早期降脂达标对极重度高三酰甘油血症急性胰腺炎患者临床预后的影响  

Impact of early triglyceride reduction on clinical outcomes in patients with extremely severe hypertriglyceridemia-induced acute pancreatitis

作　　者：刘子瑞 皋林 柯路 李维勤 Liu Zirui;Gao Lin;Ke Lu;Li Weiqin(Department of Critical Care Medicine,Eastern Theater General Hospital of the Chinese People's Liberation Army(Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University),Nanjing 210002,China)

机构地区：[1]中国人民解放军东部战区总医院(南京大学医学院附属金陵医院重症医学科),南京210002

出　　处：《中华胰腺病杂志》2025年第1期6-13,共8页Chinese Journal of Pancreatology

基　　金：国家自然科学基金(82200722)。

摘　　要：目的探讨早期(入院3 d内)降低血清三酰甘油(TG)水平至5.65 mmol/L以下对极重度高三酰甘油血症性急性胰腺炎(HTG-AP)患者临床预后的影响。方法前瞻性收集2020年11月至2023年6月PERFORM数据库中来自国内38家医学中心、总计613例入院时血清TG水平≥11.3 mmol/L的HTG-AP患者的临床资料,进一步筛选入院时TG≥22.6 mmol/L的极重度HTG患者,根据入院3 d时血清TG水平是否降至5.65 mmol/L以下,分为达标组(TG≤5.65 mmol/L)和未达标组(TG>5.65 mmol/L),观察早期降脂达标对HTG-AP患者器官功能衰竭的影响。主要观察指标为入院14 d内无器官功能衰竭天数(OFFD)。次要观察指标包括入院7、14 d是否存在器官功能衰竭,入院14 d内是否存在持续器官功能衰竭(POF)、新发器官功能衰竭、最大SOFA评分,入院60 d内胰腺坏死组织感染(IPN)发生率,ICU时长,住院时长,入院60 d内死亡率。采用线性回归模型进行多因素分析,绘制亚组森林图评估降脂达标在不同亚组人群中对OFFD的影响。采用Kaplan-Meier法绘制累积器官功能衰竭消退发生率曲线,Log-Rank检验分析两组患者差异。结果共纳入212例患者,其中达标组118例,未达标组94例。达标组与未达标组基线TG水平差异无统计学意义,但未达标组总胆固醇、低密度脂蛋白胆固醇、CRP较达标组更高,差异有统计学意义。达标组与未达标组患者入院14 d内OFFD分别为14(11,14)d和14(13,14)d,两组间差异无统计学意义(P=0.279)。达标组和未达标组患者入院7、14 d是否存在器官功能衰竭,入院14 d内发生POF、新发器官功能衰竭、最高SOFA评分,入院60 d内IPN发生率,ICU时长,住院时长,入院60 d内死亡率差异均无统计学意义。多因素分析结果显示,早期降脂达标与OFFD增加无显著相关性。亚组分析结果显示,年龄、体重指数、基线APACHEⅡ评分、基线是否存在器官功能衰竭亚组中,早期降脂达标与入院14 d内OFFD增加ObjectiveTo investigate the association between early reduction(within 3 days of admission)of serum triglyceride(TG)to 5.65 mmol/L and clinical outcomes in patients with acute pancreatitis extremely severe hypertriglyceridemia-induced(HTG-AP).MethodsThe clinical data were derived from the PERFORM database,which prospectively collected clinical information on 613 HTG-AP patients admitted to 38 medical centers across China between November 2020 and June 2023 with serum TG level≥11.3 mmol/L at admission.This study further screened extremely severe HTG patients with TG≥22.6 mmol/L.Patients were divided into the target-reaching group(TG≤5.65 mmol/L on day 3 after admission)and non-target-reaching group(TG>5.65 mmol/L on day3 after admission).The effect of early reduction of serum triglyceride to standard level on organ failure was observed.The primary outcome was organ failure-free days(OFFD)to 14 days of admission.Secondary outcomes included the presence of organ failure on day 7 and day 14,persistent organ failure(POF)to day 14,new-onset organ failure to day 14,maximum sequential organ failure assessment(SOFA)score to day 14,incidence of infected pancreatic necrosis(IPN)by day 60 of admission,length of ICU and hospital stay,mortality by day 60 of admission.The linear regression model was used for multivariate analysis.The subgroup forest plot was drawn to assess the effect of early reduction of TG on OFFD in different subgroups.The Kaplan-Meier method was used to plot the cumulative recurrence rate curve for the time to organ failure resolution and Log-Rank test was used for comparison between two groups.ResultsOverall,212 patients with HTG-AP were enrolled,with 118 in the target-reaching group and 94 in the non-target-reaching group.There was no significantly statistical difference on baseline TG level between two groups,but patients in non-target-reaching group had higher total cholesterol,LDL and CRP than those in target-reaching group.The median OFFD with 14 days of admission in target-reaching and non-tar

关 键 词：急性胰腺炎 高三酰甘油血症 多器官功能衰竭 血浆置换 预后 

分 类 号：R576[医药卫生—消化系统]