外科理论与实践 ›› 2023, Vol. 28 ›› Issue (05): 448-453.doi: 10.16139/j.1007-9610.2023.05.10
葛焱, 王国鑫, 王佳卉, 安源, 赵冰, 盛慧球, 马丽()
收稿日期:
2023-08-16
出版日期:
2023-09-25
发布日期:
2024-01-04
通讯作者:
马丽
E-mail:malipostgraduate2@163.com
GE Yan, WANG Guoxin, WANG Jiahui, AN Yuan, ZHAO Bing, SHENG Huiqiu, MA Li()
Received:
2023-08-16
Online:
2023-09-25
Published:
2024-01-04
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。
中图分类号:
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.
表1
基线数据[n/$\bar{x} \pm s$]
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 |
表2
DFPP对多脏器功能的影响
Parameters | Point-in-time | Control group | DFPP group | F value | P value | |||
---|---|---|---|---|---|---|---|---|
n | Median (95%CI) | n | Median (95%CI) | |||||
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* |
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