血浆置换在预测为重症高三酰甘油血症性急性胰腺炎患者中的疗效分析  

Clinical efficacy analysis of plasmapheresis for predicted severe hypertriglyceridemia-associated acute pancreatitis

作　　者：王兰庭 周晶 袁园 姚维杰 罗贵贤 徐怡禛 李伟健 曹龙祥 童智慧 刘玉秀 柯路 李维勤 Wang Lanting;Zhou Jing;Yuan Yuan;Yao Weijie;Luo Guixian;Xu Yizhen;Li Weijian;Cao Longxiang;Tong Zhihui;Liu Yuxiu;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;Department of Intensive Care Unit,Ningbo Medical Center Lihuili Hospital,Ningbo 315000,China;Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Critical Care Medicine,People′s Hospital of Qianxinan Prefecture,Xingyi 562400,China;Department of Emergency,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,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 [2]宁波市医疗中心李惠利医院重症医学科,宁波315000 [3]宁夏医科大学总医院肝胆外科,银川750004 [4]黔西南州人民医院重症医学科,兴义562400 [5]贵州医科大学附属医院,贵阳550004

出　　处：《中华胰腺病杂志》2025年第1期32-37,共6页Chinese Journal of Pancreatology

基　　金：江苏省自然科学基金(BK20211135)。

摘　　要：目的探讨血浆置换治疗预测为重症高三酰甘油血症性急性胰腺炎(HTG-AP)患者的临床疗效。方法回顾性分析2020年11月至2023年6月间中国急性胰腺炎临床研究小组-PERFORM数据库中全国36家医学中心收治的500例HTG-AP患者的临床资料,在PERFORM研究纳入与排除标准的基础上,进一步筛选APACHEⅡ评分≥8分或CRP>150 mg/L的预测为重症HTG-AP的患者,最终纳入189例。根据降脂治疗方式将患者分为血浆置换组(51例)和常规治疗组(138例)。记录患者一般资料、实验室检测指标、AP严重程度及临床预后指标。结果血浆置换组的基线三酰甘油水平、APACHEⅡ评分、SOFA评分及器官功能衰竭比例显著高于常规治疗组。多因素logistic回归模型结果显示,血浆置换组与常规治疗组14 d内发生持续性器官功能衰竭及第7天存在器官功能衰竭的风险差异无统计学意义[54.9%(28/51)比37.7%(52/138),OR=0.89,95%CI 0.36~2.21,P=0.810;17.7%(9/51)比15.9%(22/138),OR=0.60,95%CI 0.19~1.88,P=0.378]。血浆置换组与常规治疗组在入院后3 d内血清三酰甘油水平的动态变化趋势上的差异也无统计学意义(P=0.108)。结论早期血浆置换未能显著改善预测为重症HTG-AP患者持续性器官功能衰竭的发生率。ObjectiveTo investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis(HTG-AP)patients.MethodsThe clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed.Besides the inclusion and exclusion criteria from PERFORM study,patients who had acute physiology and chronic health evaluationⅡ(APACHEⅡ)score≥8 or CRP>150 mg/L on admission were included in the final analyses(n=189).Patients were categorized into the plasmapheresis group(n=51)and the routine treatment group(n=138)according to the triglyceride-lowering therapies they received.General data,laboratory findings,AP severity,and clinical outcomes were recorded.ResultsPatients undergoing plasmapheresis had higher initial triglyceride levels,APACHEⅡscore,SOFA score,and more organ failure than those receiving routine medical treatment.Results of multivariable logistic regression models showed that the plasmapheresis group,as compared to the routine treatment group,was neither associated with decreased risk of persistent organ failure within 14 days[54.9%(28/51)vs 37.7%(52/138),OR=0.89,95%CI 0.36-2.21,P=0.810],nor with reduced incidence of organ failure on day 7[17.7%(9/51)vs 15.9%(22/138),OR=0.60,95%CI 0.19-1.88,P=0.378].There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission(P=0.108).ConclusionsEarly plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

关 键 词：高三酰甘油血症 胰腺炎 血浆置换 多器官功能衰竭 

分 类 号：R576[医药卫生—消化系统]