【摘要】目的使用Logistic 回归分析影响血浆置换(plasma exchange,PEX)在高脂血症胰腺炎(hyperlipidemic pancreatitis,HLP)患者疗效的相关危险因素。方法回顾性分析2015 年1 月～2020 年12 月汕头市中心医院血液净化中心行PEX 治疗的58 例HLP 患者的临床资料。比较患者治疗前后的腹部CT 结果，根据复查CT 结果分为改善及进展2 组，比较2 组的临床资料差异。应用Logistic 回归分析评估HLP 影像学进展的危险因素。结果共纳入患者58 例，男性47 例(81.0%)，平均年龄为(39.0±8.8)岁，治疗前三酰甘油(TG) (16.7± 4.3)mmol/L，经PEX 治疗后TG(6.6±2.8)mmol/L，差异有统计学意义(t=19.524，P＜0.001)。复查腹部CT 结果显示影像学有改善者28 例(48.3%)，进展者30 例(51.7%)。与影像学改善组的患者比较，影像学进展组的患者血清葡萄糖更高(t=2.406，P =0.019)、血淀粉酶＞300u/L者占比更高(χ2=4.459，P=0.035)、Balthazar CT 为D/E 级者占比更高(χ2=4.351，P =0.037)、治疗后TG 更高(t= 2.441，P=0.018)，差异均有统计学意义。多因素Logistic 回归分析结果显示影响HLP 影像学进展的独立危险因素包括：血淀粉酶＞300u/L(OR=3.781，95% CI：1.124～12.723，P=0.032)，治疗后TG(OR=1.309，95% CI：1.040～1.646，P =0.022)。结论PEX 可降低HLP 患者的血脂水平，影响HLP 影像学进展的独立危险因素包括血淀粉酶及治疗后TG。
【Abstract】Objective To identify the risk factors on the efficacy of plasma exchange in hyperlipidemic pancreatitis patients by Logistic regression. Methods We retrospectively analyzed the clinical data of 58 hyperlipidemic pancreatitis patients who underwent plasma exchange treatment in the Blood Purification Center of Shantou Central Hospital from January 2015 to December 2020. According to the comparison of the abdominal CT results both before and after the plasma exchange, enrolled patients were divided into improved group and progressed group. Compare the clinical data between the two groups. Logistic regression analysis
was performed to analyze the risk factors which affected the imaging progression of hyperlipidemic pancreatitis patients. Results 58 patients recruited in this study, including 47 males and 11 females, mean age was 39.0 ± 8.8 years. There was a significant difference in the TG level of patients before and after plasma exchange treatment (16.7±4.3 mmol/L vs. 6.6±2.8 mmol/L, t= 19.524, P＜0.001). The post-treatment abdominal CT results showed 28 cases (48.3%) in the improved group and 30 cases (51.7%) in the progressed group. Compared with patients in the imaging improvement group, patients in the imaging progressed group had higher serum glucose (t=2.406, P=0.019), a higher proportion of serum amylase＞300 U/L (χ2=4.459, P=0.035), a higher proportion of Balthazar CT grade D/E (χ2=4.351, P=0.037), and higher TG after treatment (t=2.441, P=0.018). Multivariate Logistic regression analysis showed that the independent risk factors affecting the imaging progression of hyperlipidemic pancreatitis included serum amylase＞300u/L (OR=3.781, 95% CI：1.124～12.723, P=0.032), and post- treatment TG (OR= 1.309, 95% CI：1.040-1.646，P=0.022). Conclusion Plasma exchange can significantly reduce the level of blood lipid, and the independent risk factors affecting the imaging progression of hyperlipidemic pancreatitis include serum amylase and post-treatment TG.
[1]Tsuang W, Navaneethan U, Ruiz L, et al. Hypertriglyceridemic pancreatitis: presentation and management[J]. Am J Gsatroenterol,2009,104(4):984–991.
[2]Valdivielso P, Ramirez-Bueno A, Ewald N, et, al. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med,2014,25(8):689–694.
[3]Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definition by international consensus[J]. Gut,2013,62(1):102-111.
[4]Tenner S, Baillie J, Dewitt J, et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis[J]. Am J Gsatroenterol,2013,108(9):1400-1415.
[5]Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis[J]. Radiology,1990,174(2):331-336.
[6]何文华,祝荫,朱勇,等.高甘油三酯血症与其他病因所致急性胰腺炎的病情严重程度及预后比较[J].中华医学杂志,2016,96(32):2569-2572.
[7]Nawaz H, Koutroumpakis E, Easler J, et al. Elevated serum triglycerides are independently associated with persistent organ failure in acute pancreatitis[J].Am J Gsatroenterol,2015,110(10):1497-1503.
[8]Pascual I, Sanahuja A, García N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: Cohort analysis of 1457 patients[J]. Pancreatology,2019,19(5):623-629.
[19]Guo YY, Li HX, Zhang Y, et al. Hypertriglyceridemia-induced acute pancreatitis: progress on disease mechanisms and treatment modalities[J]. Discov Med,2019, 27(147):101-109.
[10]Thuzar M, Shenoy VV, Malabu UH, et al. Extreme hypertriglyceridemia managed with insulin[J].J Clin Lipidol,2014,8(6): 630-634.
[11]Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study[J].Transfus Apher Sci,2006,34(3):253-257.
[12]Ewald N, Kloer HU. Treatment options for severe hypertriglyceridemia (SHTG): the role of apheresis[J]. Clin Res Cardiol,2012,7(Suppl 1):31-35.
[13]Zawitkowska J, Lejman M, Zaucha-Prazmo A, et al. Severe drug-induced hypertriglyceridemia treated with plasmapheresis in children with acute lymphoblastic leukemia[J]. Transfus Apher Sci,2019,58(5):634-637.
[14]Szczepiorkowski ZM, Winters JL, Bandarenko N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis[J].J Clin Apher,2010,25(3):83-177.
[15]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.
[16]Gubensek J, Buturovic-Ponikvar J, Marn-Pernat A, et al. Treatment of hyperlipidemic acute pancreatitis with plasma exchange: a single-center experience[J].Ther Apher Dial,2009,13(4): 314-317.
[17]Lu Z, Li M, Guo F, et al. Timely Reduction of Triglyceride Levels Is Associated With Decreased Persistent Organ Failure in Hypertriglyceridemic Pancreatitis[J]. Pancreas,2020,49(1):105-110.
[18]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.
[19]Stegmayr B, Ptak J, Wikstrom B. World apheresis registry report[J]. Transfus Apher Sci,2007,36(1):13-16.
[20]Gubensek J, Buturovic PJ, Romozi K, et al. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: An observational cohort study[J].PLoS ONE, 2014,9(7):e102748.
[21]Di BD, Cefalù AB, Scirè E, et al. Albumin versus solvent/detergent-treated pooled plasma as replacement fluid for long-term plasma exchange therapy in a patient with primary hypertriglyceridemia and recurrent hyperlipidemic pancreatitis[J]. Transfusion,2016,56(3):755-760.
[22]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.
[23]Simsir IY, Soyaltin UE, Yürekli BS, et al. Therapeutic plasma exchange in hypertriglyceridemic patients[J].Turk J Med Sci, 2019,18;49(3):872-878.
[24]Kandemir A, Co?kun A, Yava?o?lu í, et al. therapeutic plasma exchange for hypertriglyceri-demia induced acutpancreatitis: the 33 cases experience from a tertiary reference center in Turkey [J]. Yurk J Gastroenterol,2018,29(6):676-683.
