双重滤过血浆置换治疗高脂血症胰腺炎的临床效果观察

doi:10.3969/j.issn.1006-7795.2021.06.007

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 943-949.doi: 10.3969/j.issn.1006-7795.2021.06.007

• 重症医学基础与临床研究 • 上一篇下一篇

双重滤过血浆置换治疗高脂血症胰腺炎的临床效果观察

刘立^1,2, 王冠², 赵鑫宇², 刘景院¹, 纪宇³, 刘勇³, 韩威³, 翁以炳², 李昂^1*

1.首都医科大学附属北京地坛医院重症医学科,北京 100015;
2.首都医科大学附属北京潞河医院重症医学科,北京 100149;
3.首都医科大学附属北京潞河医院普外科,北京 100149

收稿日期:2021-09-10 出版日期:2021-12-21 发布日期:2021-12-17
基金资助:
北京市通州区卫健委临床特色项目(TFZXZD-20180103)。

Clinical study of double filtration plasmapheresis in the treatment of hyperlipidemia pancreatitis

Liu Li^1,2, Wang Guan², Zhao Xinyu², Liu Jingyuan¹, Ji Yu³, Liu Yong³, Han Wei³, Weng Yibing², Li Ang^1*

1. Department of Critical Care, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
2. Department of Critical Care, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China;
3. Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China

Received:2021-09-10 Online:2021-12-21 Published:2021-12-17
Contact: * E-mail: liang@ccmu.edu.cn
Supported by:
Clinical Characteristic Project of Beijing Tongzhou District Health Commission (TFZXZD-20180103).

摘要/Abstract

摘要： 目的验证双重滤过血浆置换(double filtration plasmapheresis, DFPP)治疗高三酰甘油血症性急性胰腺炎(hypertriglyceridemia acute pancreatitis, HTG-AP)的临床效果。方法以首诊进入首都医科大学附属北京潞河医院重症医学科的HTG-AP患者为研究对象,采用类实验研究方法,将2017年9月至2021年3月收治的HTG-AP患者45例作为双重血浆分离置换组(DFPP组),采用DFPP治疗降低三酰甘油(triglyceride, TG);将2015年9月至2017年8月收治的HTG-AP患者24例作为强化胰岛素治疗组(胰岛素组),采用胰岛素和葡萄糖输注控制TG。两组患者均予禁食、抑酸、抑制胰酶分泌和营养支持等常规治疗。结果两组在性别、年龄、HTG-AP病情严重程度比较,差异无统计学意义(P>0.05)。DFPP组在降低TG所需时间、重症医学科(intensive care unit,ICU)停留时间、住院时间等3项指标,均明显优于胰岛素组(P<0.05);TG下降至3.71 mmol/L以下所需的时间,DFPP组明显少于胰岛素组,分别为(6.7±3.3) h和(44.1±11.6) h(P<0.05);在腹痛、腹胀等临床症状72 h缓解率速度方面,DFPP组明显快于胰岛素组(P<0.05);DFPP组外周血白细胞、C反应蛋白、白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α等炎性反应指标均较胰岛素组在下降速度和幅度上明显优于胰岛素组(P<0.01)。两组治疗在实施过程中,患者生命体征稳定,耐受良好,未见过敏反应、出血等不良事件,提示两组治疗安全性均良好。结论 DFPP是一种快捷、有效降低TG的治疗方法,它对严重HTG-AP的疗效取决于是否早期即实施。对于操作技术成熟的大型医疗机构,应尽早使用DFPP方法对重症HTG-AP进行治疗,以期尽早阻断HTG-AP可能的恶性进程应该是有益的。

关键词: 高三酰甘油血症性胰腺炎, 高三酰甘油血症, 双重滤过血浆置换

Abstract: Objective To verify the clinical significance of double filtration plasmapheresis (DFPP) in the treatment of hypertriglyceridemia acute pancreatitis (HTG-AP). Methods A retrospective case-control research methods was used to collect HTG-AP patients who were admitted to the Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University for the first time. The DFPP group included 45 HTG-AP patients admitted in from September 2017 to March 2021 and treated with DFPP to reduce triglyceride (TG). The insulin group collected 24 HTG-AP patients admitted in from September 2015 to August 2017, who were treated with insulin and glucose infusion to control TG. Both groups were given standard treatments such as fasting, gastric acid and pancreatic enzyme secretion suppression, and nutritional support. The demographic characteristics, biochemical blood indicators, inflammatory markers, incidence of adverse events, length of stay in intensive care unit (ICU) and hospital stay of the two groups of cases were collected. Results There was no significant difference between the two groups in terms of gender, age, and severity of HTG-AP (P>0.05). The DFPP group was significantly better than the insulin group in reducing the time required for TG, staying time in ICU, and length of hospital stay in the insulin group (P＜0.05). The time required for TG to drop below 3.71 mmol/L in the test group was significantly less than that in the insulin group (6.7±3.3) h and (44.1±11.6) h, respectively (P<0.01). The 72-hour relief rate of clinical symptoms such as abdominal pain and bloating in the test group was significantly higher than that in the insulin group (P<0.05). With regard to the speed and amplitude of decline, the peripheral blood leukocytes, C-reactive protein, interleukin 6, interleukin 8, tumor necrosis factor-alpha and other inflammatory indicators in the DFPP group are significantly better than that in the insulin group (P<0.01). During the treatment, the vital signs of the patients in both groups were stable and well-tolerated, and there were no adverse events such as allergic reactions and bleeding, suggesting the treatment safety was good. Conclusion The results showed that the DFPP is the fastest and most effective treatment for reducing TG, and its efficacy in severe HTG-AP depends on its early implementation. For large medical institutions with mature operating technology, we believe that it should be beneficial to use DFPP method to treat severe HPG-AP as early as possible with a view to blocking the possible malignant process of HPG-AP as soon as possible.

Key words: hypertriglyceridemia pancreatitis, hypertriglyceridemia, double filtration plasmapheresis

中图分类号:

R576

刘立, 王冠, 赵鑫宇, 刘景院, 纪宇, 刘勇, 韩威, 翁以炳, 李昂. 双重滤过血浆置换治疗高脂血症胰腺炎的临床效果观察[J]. 首都医科大学学报, 2021, 42(6): 943-949.

Liu Li, Wang Guan, Zhao Xinyu, Liu Jingyuan, Ji Yu, Liu Yong, Han Wei, Weng Yibing, Li Ang. Clinical study of double filtration plasmapheresis in the treatment of hyperlipidemia pancreatitis[J]. Journal of Capital Medical University, 2021, 42(6): 943-949.

参考文献

[1] Pan L, Yang Z, Wu Y, et al. China National Survey of Chronic Kidney Disease Working Group. The prevalence, awareness, treatment and control of dyslipidemia among adults in China[J].Atherosclerosis,2016,248:2-9.
[2] 伍彦辉,田玉芝.高脂血症性胰腺炎[J].中国中西医结合外科杂志,2018,24(3):366-370.
[3] Garg R, Rustagi T. Management of hypertriglyceridemia induced acute pancreatitis[J]. Biomed Res Int, 2018,2018:4721357.
[4] Joglekar K, Brannick B, Kadaria D, et al. Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis: case series and review of the literature[J]. Ther Adv Endocrinol Metab, 2017, 8(4):59-65.
[5] 中国医师协会急诊医师分会. 2013中国急诊急性胰腺炎临床实践指南[J].中国急救医学, 2013,33(12): 1057-1071.
[6] Tamez-Pérez H E, Sáenz-Gallegos R, Hernández-Rodríguez K, et al. Insulin therapy in patients with severe hypertriglyceridemia[J]. Rev Med Inst Mex Seguro Soc, 2006,44(3):235-237.
[7] Mikhail N, Trivedi K, Page C, et al. Treatment of severe hypertriglyceridemia in nondiabetic patients with insulin[J]. Am J Emerg Med, 2005, 23(3):415–417.
[8] Fortson M R, Freedman S N, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis[J]. Am J Gastroenterol,1995,90(12):2134-2139.
[9] Kilinc F, Senates E, Demircan F, et al. Are there differences in the management of acute pancreatitis cases due to severe hypertriglyceridemia in pregnant women?[J]. Med Sci Monit, 2018,24:5619-5623.
[10] Garg R, Rustagi T. Management of hypertriglyceridemia induced acute pancreatitis[J]. Biomed Res Int, 2018, 2018:4721357.
[11] Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis[J]. Ther Apher Dial, 2013,17(2):130-137.
[12] Banks P A, Bollen T L, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62(1):102-111.
[13] Diakoumakou O, Hatzigeorgiou G, Gontoras N, et al. Severe/extreme hypertriglyceridemia and LDL apheretic treatment: review of the literature, original findings[J]. Cholesterol, 2014, 2014:109263.
[14] Yuan G, Al-Shali K Z, et al. Hypertriglyceridemia: its etiology, effects and treatment[J]. CMAJ, 2007, 176(8):1113-1120.
[15] Wang S H, Chou Y C, Shangkuan W C, et al. Relationship between plasma triglyceride level and severity of hypertriglyceridemic pancreatitis[J]. PLoS One, 2016, 11(10):e0163984.
[16] Betteridge D J, Bakowski M, Taylor K G, et al. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange[J]. Lancet,1978, 1(8078):1368.
[17] Furuya T, Komatsu M, Takahashi K, et al. Plasma exchange for hypertriglyceridemic acute necrotizing pancreatitis: report of two cases[J]. Ther Apher, 2002, 6(6): 454-458.
[18] Yeh J H, Chen J H, Chiu H C. Plasmapheresis for hyperlipidemic pancreatitis[J]. J Clin Apher, 2003, 18(4):181-185.
[19] Iskandar S B, Olive K E. Plasmapheresis as an adjuvant therapy for hypertriglyceridemia-induced pancreatitis[J]. Am J Med Sci, 2004, 328(5):290-294.
[20] Kyriakidis A V, Raitsiou B, Sakagianni A,et al. Management of acute severe hyperlipidemic pancreatitis[J]. Digestion, 2006,73(4):259-264.
[21] Ewald N, Kloer H U. Severe hypertriglyceridemia: an indication for apheresis? [J] Atheroscler Suppl, 2009, 10(5):49-52.
[22] Stefanutti C, Di Giacomo S, Vivenzio A, et al. Therapeutic plasma exchange in patients with severe hypertriglyceridemia: a multicenter study[J]. Artif Organs, 2009, 33(12):1096-1102.
[23] Gubensek J, Buturovic-Ponikvar J. Treatment of hyperlipidemic acute pancreatitis with plasma exchange: a single-center experience[J]. Ther Apher Dial, 2009, 13(4):314-317.
[24] Syed H, Bilusic M, Rhondla C, et al. Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis: A community hospital's experience[J]. J Clin Apher, 2010, 25(4):229-234.
[25] Ramírez-Bueno A, Salazar-Ramírez C, Cota-Delgado F, et al. Plasmapheresis as treatment for hyperlipidemic pancreatitis[J]. Eur J Intern Med, 2014, 25(2):160-163.
[26] Gavva C, Sarode R, Agrawal D, et al. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: A rapid and practical approach[J]. Transfus Apher Sci, 2016, 54(1):99-102.
[27] Nakhoda S, Zimrin A B, Baer M R, et al. Use of the APACHE Ⅱ score to assess impact of therapeutic plasma exchange for critically ill patients with hypertriglyceride-induced pancreatitis[J]. Transfus Apher Sci, 2017,56(2):123-126.

双重滤过血浆置换治疗高脂血症胰腺炎的临床效果观察

Clinical study of double filtration plasmapheresis in the treatment of hyperlipidemia pancreatitis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 3

编辑推荐

Metrics

本文评价

[1]	柳鑫, 徐有青, 崔纯莹, 赵志刚. GPIHBP1基因敲除小鼠在严重高三酰甘油血症急性胰腺炎导致肺损伤研究中的应用[J]. 首都医科大学学报, 2020, 41(4): 564-569.
[2]	柳鑫, 徐有青, 崔纯莹, 赵志刚. 载脂蛋白C3转基因小鼠应用于严重高三酰甘油血症急性胰腺炎的探索[J]. 首都医科大学学报, 2020, 41(3): 421-427.
[3]	马亚红, 阿布杜拉·热西提, 谢北辰, 郭鑫, 杨金奎, 刘国庆. 严重高三酰甘油血症对小鼠生育及其后代糖脂代谢的影响[J]. 首都医科大学学报, 2014, 35(1): 51-55.