新型肥胖相关指标预测高脂血症性胰腺炎严重程度

New Obesity Related Indicators Predict the Severity of Hyperlipidemic Pancreatitis

摘要: 背景：肥胖在急性胰腺炎(AP)的发病机制中起着重要作用，并显著影响其严重程度。尽管体重指数(BMI)是一个广泛使用的肥胖相关测量指标，但它更倾向于描述全身脂肪分布情况，而非内脏脂肪的分布模式。为了克服这一缺点，研究人员开发了新的肥胖相关测量指标，如腰围指数(WTI)、内脏肥胖指数(VAI)、脂质积累产物(LAP)和心脏代谢指数(CMI)，以更准确地评估急性胰腺炎(AP)的严重程度。方法：回顾性分析78例高脂血症性胰腺炎(HLAP)患者的身体参数和实验室指标，计算4项新型内脏肥胖人体测量指标。HLAP的严重程度分级采用修订后的亚特兰大分级标准。通过受试者工作特征(ROC)曲线评估腰围指数(WTI)、内脏肥胖指数(VAI)、脂质积累产物(LAP)和心脏代谢指数(CMI)与高脂血症性胰腺炎(HLAP)严重程度的相关性，并采用曲线下面积(AUC)评价各指标的预测效能。脂肪改良的BISAP评分(FM-BISAP)通过将脂肪评分与BISAP评分相加来计算。通过比较FM-BISAP评分与BISAP评分的受试者工作特征曲线下面积(AUC)来预测HLAP严重程度。结果：高脂血症性胰腺炎患者中，重症胰腺炎(SAP)患者胸膜渗出、腰围、甘油三酯、血糖水平高于非重度急性胰腺炎(N-SAP)，P < 0.05。肥胖相关测量指标中，SAP患者WTI、LAP、CMI、VAI水平高于N-SAP，P < 0.05，BMI无统计学意义。通过受试者工作特征(ROC)曲线比较WTI、LAP、CMI、VAI和BISAP评分对高脂血症性胰腺炎(HLAP)严重程度的预测性能，VAI的预测效果最好，AUC为0.780 (95%可信区间(CI)：0.680~0.881)，其次是CMI，AUC为0.767 (95% CI: 0.664~0.869)，LAP为0.721 (95% CI: 0.610~0.832)，均优于BISAP评分(AUC = 0.683)，证明了新的内脏肥胖测量指标在预测HLAP严重程度方面的潜力。而在脂肪改良的BISAP评分系统中CMI-BISAP的预测效果最好，AUC为0.804 (95% CI: 0.709~0.900)，其次是VAI~BISAP，AUC为0.798 (95% CI: 0.702~0.895)，LAP-BISAP为0.767 (95% CI: 0.665~0.870)，均优于BISAP (AUC = 0.683)。结论：本研究表明HLAP严重程度与WTI、VAI、CMI和LAP等指标之间存在显著相关性。在这些人体测量指标中，VAI对HLAP严重程度的预测效果最高，其次是CMI和LAP。在经内脏脂肪测量指标修饰的BISAP评分中，CMI-BISAP的预测效果最优，其次是VAI-BISAP和LAP-BISAP。这些改良评分系统为预测和评估高脂血症性胰腺炎(HLAP)的严重程度提供了重要参考。

Abstract: Background: Obesity plays an important role in the pathogenesis of acute pancreatitis (AP) and significantly affects its severity. Although body mass index (BMI) is a widely used obesity related measurement indicator, it tends to describe the distribution of whole-body fat rather than the distribution pattern of visceral fat. To overcome this drawback, researchers have developed new obesity related measurement indicators such as waist circumference index (WTI), visceral obesity index (VAI), lipid accumulation products (LAP), and cardiac metabolic index (CMI) to more accurately assess the severity of acute pancreatitis (AP). Method: A retrospective analysis was conducted on the physical parameters and laboratory indicators of 78 patients with hyperlipidemic pancreatitis (HLAP), and four novel visceral obesity anthropometric measurement indicators were calculated. The severity grading of HLAP adopts the revised Atlanta grading standards. The correlation between waist circumference index (WTI), visceral obesity index (VAI), lipid accumulation products (LAP), and cardiac metabolic index (CMI) and the severity of hyperlipidemic pancreatitis (HLAP) was evaluated using receiver operating characteristic (ROC) curves, and the predictive power of each index was evaluated using area under the curve (AUC). The Fat Modified BISAP Score (FM-BISAP) is calculated by adding the fat score to the BISAP score. Predicting the severity of HLAP by comparing the area under the working characteristic curve (AUC) of subjects with FM-BISAP score and BISAP score. Result: Among patients with hyperlipidemic pancreatitis, those with severe pancreatitis (SAP) had higher levels of pleural effusion, waist circumference, triglycerides, and blood glucose than those with non severe acute pancreatitis (N-SAP), with P < 0.05. Among the obesity related measurement indicators, the levels of WTI, LAP, CMI, and VAI in SAP patients were higher than those in N-SAP, with P < 0.05, and BMI was not statistically significant. Comparing the predictive performance of WTI, LAP, CMI, VAI, and BISAP scores for the severity of hyperlipidemic pancreatitis (HLAP) through receiver operating characteristic (ROC) curves, VAI showed the best predictive performance with an AUC of 0.780 (95% confidence interval (CI): 0.680~0.881), followed by CMI. The AUC was 0.767 (95% CI: 0.664~0.869) and LAP was 0.721 (95% CI: 0.610~0.832), both better than the BISAP score (AUC = 0.683), demonstrating the potential of the new visceral obesity measurement index in predicting the severity of HLAP. In the fat modified BISAP scoring system, CMI-BISAP showed the best predictive performance with an AUC of 0.804 (95% CI: 0.709~0.900), followed by VAI-BISAP, AUC is 0.798 (95% CI: 0.702~0.895), LAP-BISAP is 0.767 (95% CI: 0.665~0.870), both of which are better than BISAP (AUC = 0.683). Conclusion: This study indicates a significant correlation between the severity of HLAP and indicators such as WTI, VAI, CMI, and LAP. Among these anthropometric indicators, VAI has the highest predictive effect on the severity of HLAP, followed by CMI and LAP. In the BISAP score modified by visceral fat measurement indicators, CMI-BISAP showed the best predictive performance, followed by VAI-BISAP and LAP-BISAP. These improved scoring systems provide important references for predicting and evaluating the severity of hyperlipidemic pancreatitis (HLAP).