双重滤过血浆置换在严重高三酰甘油血症性急性胰腺炎患者中的疗效观察  

The efficacy of double filtration plasmapheresis in patients with severe hypertriglyceridemic acute pancreatitis

作　　者：张辉[1,2] 葛赟[2] 吴云龙 黄曼[2] ZHANG Hui;GE Yun;WU Yun-long;HUANG Man(Department of Critical Care Medicine,Linping Campus of the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 311100,China;Department of General Intensive Care Unit,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属第二医院临平院区重症医学科,杭州311100 [2]浙江大学医学院附属第二医院综合重症医学科,杭州310052

出　　处：《中国血液净化》2023年第10期749-753,共5页Chinese Journal of Blood Purification

摘　　要：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.

关 键 词：高三酰甘油血症性急性胰腺炎 三酰甘油 双重滤过血浆置换 胰岛素 

分 类 号：R459.5[医药卫生—治疗学]