Therapeutic effect of double filtration plasmapheresis in hyperlipidemic acute pancreatitis
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摘要: 目的 探究双重血浆置换(double filtration plasmapheresis，DFPP)在高脂血症性急性胰腺炎(hypertriglyceridemia acute pancreatitis，HTG-AP)的治疗中的临床效果。方法 纳入2016年1月-2022年11月入住安徽医科大学第二附属医院重症医学科的HTG-AP患者共33例。其中常规治疗23例为对照组，DFPP治疗10例作为试验组。记录和比较治疗前后两组中甘油三酯(triglyceride，TG)、总胆固醇(cholesterol，CHO)、高敏C反应蛋白(hypersensitive C-reactive protein，hsCRP)及白细胞(white blood cell，WBC)计数、白蛋白及纤维蛋白原以及预后指标(SOFA评分及APACHEⅡ评分)的变化，以此来分析及比较HTG-AP患者中使用DFPP的治疗效果。结果 试验组及对照组在性别、生活习惯、胰腺炎分级、Rason评分等方面进行比较，差异无统计学意义(P>0.05)。DFPP可降低血脂(TG和CHO)、炎症相关因子及细胞(WBC及hsCRP)以及改善预后(SOFA评分及APACHEⅡ评分)，TG、hsCRP，SOFA及APACHEⅡ评分降低幅度均高于对照组，两组差异有统计学意义(P < 0.05)。结论 DFPP能更加快速并有效地清除过高的血脂和降低炎症相关因子，有利于改善患者的预后，值得临床推广。Abstract: Objective To investigate the clinical therapeutic effect of double filtration plasmapheresis(DFPP) in the treatment of acute hyperlipidemic pancreatitis(HTG-AP).Methods We included 33 cases of HTG-AP who were admitted to the Second Hospital of Anhui Medical University from January 2016 to November 2022. Among them, 23 patients were treated with routine therapy as the control group, and 10 patients were treated with DFPP as the experimental group. The changes of the triglyceride(TG), total cholesterol(CHO), hypersensitive C-reactive protein(hsCRP), white blood cell(WBC), albumin, fibrinogen and prognostic index(SOFA score and APACHEⅡ score) before and after treatment were recorded and compared to explore the clinical efficacy of DFPP.Results There were no significant differences in gender, lifestyle habits, pancreatitis grade, and Ranson score between the two groups(P>0.05). DFPP can reduce blood lipid(TG and CHO), inflammatory factors(WBC and hsCRP) and improve the prognosis of patients(SOFA score and APACHEⅡ score), and there was no statistical difference in the changes of fibrinogen and albumin before and after treatment. The decreases of TG, hsCRP, SOFA score and APACHEⅡ score were higher than those of the control group, and the differences were statistically significant(P < 0.05).Conclusion DFPP can more quickly and effectively eliminate excessive blood lipids and reduce inflammation-related factors and improve prognosis which is worthy to promote in clinical.
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表 1 患者一般情况
例(%) 指标 试验组
(10例)对照组
(23例)t P 年龄/岁 32±6 40±9 -2.489 0.018 性别/例 0.448 男 4 14 女 6 9 ICU入住天数/d 9±7 10±8 -0.589 0.560 胰腺炎严重程度分级 / 0.961 轻度 1(10) 3(13) 中度 2(20) 4(17) 重度 7(70) 16(70) 饮酒史 3(30) 9(39) / 0.71 吸烟史 2(20) 7(30) / 0.686 腹腔积液 5(50) 9(39) / 0.707 胸腔积液 5(50) 9(39) / 0.707 急性呼吸窘迫综合征 3(30) 5(22) / 0.673 急性肾衰竭 6(60) 8(34) / 0.257 糖尿病 5(50) 9(39) / 0.707 死亡 0(0) 1(4) / 1.000 Ranson评分 4±1 4±1 0.737 0.467 
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表 2 治疗组DFPP治疗前后各项指标变化
指标 治疗前 治疗后 t P TG/(mmol/L) 40.87±2.26 13.27±1.86 10.758 < 0.001 CHO/(mmol/L) 13.60±1.85 6.47±1.60 5.608 < 0.001 WBC/(×109/L) 14.51±1.44 10.76±1.70 3.576 0.006 hsCRP/(mg/L) 333.84±179.52 199.58±74.19 3.005 0.017 APACHEⅡ评分 12±1 7±2 3.991 0.003 SOFA评分 4±2 3±1 3.284 0.009 纤维蛋白原/(g/L) 6.38±2.09 6.00±2.11 0.755 0.470 白蛋白/(g/L) 33.40±9.66 30.15±5.67 1.597 0.145
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表 3 治疗前后各项指标组间比较
X±S 治疗指标 治疗前 治疗后 试验组 对照组 t P 试验组 对照组 t P TG/(mmol/L) 40.87±2.26 20.18±1.41 2.641 0.024 13.27±1.86 9.55±1.90 1.369 0.181 CHO/(mmol/L) 13.60±1.85 9.75±1.76 1.516 0.140 6.47±1.60 5.94±2.03 -0.452 0.674 WBC/(×109/L) 14.51±1.44 10.76±1.70 1.624 0.114 10.28±1.68 7.93±1.68 1.315 0.198 hsCRP/(mg/L) 333.84±179.52 171.08±139.09 2.743 0.010 199.58±74.19 211.64±93.18 -0.347 0.731 APACHEⅡ评分 12±1 14±2 -0.985 0.345 7±2 11±2 -2.134 0.041 SOFA评分 4±2 5±4 -0.314 0.756 3±1 5±3 -2.204 0.035
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