups was (31.8±4.5) mg/dl, (53.3±5.1) mg/dl, and (40.5±3.7 ) mg/dl, respectively. The HDL and LDL values in HD group were higher than those of other two groups (Plt;0.05, Plt;0.01). The LOX-1 protein and mRNA expressions in HD group were much higher than those of other groups (Plt;0.01). Adipose staining in HD group was also ber than that of other groups. ConclusionsHigh-fat diet can induce elevation of LOX-1 protein and mRNA expression in aorta. Sleeve gastrecto my can relieve plasma LDL level, as a result, LOX-1 protein and mRNA expression should be down-regulated.

高脂血症急性胰腺炎临床特点回顾性分析

目的探讨高脂血症急性胰腺炎（HLAP）的临床特征及治疗。 方法回顾性分析2011年3月至2013年12月期间在笔者所在医院治疗的25例HLAP患者的临床资料，并与同期128例胆源性胰腺炎（ABP）患者进行对比研究。 结果HLAP组患者年龄偏年轻、男性多于女性，在体质量指数、合并糖尿病的比例、复发率、病情严重程度及血糖上明显高于ABP组（P<0.05），甘油三酯明显升高（P<0.01）；ABP组血尿淀粉酶水平较HLAP组明显升高（P<0.05）。 结论HLAP多发生于年轻的男性肥胖患者，常合并有糖尿病，具有重症胰腺炎发病率高、血甘油三酯高和血尿淀粉酶低的不同于ABP的临床特点。采用血液净化等治疗，可降低其病死率。

Reassessment of Lipid Regulating Effect of Xuezhikang on Primary Hyperlipidemia Patients: A Systematic Review

ObjectiveTo assess the effect of Xuezhikang 1.2 g/d after 4 weeks' treatment on primary hyperlipidemia patients' lipid contents including total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) by literature analysis. MethodsA literature research was carried out in CNKI, Wanfang and Weipu full-text database to collect articles published from January 1st, 1994 to August 30 th, 2014, concerning the self-controlled trials on the lipid regulating effects of Xuezhikang 1.2 g/d for 4 weeks in primary hyperlipidemia patients. Statistical analysis was performed with Review Manager 5.2. ResultsFifty-five independent trials were included in this review. All of the independent studies showed no homogeneity (P<0.01, I2>70%), and had publication bias. The contents of TC, TG, and LDL-C after a 4-week treatment with 1.2 g/d Xuezhikang were significantly lower than those before treatment [WMD=1.14 mmol/L, 95%CI (1.02, 1.25) mmol/L, P<0.000 01; WMD=0.72 mmol/L, 95%CI (0.59, 0.85) mmol/L, P<0.000 01; WMD=0.87 mmol/L, 95%CI (0.74, 1.00) mmol/L, P<0.000 01] and the contents of HDL-C was significantly higher than that before treatment [WMD=-0.16 mmol/L, 95%CI (-0.26, -0.12) mmol/L, P<0.000 01]. ConclusionXuezhikang can reduce the primary hyperlipidemia patients' TC, TG and LDL-C, and increase HDL-C after 4 weeks' treatment.

Analysis for Hyperlipemia Correlation with Hepatic Involvement in Systemic Lupus Erythematosus

目的:比较伴或不伴高脂血症的系统性红斑狼疮(SLE)患者的狼疮性肝损害的构成比例,了解高脂血症与狼疮性肝损害的相关性。方法:收集SLE患者100例,根据高脂血症和狼疮性肝损害的诊断标准,将患者分为高脂血症组,非高脂血症组和肝损害组,非肝损害组,收集其相关临床数据进行比较分析。结果:1高脂血症组发生肝损害的比例高于非高脂血症组(χ2=9.908,P=0.002);2血脂水平中甘油三酯与γGT(r=0366,P=0.000),碱性磷酸酶(r=0.241,P=0.018),强的松剂量(r=0.31,P=0.006),24h尿蛋白定量(r=0.273,P=0.007)相关;TC与24h尿蛋白定量(r=0.273,P=0.007)相关;HDL与γ谷氨酸转肽酶(r=0.233,P=0.022),碱性磷酸酶(r=0.265,P=0.009)相关;3-SLE活动组出现高脂血症的比例高于非活动组(χ2=6.986,P=0.008)。结论:长期的高脂血症可导致或加重SLE患者肝功能损害,高脂血症是狼疮性肝损害的危险因素之一。

Continuous Veno-venous Hemofiltration for Patients with Hyperlipidemic Pancreatitis: A Systematic Review

ObjectiveTo systematically review the effect and safety of continuous veno-venous hemofiltration (CVVH) on patients with hyperlipidemic pancreatitis. MethodsDatabases including the Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI and WanFang Data were electronically searched for randomized controlled trials (RCTs) about CVVH on patients with hyperlipidemic pancreatitis till Feb. 12, 2014. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 7 trials met eligibility criteria, involving 360 cases, including 183 cases of CVVH group and 177 cases of control group. The results of meta-analysis showed that compared with only routine medical treatment, CVVH significantly reduced the levels of lipid (WMD=-4.63, 95%CI-5.98 to-3.27, P < 0.000 01), levels of IL-6 (WMD=-29.59, 95%CI-34.30 to-24.89, P < 0.000 01), overall mortality (RR=0.39, 95%CI 0.18 to 0.84, P=0.02), and APACHE II score (WMD=-3.34, 95%CI-5.12 to-1.56, P=0.000 2) after treatment. ConclusionCVVH is more effective for hyperlipidemic pancreatitis than only routine medical treatment. Due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are required to verify the above conclusion.

Lennox-Gastaut综合征患者的非药物治疗——生酮饮食和迷走神经刺激

Lennox-Gastaut综合征（Lennox-Gastaut syndrome，LGS）的患者常常对于药物治疗无效或耐药。对于这些药物难治性患者，生酮饮食（Ketogenic diets，KD）和迷走神经刺激（Vagus nerve stimulation，VNS）可作为非药物治疗的选择。传统的KD用于癫痫治疗已经有90余年的历史了，它是一种高脂、低碳水化合物饮食，其中90%的热量来自于脂肪。KD治疗对于约半数的LGS患者有效，癫痫发作可减少50%以上，有些患者癫痫发作甚至可减少90%以上。VNS疗法，需要手术植入一个刺激发生器，它可以通过缠绕在左侧迷走神经上的电极对大脑进行间断性电刺激。VNS作为辅助疗法可用于不宜手术治疗的药物难治性癫痫患者（包括LGS）。与KD相似，VNS对约半数的LGS患者有效，癫痫发作将减少50%以上，而且随时间的推移，疗效会逐渐增强。KD和VNS均可作为LGS患者的治疗选择。