中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (10): 663-666.doi: 10.3969/j.issn.1671-4091.2018.10.004

• 临床研究 • 上一篇    下一篇

血液灌流及双重滤过血浆置换对高脂性重型急性胰腺炎的治疗效果

程丽1,刘德林1,尹小雪1,王敏娜1,叶钢1   

  1. 1. 首都医科大学附属北京潞河医院急诊监护室
  • 收稿日期:2018-05-31 修回日期:2018-08-07 出版日期:2018-10-12 发布日期:2018-10-12
  • 通讯作者: 叶钢 steelye@126.com E-mail:steelye@126.com

EEffect of hemoperfusion and double-filtration plasmapheresis for the treatment of hyperlipidemia in severe acute pancreatitis patients

  • Received:2018-05-31 Revised:2018-08-07 Online:2018-10-12 Published:2018-10-12

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摘要： 【摘要】目的探讨血液灌流(hemoperfusion，HP)及双重滤过血浆置换(double-filtration plasmapheresis，DFPP)对高脂性重型急性胰腺炎血脂的疗效影响。方法对在2016 年01 月～2018 年04 月确诊为高脂性重型急性胰腺炎的50 例患者随机分为HP 及DFPP，分析其治疗效果，对其并发症、腹部进展情况、死亡人数(率)、单次费用、单次平均下降百分数及血脂下降疗效的分析。结果HP 组及DFPP 组患者性别、年龄、体质量指数(body mass index，BMI)、入院时急性生理与慢性健康评分(acute physiology,age,chronic health evaluation II，APACHEⅡ评分)及入院时血脂水平无统计学差异。2 组并发症、腹部CT 进展情况及死亡人数进行比较,无统计学差异。单次费用DFPP 较HP 高，单次平均血浆三酰甘油及总胆固醇下降百分数HP 组分别为60.1%，37.0%，DFPP 组分别为63.2%，41.8%。HP 组灌流前后血浆三酰甘油[(47.08±35.8)mmol/L 比(17.49±20.37)mmol/L，t=4.124，P=0.001]、总胆固醇水平[(13.52±5.90)mmol/L 及(10.01±6.11)mmol/L，t=5.737, P=0.000]有显著差异。DFPP 组血浆置换前后血浆三酰甘油[(44.42±42.30)mmol/L 比(16.31±17.68)mmol/L, t=3.298, P=0.011]、总胆固醇水平[(18.29± 16.13)mmol/L比(9.73±7.17)mmol/L, t=2.656, P=0.029]有显著差异。HP 组与DFPP 组TG 下降程度无显著差异[(18.55±21.99)mmol/L 比(16.31±17.68)mmol/L，t=0.207，P=0.084]，2 组血浆总胆固醇下降程度亦无统计学差异[(10.78±6.27)mmol/L 比(9.37±7.17)mmol/L,t=0.272，P=0.792]。结论HP 及DFPP 均不同程度的减低三酰甘油及总胆固醇水平，HP及DFPP 对其血脂水平的降低效果相当。

关键词: 高脂性重型急性胰腺炎, 血液灌流, 双重滤过血浆置换, 急性生理与慢性健康评分

Abstract: 【Abstract】Objective To investigate the effect of hemoperfusion and double- filtration plasmapheresis for the treatment of hyperlipidemia in severe acute pancreatitis patients. Methods Fifty patients diagnosed as severe acute pancreatitis with hyperlipidemia between January 2016 and April 2018 were randomly divided into hemoperfusion (HP) group and double-filtration plasmapheresis (DFPP) group. Results HP group and DFPP group were comparable in terms of gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE Ⅱ) score and blood lipid levels at admission. There were also no statistical differences in complications, changes of abdominal CT images, and number of death between the two groups. The medical expense of DFPP was higher than that of HP. The mean decrease percentages of plasma triglyceride (TG) and total cholesterol (TC) after one treatment were 60.1% and 37.0%, respectively, in HP group and were 63.2% and 41.8%, respectively, in DFPP group. In HP group before and after the treatment, plasma TG
levels were (47.08±35.8)mmol/L and 17.49±20.37 mmol/L, respectively (t=4.124, P=0.001), and TC levels were (13.52±5.90)mmol/L and 10.01±6.11mmol/L, respectively (t=5.737, P=0.000). In DFPP group before and after the treatment, plasma TG levels were (44.42±42.30)mmol/L and (16.31±17.68)mmol/L, respectively (t=3.298, P=0.011), and TC levels were (18.29 ± 16.13) mmol/L, and (9.73 ± 7.17)mmol/L, respectively (t= 2.656, P=0.029). There were no differences in the decrease of TG [(18.55±21.99)mmol/L in HP group and (16.31 ± 17.68)mmol/L in DFPP group, t=0.207 P=0.084] and TC [(10.78 ± 6.27)mmol/L in HP group and (9.37±7.17)mmol/L in DFPP group, t=0.272 P=0.792] between the two groups. Conclusions Both HP and DFPP reduced TG and TC levels. Moreover, HP and DFPP had comparable effects on lowering blood lipid levels.

Key words: Severe acute pancreatitis with hyperlipidemia, Hemoperfusion, Double-filtration plasmapheresis, APACHE Ⅱscore