高脂血症性重症急性胰腺炎患者血脂水平对血浆置换反应性因素及预后分析

Reactive factors and prognosis analysis of serum lipid level to plasma exchange in patients with hyperlipidemic severe acute pancreatitis

目的高脂血症性重症急性胰腺炎是临床常见的急危重症,具有不良预后。文中探讨高脂血症性重症急性胰腺炎(HL-SAP)患者血脂水平对血浆置换反应性因素及预后分析。方法回顾性研究南京鼓楼医院重症医学科2010年1月-2018年5月收治的70例HL-SAP患者临床资料。所有患者均行血浆置换治疗,并根据血清三酰甘油(TG)水平下降幅度分为高反应组(>60%)和低反应组(<60%)。患者性别、年龄、体重指数(BMI)、Ranson评分、临床急性生理学及慢性健康状况评分(APACHE)、序贯器官衰竭评分(SOFA)、发病至血浆置换开始时间、置换血浆量、血流速度、血清淀粉酶、清蛋白、血红细胞压积(Hct)、血浆置换前血TG、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)行χ^2或Mann-Whitney U检验进行单因素分析,将单因素分析有统计学差异的因素性别、发病至血浆置换开始时间、TG、Hct纳入Logstic回归分析进行多因素分析。结果70例患者血浆置换前TG水平10.10~53.60 mmol/L,平均(21.45±13.56)mmol/L;置换后为1.97~20.00 mmol/L,平均(6.10±3.58)mmol/L,差异具有统计学意义(P<0.05)。本组患者TG下降幅度为12.75%~89.43%,并纳入高反应组46例、低反应组24例。与低反应组相比,高反应组患者性别、发病至血浆置换开始时间、血清淀粉酶、置换血浆量、血红细胞比容及置换前血脂、TC、HDL-C差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示HL-SAP经血浆置换后血脂水平变化与性别、发病至血浆置换开始时间、血红细胞比容及置换前血脂呈显著相关性(P<0.05)。与低反应组相比,高反应组急性肾损伤、病死率差异均有统计学意义(P<0.05)。结论性别、发病至血浆置换开始时间、血红细胞比容及置换前血脂是血浆置换治疗HL-SAP的影响因素;低反应组患者具有较高的急性肾损伤及不良预后发生率。

Objective Hyperlipidemic severe acute pancreatitis,which has a poor prognosis,is a common acute and critical disease.To discuss the reactive factors and prognosis analysis of serum lipid level to plasma exchange in patients with hyperlipidemic severe acute pancreatitis(HL-SAP).Methods A retrospective study was conducted on the clinical data of 70 HL-SAP patients admitted to the department of critical care medicine in Nanjing drum tower hospital from January 2010 to May 2018.All patients received plasma exchange therapy,and were divided into the high-response group(>60%)and the low-response group(<60%)according to the decrease of serum triglyceride(TG)level.Single factor analysis was conducted withχ2 or Mann-Whitney U test in the patients'gender,age,body mass index(BMI),Ranson score,clinical acute physiology assessment and chronic health evaluation(APA-CHE),sequential organ failure assessment(SOFA),start time from incidence to plasmapheresis,plasma exchange dosage,blood flow velocity,serum amylase,albumin,red blood cells hematocrit(Hct),blood TG before plasma exchange,total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL).The factors,which include gender,start time from incidence to plasmapheresis,TG,and Hct,have statistical differences in single factor analysis and were incorporated into the Logstic regression analysis for a multifactor analysis.Results TG levels ranged from 10.10 to 53.60 mmol/L in 70 patients with an average of(21.45±13.56)mmol/L before plasma exchange while it ranged from 1.97 to 20.00 mmol/L with an average of(6.10±3.58)mmol/L after plasma exchange,and the difference was statistically significant(P<0.05).In this group,the TG decreased by 12.75%~89.43%,which included 46 patients in the high-response group and 24 patients in the low-response group.Compared with the low-response group,the high-response group has statistically significant(P<0.05)in the differences of gender,start time from incidence to plasmapheresis,serum amylase,plasma exchange dosage,red blood cells hematocrit(Hct),blood lipid before exchange,TC,and HDL.Multivariate Logistic regression analysis showed that changes in blood lipid level after plasmapheresis in HL-SAP patients were significantly correlated with gender,start time from incidence to plasmapheresis,red blood cells hematocrit(Hct),blood lipid before plasmapheresis(P<0.05).Compared with the low-response group,it has statistically significant in difference between acute kidney injury and mortality in the high-response group(P<0.05).Conclusion The reactive factors for the efficacy of plasma exchange in patients with HL-SAP are gender,tart time from incidence to plasmapheresis,red blood cells hematocrit(Hct),and blood lipid before plasmapheresis.The low response group had a higher incidence of acute kidney injury and a poor prognosis.