中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (09): 663-667.doi: 10.3969/j.issn.1671-4091.2024.09.006

• 临床研究 • 上一篇    下一篇

高脂血症型胰腺炎患者内脏脂肪组织面积与双重滤过血浆置换临床疗效的相关性分析

刘 端    钟镒霞    曾 潘    王小鹃   

  1. 643000 自贡，1自贡市第一人民医院重症医学科
  • 收稿日期:2024-03-26 修回日期:2024-06-07 出版日期:2024-09-12 发布日期:2024-09-12
  • 通讯作者: 王小鹃 E-mail:let_me_one@163.com

Correlation between visceral adipose tissue area and clinical efficacy of double filtered plasma exchange in patients with hyperlipidemic pancreatitis

LIU Duan, ZHONG Yi-xia, ZENG Pan, WANG Xiao-juan   

  1. Department of Critical Care Medicine, The First People's Hospital of Zigong City, Zigong 643000, China
  • Received:2024-03-26 Revised:2024-06-07 Online:2024-09-12 Published:2024-09-12
  • Contact: 643000 自贡，1自贡市第一人民医院重症医学科 E-mail:let_me_one@163.com

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摘要： 目的 探讨高脂血症型胰腺炎(hyperlipidemic pancreatitis，HLAP)患者内脏脂肪组织面积(visceral fat area，VFA)与双重滤过血浆置换(double filtered plasmapheresis，DFPP)临床疗效的相关性。 方法 选取2020年1月—2022年12月自贡市第一人民医院收治的行DFPP治疗的HLAP患者，根据临床疗效不同分为有效组和无效组。比较2组的一般资料及VFA；通过多元Logistic回归分析无效结局的影响因素；分析VFA水平与疗效无效概率的剂量反应关系，基于影响因素逐步Logistic回归模型。 结果 共纳入225例患者，其中有效组180例，无效组45例。饮酒史(OR=3.603，95% CI：2.577～4.868，P=0.018)、高体质量指数(body mass index，BMI)(OR=2.407，95% CI：1.381～3.672，P=0.016)、高急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health status scoring system II，APACHE Ⅱ)评分(OR=3.087，95% CI：2.061～4.352，P=0.026)、高空腹血糖(FPG)(OR=1.313，95% CI：1.007～2.578，P=0.009)、高总胆固醇(TC)(OR=2.511，95% CI：1.485～3.776，P=0.025)、高三酰甘油(TG)(OR=4.885，95% CI：3.859～6.150，P=0.035)、高低密度脂蛋白胆固醇(LDL-C)(OR=3.165，95% CI：2.139～4.430，P=0.010)、低高密度脂蛋白胆固醇(HDL-C)(OR=4.163，95% CI：3.137～5.428，P=0.011)、高白细胞介素-6(interleukin-6,IL-6)(OR=2.117，95% CI：1.091～3.382，P=0.006)、高白细胞介素-8(interleukin-8，IL-8)(OR=3.115，95% CI：2.089～4.380，P=0.023)、高C反应蛋白(CRP)(OR=1.975，95% CI：1.049～3.240，P=0.035)、高降钙素原(procalcitonin，PCT)(OR=3.665，95% CI：2.639～4.930，P=0.036)、高血淀粉酶(OR=4.547，95% CI：3.521～5.812，P=0.041)、高血脂肪酶(OR=2.229，95% CI：1.203～3.494，P=0.043)、VFA大(OR=2.827，95% CI：1.801～4.092，P=0.031)是疗效无效的影响因素。剂量反应关系分析提示：随着VFA增加，临床疗效无效的发生概率也相应增加。回归方程P=1/[1+exp(-3.265+1.282×饮酒史+0.878×BMI+1.127×APACHE Ⅱ评分+0.272×FPG+0.921×TC+1.586×TG+1.152×LDL-C+1.426×HDL-C+0.750×IL-6+1.136×IL-8+0.681×CRP+1.299×PCT+1.514×血淀粉酶+0.802×血脂肪酶+1.039×VFA)]。 结论 HLAP患者VFA与DFPP临床疗效具有显著相关性。随着VFA的增加，临床疗效无效的发生概率逐渐升高。

关键词: 高脂血症型胰腺炎, 内脏脂肪组织面积, 双重滤过血浆置换, 临床疗效

Abstract: Objective   To investigate the correlation between the visceral adipose tissue area (VFA) and the clinical efficacy of double filtered plasma exchange (DFPP) in patients with hyperlipidemic pancreatitis (HLAP).  Methods   A total of 225 patients with HLAP treated with DFPP in First People's Hospital of Zigong City from January 2020 to December 2022 were selected and divided into effective group (n=180) and ineffective group (n=45) according to the clinical efficacy. General clinical data and VFA were compared between the two groups. Multivariate logistic regression was used to analyze the influencing factors for the ineffective outcomes. The dose-response relating to VFA level and the probability of ineffective treatment was analyzed. Based on the influencing factors, a prediction model was established and verified.  Results  Drinking history (OR=3.603, 95% CI: 2.577～4.868, P=0.018), high BMI (OR=2.407, 95% CI: 1.381～3.672, P=0.016), high APACHE Ⅱ score (OR=3.087, 95% CI:2.061～4.352,P=0.026), high fasting plasma glucose (FPG) (OR=1.313, 95% CI: 1.007～2.578, P=0.009), high total cholesterol (TC) (OR=2.511, 95% CI: 1.485～3.776, P=0.025), high triglycerides (TG) (OR=4.885, 95% CI: 3.859～6.150, P=0.035), high LDL-C (OR=3.165, 95% CI: 2.139～4.430, P=0.010), low HDL-C (OR=4.163, 95% CI: 3.137～5.428, P=0.011), high IL-6 (OR=2.117, 95% CI: 1.091～3.382, P=0.006), high IL-8 (OR=3.115, 95% CI: 2.089～4.380, P=0.023), high C-reactive protein (CRP) (OR=1.975, 95% CI: 1.049～3.240, P=0.035), high procalcitonin (PCT) (OR=3.665, 95% CI: 2.639～4.930, P=0.036), high blood amylase (OR=4.547, 95% CI: 3.521～5.812, P=0.041), high blood lipase (OR=2.229, 95% CI: 1.203～3.494, P=0.043), and large VFA (OR=2.827, 95% CI: 1.801～4.092, P=0.031) were the influential factors for efficacy. Dose-response relationship analysis showed that with the increase of VFA, the probability of clinical ineffective treatment increased as well. The regression equation was P=1/[1+exp(-3.265+1.282×drinking history+0.878×BMI+1.127×APACHE Ⅱ score +0.272×FPG+0.921×TC+1.586×TG+1.152×LDL-C+1.426×HDL-C+0.750×IL-6+1.136×IL-8+0.681×CRP+1.299×PCT+1.514×blood amylase+0.802×blood lipase+1.039×VFA)].   Conclusion  In HLAP patients, VFA is significantly correlated with the clinical efficacy of DFPP, and the probability of clinical non-efficacy is gradually increased along with the increase of VFA.

Key words: Hyperlipidemic pancreatitis, Visceral adipose tissue area, Double filtered plasma exchange, Clinical effect

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