胆囊结石患者结石形态学特征及血浆脂多糖水平与急性胆源性胰腺炎的关系研究

摘要 目的：探讨胆囊结石患者结石形态学特征及血浆脂多糖（LPS）水平与急性胆源性胰腺炎（ABP）的关系。方法：选取2015年10月~2018年9月期间武汉大学人民医院收治的胆囊结石患者164例为研究对象，分析结石形态学特征与并发ABP的关系，同时采用Logistic回归分析ABP发生的危险因素。将所有患者根据LPS水平分为低LPS组（n=65，<10 pg/mL）以及高LPS组（n=99，≥10 pg/mL），分析血浆LPS水平对不同结石大小、不同总胆固醇（TG）水平患者并发ABP的影响。结果：多发胆囊结石、球状结石、<3 mm结石、软碎型结石患者并发ABP的概率明显高于单发胆囊结石、不规则状结石或泥沙状结石、3~10 mm结石或>10 mm结石、硬型结石或胶冻型结石（P<0.05）。Logistic回归分析结果显示，多发胆囊结石、球状结石、<3 mm结石以及软碎型结石均是ABP发生的高危因素（P<0.05）。当患者处于高TG水平时，高LPS组并发ABP的概率高于低LPS组（P<0.05），在细小结石患者中，高LPS组并发ABP的概率高于低LPS组（P<0.05）。结论：依据结石形态学特征可对胆囊结石患者并发ABP的可能性作出早期的判断，同时血浆LPS水平升高是高TG以及细小胆囊结石患者易并发ABP的重要因素之一。

Morphological Characteristics of Gallstones and the Relationship between Plasma Lipopolysaccharide Level and Acute Biliary Pancreatitis in Patients with Gallstones

ABSTRACT Objective: To investigate the morphological characteristics of gallstones and the relationship between plasma lipopolysaccharide (LPS) level and acute biliary pancreatitis (ABP) in patients with gallstones. Methods: 164 patients with cholecystolithiasis who were admitted to Renmin Hospital of Wuhan University from October 2015 to September 2018 were selected as the study subjects. The morphological characteristics of gallstones and whether ABP was concurrent in all subjects were recorded. The relationship between the morphological characteristics of gallstones and the concurrent ABP was analyzed. Logistic regression analysis was used to analyze the high risk factors of incidence of ABP. All patients were divided into low LPS group (n=65, <10 pg/mL) and high LPS group (n=99, >10 pg/mL) according to the level of LPS. The effect of plasma LPS level on concurrent ABP in patients with different stone sizes and different levels of total cholesterol (TG) were analyzed. Results: The incidence of concurrent ABP in patients with multiple gallstones, spherical gallstones, <3 mm gallstones and soft-crushed gallstones was significantly higher than that in patients with single gallstone, irregular gallstones or sandy gallstones, 3-10 mm gallstones or >10 mm gallstones, hard gallstones or gelatinous gallstones (P<0.05). Logistic regression analysis showed that multiple cholecystolithiasis, spherical gallstones, <3 mm gallstones and soft crushed gallstones were all high risk factors for ABP (P<0.05). When patients were in high TG, the incidence of concurrent ABP in high LPS group was higher than that in low LPS group (P<0.05). When patients in small gallstones, the incidence of concurrent ABP in high LPS group was higher than that in low LPS group (P<0.05). Conclusion: According to the morphological characteristics of gallstones, the possibility of concurrent ABP complication in patients with gallstones can be early judged. At the same time, the elevated plasma LPS level is one of the important factors for concurrent ABP in patients with high TG and small gallstones.