中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (03): 145-150.doi: 10.3969/j.issn.1671-4091.2018.03.001

• 临床研究 •    下一篇

不同血液净化方式治疗高三酰甘油血症胰腺炎的临床疗效研究

丁鲲1,苏东东1,陈仁贵1   

  1. 1.中国人民解放军武汉总医院血液净化科
  • 收稿日期:2017-10-23 修回日期:2018-01-14 出版日期:2018-03-12 发布日期:2018-03-12
  • 通讯作者: 丁鲲 20701122@qq.com E-mail:20701122@qq.com

Clinical efficacy of different blood purification modalities for the treatment of patients with hypertriglyceridemia pancreatitis

  • Received:2017-10-23 Revised:2018-01-14 Online:2018-03-12 Published:2018-03-12

PDF

514

摘要： 目的探讨不同血液净化方式对高三酰甘油血症胰腺炎(hypertriglyceridemia pancreatitis，HTGP)的治疗效果及预后的影响。方法收集2012 年3 月～2017 年3 月中国人民解放军武汉总医院收治的采用不同血液净化方式治疗的中重度HTGP 住院患者临床资料共63 份，根据净化方式分为2组，其中连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration，CVVH)联合血液灌流(hemoperfusion，HP)组(联合组)33 例，单用CVVH 治疗组(CVVH 组)30 例，观察比较2 组治疗前及治疗24h、72h 及1 周后的生命体征、血清三酰甘油(triglyceride，TG)、血清淀粉酶(amylase，AMS)、白细胞介素-6(interleukin-6，IL-6)、血钙(Ca2+)、白细胞(white blood cell，WBC)、血红蛋白(haemoglobin，Hb)、血小板(platelets，PLT)及急性生理及慢性健康(acute physiology and chronic health evaluation，
APACHE)II 评分变化情况，对比2 组TG 恢复时间、血液净化治疗次数、病情转稳、住院时间以及病死率。结果2 组治疗前的生命体征、TG 水平、炎症内环境等实验室检测指标及APACHEII 评分均无显著差异(P＞0.05)；2 组治疗后除对Hb 和PLT 影响不大，其它指标均较治疗前显著改善：体温(联合组F=87.116，P=0.021；CVVH 组F=46.658，P=0.038)、呼吸频率(联合组F=276.236，P＜0.001；CVVH 组F=109.768，P=0.004)、心率(联合组F=207.657，P＜0.001；CVVH 组F=96.857,P=0.023)、TG(联合组F=16.853，P＜0.001；CVVH 组F=4.315，P=0.015)、AMS(联合组F=10.254，P＜0.001；CVVH 组F=8.795，P＜0.001)、Ca2+(联合组F=23.795, P＜0.001；CVVH 组F=22.836, P＜0.001)、IL-6(联合组F=13.982, P＜0.001；CVVH 组F=10.352, P=0.005)、WBC(联合组F=17.249, P＜0.001；CVVH 组F=7.582，P=0.017)、APACHEⅡ评分(联合组F=277.158，P＜0.001；CVVH 组F=63.052，P＜0.001)；但联合组TG[(7.14±1.04)mmol/L 比(10.83±1.10)mmol/L，t=3.334, P=0.015]水平、AMS[(457.80±60.56)U/L 比(705.56±72.46)U/L, t=3.604, P=0.010]和APACHEII评分[(8.96±0.77)比(10.63±0.93)分，t=3.726，P=0.001]下降速度较CVVH 组更快，治疗24h 后2 组即有显著差异；联合组较CVVH 组优先达安全水平(TG：t=4.090，P=0.001；AMS：t=1.843，P=0.032；APACHEII评分：t=8.059, P＜0.001)；联合组生命体征和WBC 也优先CVVH 组达正常范围(体温：t=15.356, P=0.035；呼吸频率：t=9.909, P=0.035；心率：t=9.729, P＜0.001；WBC：t=2.861, P=0.007)；联合组的病死率低于CVVH 组，但由于样本量较小，差异未显示统计学意义(0 比10.00%，校正χ2=1.611, P=0.204)；TG 恢复时间[(2.58±1.45)d 比(7.71±2.69)d，t=4.866，P=0.002]、血液净化治疗次数[2.38±0.98 比7.57±2.57，t=5.232，P=0.002]、病情转稳时间[(7.46±3.05)d 比(16.14±4.10)d，t=6.136，P＜0.001]及住院时间[(20.00±12.12)d 比(30.00±6.40)d，t=2.088，P=0.045]，联合组均明显少于CVVH 组，临床转归更优。结论CVVH 联合HP 相较单用CVVH 治疗能更加快速有效降脂，同时更早阻断炎症反应，从而更快改善稳定病情，临床疗效更显著。

关键词: 高脂血症, 胰腺炎, 血液净化, 治疗模式

Abstract: 【Abstract】Objective To evaluate different blood purification modalities on the clinical efficacy and prognosis in patients with hypertriglyceridemia pancreatitis (HTGP). Methods Clinical data of the 63 patients with moderate-to-severe HTGP treated with blood purification in our hospital in the period from March 2012 to March 2017 were recruited. The patients were divided into two groups based on blood purification modalities: combined group treated with continuous veno-venous hemofiltration (CVVH) plus hemoperfusion(HP) (n=33), and CVVH group treated with CVVH only (n=30). Vital signs, serum levels of triglyceride (TG), amylase (AMS), interleukin-6 (IL-6) and blood calcium (Ca2+  ), white blood cells (WBC), hemoglobin (Hb), platelets (PLT), and scores of acute physiology and chronic health evaluation (APACHE II) were compared between the two groups before treatment and after the treatment for 24 hours, 72 hours and one week. Duration from abnormal to target TG level, number of blood purification times, recovery period to stable disease status, hospitalization day and mortality rate were also compared between the two groups. Results There were no significant differences in vital signs, serum TG level, other laboratory tests including inflammatory makers and internal environment indices, and APACHE II scores between the two groups before the treatment
(P＞0.05). After the treatment, clinical indices were significantly improved in combined group and CVVH group, including temperature, respiratory rate, heart rate, TG, AMS, Ca2+ , IL-6, WBC and APACHE II score, but HB and PLT were not changed (for temperature, F=87.116, P=0.021 and F=46.658, P=0.038, respectively; for respiratory rate, F=276.236, P＜0.001 and F=109.768, P=0.004, respectively; for heart rate, F=207.657, P＜0.001 and F=96.857, P=0.023, respectively; for TG, F=16.853, P＜0.001 and F=4.315, P=0.015, respectively; for AMS, F=10.254, P＜0.001 and F=8.795, P＜0.001, respectively; for Ca2+, F=23.795, P＜0.001 and F=22.836, P＜0.001, respectively; for IL-6, F=13.982, P＜0.001 and F=10.352, P=0.005, respectively; for WBC, F=17.249, P＜0.001 and F=7.582, P=0.017, respectively; for APACHE II score, F=277.158, P＜0.001 and F=63.052, P＜0.001, respectively). Serum TG, AMS and APACHE II score decreased faster in combined group than in CVVH group (7.14±1.04 vs. 10.83±1.10 mmol/L, t=3.334, P=0.015 for TG; 457.80±60.56 vs. 705.56±72.46U/L, t=3.604, P=0.010 for AMS; 8.96±0.77 vs. 10.63±0.93, t=3.726, P=0.001 for APACHEⅡ score), and the differences in decrease rates between the two groups became more remarkable after the treatment for 24 hours. The durations to reach safe serum levels, normal vital signs and WBC were shorter in combined group than in CVVH group (t=4.090, P=0.001 for TG; t=1.843, P=0.032 for AMS; t= 8.059, P＜0.001 for APACHE II score; t=15.356, P=0.035 for temperature; t=9.909, P=0.035 for respiratory rate; t=9.729, P＜0.001 for heart rate; t=2.861, P=0.007 for WBC). Mortality rate was also lower in combined group than in CVVH group but without statistical significance, probably due to insufficient case number (0% vs. 10.00%, corrected χ2=1.611, P=0.204). The duration to achieve normal TG and stable disease status, blood purification times, hospitalization day were less in combined group than in CVVH group (2.58±1.45 vs.7.71±2.69 days, t=4.866, P=0.002 for TG; 7.46±3.05 vs.16.14±4.10 days, t=6.136, P＜0.001 for stable disease status; 2.38±0.98 vs. 7.57±2.57 times, t=5.232, P=0.002 for blood purification times; 20.00±12.12 vs. 30.00± 6.40 days, t=2.088, P=0.045 for hospitalization days). Consequently, prognosis was better in combined group than in CVVH group. Conclusion CVVH combined with hemoperfusion has the advantages of quickly lowering serum TG and blocking inflammation responses, resulting in a better therapeutic effects and improved disease condition in a short period of time.

Key words: hypertriglyceridemia, pancreatitis, blood purification, treatment modality