目的 比较双重滤过血浆置换(double-filtration plasmapheresis，DFPP)、DFPP+胰岛素、胰岛素3种不同治疗方案对高三酰甘油血症性急性胰腺炎(hypertriglyceridemic acute pancreatitis，HTG-AP)患者降低三酰甘油效果及其预后的影响。 方法 共纳入确诊为HTG-AP患者62例，将其分为 DFPP组、DFPP+胰岛素组和胰岛素组，分析3组患者基本情况及检验结果。计量资料采用单因素方差分析(One-way ANOVA)或者Kruskal-Wallis 检验，计数资料采用卡方检验或 Fisher检验，采用多元线性回归分析影响患者疾病严重程度的因素。 结果 DFPP+胰岛素组较另外2组患者在体质量指数(body mass index，BMI)(F =4.414，P=0.016)，医疗费用(K =35.923，P＜0.001)，入住ICU时间(K =46.105，P＜0.001)，序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分(K =9.089，P=0.011)与急性生理与慢性健康(acute physiology and chronic health evaluation II，APACHE II)评分(K =12.059，P =0.002)差异存在统计学意义。DFPP组与胰岛素组在治疗前血脂比较无统计学差异(K = -2.136，P=0.098)，在三酰甘油降至5.65 mmol/L上存在显著性差异(K =25.508，P＜0.001)。多元线性回归分析结果显示：患者疾病严重程度与入院时胆固醇(β=0.320，P=0.005)、降钙素原(β=0.243，P =0.042)、D二聚体(β=0.385，P=0.001)、血糖指标(β=0.251，P=0.050)、是否有糖尿病(β=﹣0.284，P =0.008)及患者年龄(β=0.302，P=0.007)独立相关。 结论 对于严重高三酰甘油血症性急性胰腺炎的患者，行DFPP治疗能够快速降低患者三酰甘油水平。
Objective To compare the effects of double filtration plasmapheresis (DFPP), DFPP + insulin and insulin in the treatment of patients with severe hypertriglyceridemic acute pancreatitis (HTG-AP). Methods A total of 62 patients with HTG-AP were divided into three groups: DFPP group, DFPP + insulin group and insulin group. Their basic clinical information and laboratory test results were analyzed. One-way ANOVA or Kruskal-Wallis test was used for analyses of quantitative data, and Chi-square test or Fisher test was used for analyses of numerical data. Multivariate linear regression was used to identify the factors affecting disease severity of the patients. Results BMI (F=4.414, P=0.016), medical expenses (K=35.923, P<0.001), days in ICU (K=46.105, P＜0.001), and the sequential organ failure assessment (SOFA) score (K=9.089, P=0.011) and APACHE II scores (K=12.059, P=0.002) were statistically different between DFPP + insulin group and the other two groups. Serum triglyceride level had no difference before treatment between DFPP group and insulin group (K=-2.136, P=0.098), but reduced to 5.65mmol/L after the treatment in DFPP group and became statistically different with the serum triglyceride level in insulin group (K=25.508, P<0.001). Multivariate linear regression showed that the disease severity was independently associated with serum cholesterol (β=0.320, P=0.005), procalcitonin (β=0.243, P=0.042), D dimer (β=0.385, P=0.001), blood glucose (β=0.251, P=0.050), diabetes mellitus (β=-0.284, P=0.008) and age (β=0.302, P=0.007) at admission. Conclusions DFPP treatment is effective to reduce triglyceride in patients with severe HTG-AP.
[1]Petrov M S, Yadav D.Global epidemiology and holistic prevention of pancreatitis[J].Nature reviews Gastroenterology & hepatology, 2019, 16(3):175-184
[2]Jin M, Bai X, Chen X, et al.A 16-year trend of etiology in acute pancreatitis: The increasing proportion of hypertriglyceridemia-associated acute pancreatitis and its adverse effect on prognosis[J].Journal of clinical lipidology, 2019, 13(6):947-953
[3]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
[4]Yang A L, McNabb-Baltar J.Hypertriglyceridemia and acute pancreatitis[J].Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al, 2020, 20(5):795-800
[5]Li X, Ke L, Dong J, et al.Significantly different clinical features between hypertriglyceridemia and biliary acute pancreatitis: a retrospective study of 730 patients from a tertiary center[J].BMC gastroenterology, 2018, 18(1):89-89
[6]Zhou B F.Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults[J].Biomedical and environmental sciences : BES, 2002, 15(1):83-96
[7]Ikeura T, Kato K, Takaoka M, et al.A body mass index ≥25 kgm(2) is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients[J].Hepatobiliary & pancreatic diseases international : HBPD INT, 2017, 16(6):645-651
[8]Ye X, Lu G, Huai J, et al.Impact of smoking on the risk of pancreatitis: a systematic review and meta-analysis[J].PloS one, 2015, 10(4):1-17
[9]Kabagambe E K, Ordovas J M, Tsai M Y, et al.Smoking,inflammatory patterns and postprandial hypertriglyceridemia[J].Atherosclerosis, 2009, 203(2):633-639
[10]Forsmark C E, Vege S S, Wilcox C M.Acute Pancreatitis[J].The New England journal of medicine, 2016, 375(20):1972-1981
[11]Juneja D, Gopal P B, Ravula M.Scoring systems in acute pancreatitis: which one to use in intensive care units?[J].Journal of critical care, 2010, 25(2):358-358
[12]Godinjak A, Iglica A, Rama A, et al.Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit[J].Acta medica academica, 2016, 45(2):97-103
[13]Mounzer R, Langmead C J, Wu B U, et al.Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis[J].Gastroenterology, 2012, 142(7):1476-1482
[14]Crockett S D, Wani S, Gardner T B, et al.American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis[J].Gastroenterology, 2018, 154(4):1096-1101
[15]Schulze R J, McNiven M A.Fasting Inhibits the Recruitment of Kinesin-1 to Lipid Droplets and Stalls Hepatic Triglyceride Secretion[J].Hepatology (Baltimore, Md), 2019, 69(1):444-446
[16]Coskun A, Erkan N, Yakan S, et al.Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin[J].Przeglad gastroenterologiczny, 2015, 10(1):18-22
[17]Ibarra F, Jr.Loi K,Vu A WSafety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia[J].The Annals of pharmacotherapy, 2022, 56(9):1016-1022
[18]Hirano R, Namazuda K, Hirata N.Double filtration plasmapheresis: Review of current clinical applications[J].Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 2021, 25(2):145-151
[19]Padmanabhan A, Connelly-Smith L, Aqui N, et al.Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue[J].Journal of clinical apheresis, 2019, 34(3):171-354
[20]Berberich A J, Ziada A, Zou G Y, et al.Conservative management in hypertriglyceridemia-associated pancreatitis[J].Journal of internal medicine, 2019, 286(6):644-650
[21]Dichtwald S, Meyer A, Zohar E, et al.Hypertriglyceridemia Induced Pancreatitis: plasmapheresis or conservative management?[J].Journal of intensive care medicine, 2022, 37(9):1174-1178
[22]Galán Carrillo I, Demelo-Rodriguez P, Rodríguez Ferrero M L, et al.Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia[J].Journal of clinical lipidology, 2015, 9(5):698-702
