Abstract: Objective  To compare the effects of double filtration plasmapheresis (DFPP), DFPP + insulin and insulin in the treatment of patients with severe hypertriglyceridemic acute pancreatitis (HTG-AP).  Methods  A total of 62 patients with HTG-AP were divided into three groups: DFPP group, DFPP + insulin group and insulin group. Their basic clinical information and laboratory test results were analyzed. One-way ANOVA or Kruskal-Wallis test was used for analyses of quantitative data, and Chi-square test or Fisher test was used for analyses of numerical data. Multivariate linear regression was used to identify the factors affecting disease severity of the patients.  Results  BMI (F=4.414, P=0.016), medical expenses (K=35.923, P<0.001), days in ICU (K=46.105, P＜0.001), and the sequential organ failure assessment (SOFA) score (K=9.089, P=0.011) and APACHE II scores (K=12.059, P=0.002) were statistically different between DFPP + insulin group and the other two groups. Serum triglyceride level had no difference before treatment between DFPP group and insulin group (K=-2.136, P=0.098), but reduced to 5.65mmol/L after the treatment in DFPP group and became statistically different with the serum triglyceride level in insulin group (K=25.508, P<0.001). Multivariate linear regression showed that the disease severity was independently associated with serum cholesterol (β=0.320, P=0.005), procalcitonin (β=0.243, P=0.042), D dimer (β=0.385, P=0.001), blood glucose (β=0.251, P=0.050), diabetes mellitus (β=-0.284, P=0.008) and age (β=0.302, P=0.007) at admission. Conclusions  DFPP treatment is effective to reduce triglyceride in patients with severe HTG-AP.

Key words: Hypertriglyceridemic acute pancreatitis, Triglyceride, Double filtration plasmapheresis, Insulin