双重滤过血浆置换对高脂血症性急性胰腺炎的疗效分析

doi:10.16139/j.1007-9610.2023.05.10

摘要/Abstract

摘要：

目的：评估双重滤过血浆置换(double filtration plasmapheresis, DFPP)对高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis, HL-AP）的疗效。方法：收集2019年1月至2022年5月入院的高脂血症性重症和中度重症急性胰腺炎病人的临床数据，按照治疗方式分为接受常规治疗的对照组和DFPP组，分析治疗后7 d内的临床数据。结果：与对照组相比，DFPP组血清甘油三酯(triglyceride, TG)，丙氨酸转氨酶和天冬氨酸转氨酶在入组第1、2天显著降低，估计肾小球滤过率在第1、2、3、5天升高。白细胞和中性粒细胞数量在第1、2天降低，血红蛋白在第1、2、3天降低，C反应蛋白在第1、2、3、5、7天降低，DFPP组接受机械通气的病人减少。结论：与常规治疗方法相比，DFPP可更快降低TG，改善肺、肝、肾功能，降低炎症指标，并有利于早期液体复苏。

关键词: 高脂血症性急性胰腺炎, 双重滤过血浆置换, 多器官功能障碍综合征

Abstract:

Objective To evaluate the effect of double filtration plasmapheresis (DFPP) on patients with hyperlipidemic acute pancreatitis (HL-AP). Methods The clinical data of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP) or moderately severe acute pancreatitis (HL-MSAP) from January 2019 to May 2022 were collected. The patients were divided into two groups,the control group received conventional treatment, DFPP group received DFPP treatment on the basis of conventional treatment. Results Compared with the control group, the following parameters changed significantly in DFPP group, triglyceride (TG), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) decreased on day 1 and 2, estimated glomerular filtration rate (eGFR) increased on day 1, 2, 3 and 5, leukocyte and neutrophil counts decreased on day 1 and 2, hemoglobin (HGB) decreased on day 1, 2, and 3, C-reactive protein (CRP) decreased on day 1, 2, 3, 5, and 7. And the patients in DFPP group receiving mechanical ventilation decreased compared with that in control group. Conclusion Compared with conventional treatment, DFPP can reduce plasma TG faster, improve lung, liver and kidney function, reduce inflammatory markers, and facilitate early fluid recovery.

Key words: Hyperlipidemic acute pancreatitis, Double filtration plasmapheresis, Multiple organ dysfunction syndrome

中图分类号:

R457
R576

葛焱, 王国鑫, 王佳卉, 安源, 赵冰, 盛慧球, 马丽. 双重滤过血浆置换对高脂血症性急性胰腺炎的疗效分析[J]. 外科理论与实践, 2023, 28(05): 448-453.

GE Yan, WANG Guoxin, WANG Jiahui, AN Yuan, ZHAO Bing, SHENG Huiqiu, MA Li. Analysis of the effect of double filtration plasmapheresis on hyperlipidemic acute pancreatitis[J]. Journal of Surgery Concepts & Practice, 2023, 28(05): 448-453.

图/表 2

表1

表2

DFPP对多脏器功能的影响

Parameters	Point-in-time	Control group		DFPP group		F value	P value
Parameters	Point-in-time	n	Median (95%CI)	n	Median (95%CI)	F value	P value
TG (mmol/L)	Day0	12	58.38(41.59,75.16)	20	64.87(53.85,75.88)	0.521	0.476
	Day1	10	22.06(13.99,30.12)	14	11.75(8.82,14.68)	9.219	0.006^*
	Day2	11	10.69(7.16,14.24)	12	7.18(4.68,9.67)	4.706	0.042^*
	Day3	7	7.02(2.08,11.95)	13	5.28(3.72,6.85)	0.976	0.336
	Day5	9	5.32(2.92,7.73)	8	4.92(2.81,7.03)	0.086	0.773
	Day7	9	4.09(2.10,6.09)	11	3.71(2.80,4.62)	0.178	0.678
ALT (U/L)	Day0	12	25.75(13.28,38.22)	19	24.00(18.50,29.49)	0.099	0.755
	Day1	11	24.36(13.40,35.32)	14	14.28(11.00,17.57)	4.667	0.041^*
	Day2	10	19.90(13.73,26.07)	17	13.88(11.92,15.85)	6.315	0.019^*
	Day3	9	19.11(9.85,28.37)	16	12.56(10.34,14.78)	3.999	0.057
	Day5	9	16.78(10.60,22.96)	12	13.83(10.77,16.90)	1.096	0.308
	Day7	9	15.88(11.17,20.60)	10	12.60(9.79,15.41)	1.983	0.177
AST (U/L)	Day0	11	40.82(28.76,52.87)	19	43.32(31.80,54.83)	0.090	0.766
	Day1	10	37.80(22.70,52.89)	13	24.69(20.17,29.21)	4.361	0.049^*
	Day2	10	34.10(22.39,45.81)	17	23.88(19.44,28.32)	4.554	0.043^*
	Day3	11	27.00(14.27,39.72)	16	21.00(16.38,25.61)	1.245	0.275
	Day5	9	25.00(11.36,38.64)	12	20.58(16.30,24.87)	0.631	0.437
	Day7	9	24.56(9.44,39.67)	11	20.73(15.57,25.89)	0.354	0.559
ALP (U/L)	Day0	12	76.50(56.72,96.28)	18	74.22(55.66,92.79)	0.073	0.863
	Day1	10	64.50(37.82,91.18)	15	69.07(46.20,91.93)	0.089	0.781
	Day2	8	57.88(38.96,76.79)	11	61.91(45.32,78.50)	0.233	0.720
	Day3	6	62.83(43.43,82.23)	13	70.31(46.73,93.89)	0.832	0.664
	Day5	6	63.33(43.24,83.43)	16	64.13(54.60,73.65)	0.044	0.929
	Day7	7	63.43(43.24,83.62)	11	73.00(49.12,96.88)	0.473	0.534
GGT (U/L)	Day0	12	58.25(26.33,90.17)	18	63.56(40.67,86.44)	0.092	0.768
	Day1	10	51.70(15.40,88.00)	15	55.40(28.98,81.82)	0.083	0.855
	Day2	8	53.13(14.19,92.06)	11	51.00(30.20,71.80)	0.056	0.906
	Day3	6	55.00(17.76,92.24)	13	56.15(32.52,79.79)	0.067	0.952
	Day5	6	48.83(10.48,87.19)	16	53.75(36.25,71.25)	0.562	0.764
	Day7	7	35.29(22.10,48.47)	11	70.09(15.01,125.16)	1.321	0.287
LDH (U/L)	Day0	9	536.00(285.91,786.09)	9	515.33(255.65,775.01)	0.047	0.896
	Day1	6	383.00(108.52,657.48)	8	384.63(110.08,659.17)	0.029	0.992
	Day2	7	369.86(165.50,574.21)	8	353.13(135.94,570.31)	0.183	0.896
	Day3	7	344.00(153.50,534.50)	8	322.50(172.75,472.25)	0.192	0.832
	Day5	6	290.67(106.47,474.86)	7	259.71(174.45,344.97)	0.267	0.691
	Day7	6	169.00(114.59,223.41)	7	147.57(119.45,175.69)	0.966	0.374
TBIL (μmol/L)	Day0	10	13.76(11.14,16.38)	19	13.22(11.32,15.12)	0.097	0.721
	Day1	10	13.24(10.14,16.34)	13	12.62(8.95,16.28)	0.099	0.786
	Day2	10	12.91(9.78,16.03)	17	12.89(9.93,15.84)	0.032	0.992
	Day3	11	12.70(10.42,14.98)	16	12.50(10.78,14.22)	0.066	0.878
	Day5	7	12.79(10.54,15.03)	10	12.21(10.57,13.85)	0.177	0.626
	Day7	7	11.66(8.69,14.63)	11	11.94(9.57,14.30)	0.099	0.868
Scr (μmol/L)	Day0	10	70.80(58.73,82.87)	19	73.21(56.56,89.86)	0.078	0.838
	Day1	10	63.30(51.75,74.85)	14	61.64(43.66,79.62)	0.066	0.879
	Day2	10	57.30(46.86,67.73)	17	55.06(45.27,64.85)	0.122	0.752
	Day3	11	59.91(51.61,68.21)	16	53.88(47.53,60.22)	1.677	0.214
	Day5	7	55.43(40.32,70.54)	10	53.70(40.99,66.41)	0.075	0.841
	Day7	8	56.50(47.00,66.00)	10	56.60（46.64,66.59）	0.023	0.987
eGFR (mL/min)	Day0	10	111.07(102.12,120.02)	18	113.02(100.20,125.85)	0.050	0.825
	Day1	9	118.23(107.16,129.31)	14	131.17(123.45,138.88)	4.835	0.039^*
	Day2	10	122.68(114.82,130.54)	17	133.59(127.50,139.68)	5.619	0.026^*
	Day3	11	123.01(108.97,137.07)	16	136.21(130.39,142.02)	4.599	0.042^*
	Day5	7	131.56(123.48,139.63)	10	141.15(134.70,147.59)	4.783	0.045^*
	Day7	9	136.86(127.58,146.13)	8	143.73(137.17,150.31)	1.885	0.190
CKMB (mmol/L)	Day0	6	3.10(0.83,5.37)	12	1.96(0.20,3.72)	0.677	0.394
	Day1	8	2.07(1.21,2.94)	8	3.21(0.53,5.89)	0.765	0.355
	Day2	10	1.79(0.59,2.99)	13	2.89(1.42,4.37)	1.366	0.234
	Day3	6	1.48(0.66,2.31)	13	2.81(0.72,4.90)	0.756	0.372
	Day5	6	2.30(0.21,4.40)	7	2.60(0.07,5.12)	0.233	0.830
	Day7	6	3.00(0.54,6.55)	8	2.66(0.62,4.71)	0.218	0.832
TNI (μg/L)	Day0	6	2.52(0.13,4.91)	13	4.26(1.32,7.19)	0.722	0.420
	Day1	7	3.21(0.28,6.13)	9	3.78(4.12,7.15)	0.132	0.774
	Day2	8	3.57(1.02,6.11)	11	4.68(1.61,7.76)	0.454	0.559
	Day3	6	4.64(0.88,8.40)	11	4.83(0.96,8.69)	0.023	0.943
	Day5	6	3.92(0.48,7.37)	7	5.32(0.30,10.33)	0.334	0.595
	Day7	6	3.60(0.49,6.70)	7	5.50(0.10,10.90)	0.654	0.486
WBC (×10⁹/L)	Day0	12	14.25(11.18,17.32)	19	15.04(12.63,17.46)	0.189	0.667
	Day1	11	12.68(9.34,16.03)	18	9.54（8.37,10.72）	5.291	0.029^*
	Day2	10	10.61(7.66,13.57)	19	7.98(6.83,9.15)	4.735	0.038^*
	Day3	11	8.57(6.89,10.26)	20	7.53(6.48,8.60)	1.383	0.249
	Day5	10	7.76(6.04,9.49)	16	7.79(6.68,8.90)	0.001	0.981
	Day7	10	7.86(6.08,9.64)	15	7.60(6.54,8.67)	0.086	0.772
N (×10⁹/L)	Day0	11	12.86(9.64,16.07)	19	13.70(11.63,15.77)	0.244	0.625
	Day1	11	11.85(8.63,15.08)	18	8.52(7.15,9.89)	5.705	0.024^*
	Day2	10	10.47(7.58,13.36)	19	7.80(6.53,9.09)	4.561	0.042^*
	Day3	11	8.23(6.57,9.90)	12	7.06(5.75,8.37)	1.337	0.257
	Day5	10	7.75(5.58,9.91)	16	6.77(5.33,8.20)	0.743	0.397
	Day7	10	6.75(4.98,8.51)	15	6.31(4.93,7.70)	0.183	0.673
HGB (g/L)	Day0	11	170.64(158.63,182.65)	19	167.42(155.45,179.39)	0.141	0.710
	Day1	11	146.63(133.32,159.96)	18	125.56(112.47,138.64)	5.218	0.030^*
	Day2	10	132.60(116.03,149.17)	19	111.26(100.60,121.93)	5.902	0.022^*
	Day3	11	124.18(114.85,133.51)	20	108.25(97.30,119.20）	4.234	0.049^*
	Day5	10	123.30(112.16,134.44)	16	112.38(102.31,122.44)	2.339	0.139
	Day7	10	128.20(115.82,140.58)	15	117.26(106.33,128.21)	2.022	0.168
PLT (×10⁹/L)	Day0	11	153.18(128.54,177.83)	18	151.39(126.74,176.04)	0.011	0.918
	Day1	11	151.36(118.92,183.80)	18	181.11(156.08,206.14)	1.970	0.129
	Day2	10	155.50(121.65,189.36)	19	179.68(156.00,203.37)	1.377	0.213
	Day3	11	163.64(134.32,192.95)	20	189.90(166.10,213.50)	2.914	0.160
	Day5	10	173.60(137.61,209.60)	16	205.68(178.71,232.67)	1.748	0.128
	Day7	10	193.40(150.46,236.46)	15	233.33(206.29,260.38)	3.334	0.080
CRP (mg/L)	Day0	10	288.46(221.60,355.32)	19	286.16(244.07,328.26)	0.004	0.948
	Day1	11	280.73(221.97,339.49)	18	215.83(178.07,253.59)	4.448	0.044^*
	Day2	10	248.40(198.42,298.37)	19	179.23(142.57,215.90)	5.715	0.024^*
	Day3	11	201.18(155.72,246.65)	20	147.42(116.20,178.64)	4.564	0.041^*
	Day5	10	132.60(101.97,163.23)	16	89.98(62.87,117.09)	4.848	0.038^*
	Day7	10	96.10(71.29,120.91)	15	60.41(41.36,79.45)	6.420	0.019^*

表2

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Characteristics		Control group （n=12）	DFPP group （n=20）	Statistical value	P value
Gender	Male	11	14	χ2=2.060	0.32
	Female	1	6
Age（years）		36.25±5.345	36.65±6.54	F=0.079	0.859
SAP		6	10	χ2=0.060	1.000
MSAP		2	4	χ2=0.039	1.000
MAP		4	6	χ2=0.055	1.000
Chronic disease	Diabetes	6	11	χ2=0.075	0.536
	Hypertension	3	3	χ2=0.492	0.647
	Heart disease	1	0	χ2=1.720	0.375
	Lung disease	0	0
	Kidney disease	1	0	χ2=1.720	0.375
	DKA	6	9	χ2=0.077	0.536
	Fatty liver	7	12	χ2=0.009	0.607
	Recurrent pancreatitis	2	2	χ2=0.305	0.485
Onset-time of admission(d)		1.83±0.83	1.25±0.72	F=0.841	0.055