连续性血液净化治疗高脂血症性胰腺炎的疗效观察

Effect of continuous blood purification on hyperlipidemic pancreatitis

目的探讨连续性血液净化(CBP)治疗对高脂血症性胰腺炎(HLP)中的治疗作用。方法选择2015年7月至2016年12月华中科技大学同济医学院附属武汉中心医院住院HLP患者48例,其中男性30例,女性18例,年龄21~52岁。按治疗方法分观察组(CPB治疗)和对照组(常规治疗)。对照组23例,其中男性14例,女性9例;年龄25~52岁,平均年龄35.3岁。观察组25例,其中男性16例,女性9例;年龄21~51岁,平均年龄34.4岁。两组患者均按照诊疗规范予以常规治疗,观察组再连续24 h行CBP治疗3~5 d,待临床症状好转后改为间断性血液净化治疗或停止CBP治疗。比较两组血液净化前、血液净化治疗72 h后生命体征、氧合指数、血清甘油三酯、C-反应蛋白和血浆炎性介质及细胞因子(TNF-α、IL-6、IL-8)水平变化;比较两组机械通气时间、重症监护病房(ICU)住院时间及死亡率。结果两组患者治疗后生命体征明显趋于稳定,血清甘油三酯、C-反应蛋白及血浆炎性介质水平均较治疗前下降[观察组(2.7±0.6)mmol/L vs(23.8±7.6)mmol/L,(12.7±4.6)mg/L vs(34.2±11.6)mg/L,TNF-α(320.5±35.5)ng/L vs(405.2±39.4)ng/L,IL-6(382.3±42.2)ng/L vs(578.7±62.6)ng/L,IL-8(456.3±34.4)ng/L vs(635.1±59.7)ng/L;对照组(5.6±0.4)mmol/L vs(24.2±8.5)mmol/L,(18.9±7.6)mg/L vs(35.3±12.6)mg/L,TNF-α(380.9±26.6)ng/L vs(412.7±40.2)ng/L,IL-6(450.8±36.7)ng/L vs(563.5±52.4)ng/L,IL-8(507.7±46.7)ng/L vs(655.2±58.8)ng/L;P<0.05]。观察组患者血清甘油三酯、C-反应蛋白及血浆炎性介质水平在相同时间点明显低于对照组(P<0.05)。观察组患者机械通气时间、ICU住院时间、死亡率明显低于对照组,临床转归优于对照组(P<0.05)。结论 HLP患者在内科综合治疗的基础上,联合CBP治疗能有效清除甘油三酯及炎性介质,缓解临床症状,缩短病程,显著改善预后。

Objective To evaluate the curative effect of continuous blood purification（CBP） on patients with hyperlipidem-ic pancreatitis（HLP）. Methods From July 2015 to December 2016, a total of 48 HLP patients were enrolled, which includ-ed 30 males and 18 females, aged 21-52 years old. All of them were divided into control group（ n = 23, 14 males and 9 females, aged 25-52 years old with mean age of 35.3 years old） and observation group（ n = 25, 16 males and 9 females,aged 21-51 years old with mean age of 34.4 years old）. All patients were routinely treated by protocol, and observation group received 24-hour CBP treatment for 3-5 days, then performed intermittent blood purification treatment or stop CBP treatment after clinical symptoms recover. The levels of vital signs, oxygenation index, serum triglyceride, C-reactive protein and plasma inflammatory mediators and cytokines[tumor necrosis factor α（TNF-α）, interleukin（IL）-6, IL-8] before and after hemodialysis were measured. The mechanical ventilation time, intensive care unit（ICU） hospitalization and mortality between 2 groups were compared. Results The clinical symptoms of 2 groups were improved after treatment, the levels of serum triglyceride, C-reactive protein and plasma inflammatory mediators were lower than those of before treatment[observation group, serum triglyceride（2.7 ± 0.6） mmol/L vs（23.8 ± 7.6） mmol/L, C-reactive protein（12.7 ± 4.6） mg/L vs（34.2 ± 11.6） mg/L, TNF-α（320.5 ± 35.5） ng/L vs（405.2 ± 39.4） ng/L, IL-6（382.3 ± 42.2） ng/L vs（578.7 ± 62.6） ng/L and IL-8（456.3 ± 34.4） ng/L vs（635.1 ± 59.7） ng/L;control group, serum triglyceride（5.6 ± 0.4） mmol/L vs（24.2 ± 8.5） mmol/L, C-reactive protein（18.9 ± 7.6） mg/L vs（35.3 ±12.6） mg/L, TNF-α（380.9 ± 26.6） ng/L vs（412.7 ± 40.2） ng/L, IL-6（450.8 ± 36.7） ng/L vs（563.5 ± 52.4） ng/L and IL-8（507.7 ± 46.7） ng/L vs（655.2 ± 58.8） ng/L; P〈0.05]. The levels of serum triglyceride, C-reactive protein and plasma inflammatory mediators of observation group at the same time points were significantly lower than those of control group（ P〈0.05）.The duration of mechanical ventilation, ICU hospitalization, mortality rate and clinical outcome of observation group were bet-ter than those of control group（P〈0.05）. Conclusion It is demonstrated that internal medicine treatment combined with CBP could effectively remove triglycerides and inflammatory mediators, relieve clinical symptoms, shorten course of disease, andsignificantly improve prognosis in HLP patients.