早期血浆置换联合生长抑素治疗高脂血症性急性胰腺炎的疗效

Efficacy of early plasma exchange combined with somatostatin on hyperlipidemic acute pancreatitis

目的 探究早期血浆置换(PE)联合生长抑素治疗高脂血症性急性胰腺炎(HLAP)的疗效。方法 回顾性分析2021年2月—2023年12月本院收治HLAP患者资料,患者入院后,均根据急性胰腺炎指南接受常规治疗,包括以目标为导向的液体复苏、抑制胰酶分泌、尽早肠内营养以及根据需要进行维护脏器功能支持治疗,根据治疗方法的不同分为常规组(常规降脂治疗联合生长抑素)和PE组(早期PE联合生长抑素),应用倾向性评分匹配法(卡钳值为0.01),以1∶1匹配常规组和PE组,每组获得58例基线资料可比的患者。比较两组恢复情况(腹痛缓解时间、肛门排气时间、ICU留治时间、住院时间),治疗前、治疗3 d后生化指标[血清三酰甘油(TG)、血清淀粉酶(AMY)、脂肪酶(LPS)]、炎症指标及不良事件发生率。结果 PE组腹痛缓解时间、肛门排气时间、ICU留治时间、住院时间均显著短于常规组(P<0.05);血乳酸、TG、AMY、LPS组间、时间点及交互差异具有统计学意义(P<0.05),PE组治疗后各时间点AMY、LPS均低于常规组(P<0.05);治疗后,两组PCT、IL-6、TNF-α水平均下降(P<0.05),且治疗后PE组低于常规组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 早期PE联合生长抑素治疗可有效清除HLAP患者血液循环中的TG,促使乳酸、AMY、LPS水平下降,有效缓解症状,进一步促进患者康复和预后。

Objective To explore the efficacy of early plasma exchange(PE) combined with somatostatin in the treatment of hyperlipidemic acute pancreatitis(HLAP).Methods The data of HLAP patients in the hospital were retrospectively analyzed from February 2021 to December 2023.After admission,all patients received routine treatments according to the guidelines for acute pancreatitis,including goal-oriented fluid resuscitation,inhibition of pancreatic enzyme secretion,early enteral nutrition,and maintenance of organ function support therapy as needed.According to different treatment methods,they were divided into conventional group(conventional lipid-lowering therapy combined with somatostatin) and PE group(early PE combined with somatostatin).The propensity score matching method(caliper=0.01)was used to match the conventional group and the PE group at a ratio of 1∶1,thus 58 patients with comparable baseline data were included in each group.The recovery status(abdominal pain relief time,anal exhaust time,ICU stay,hospital stay),biochemical indicators [serum triglyceride(TG),serum amylase(AMY),lipase(LPS)] and inflammatory indicators before treatment and after 3 days of treatment and incidence rates of adverse events were compared between both groups.Results The abdominal pain relief time,anal exhaust time,ICU stay and hospitalization time in PE group were shorter than those in conventional group(P<0.05).There were statistical differences in the levels of serum lactic acid,TG,AMY and LPS from the aspects of between-group effect,time-point effect and interaction effect(P<0.05),and the levels of AMY and LPS at each time point after treatment were lower in PE group than those in conventional group(P<0.05).The levels of PCT,IL-6 and TNF-α in the two groups were reduced after treatment(P<0.05),and the PE group had lower PCT,IL-6 and TNF-α after treatment(P<0.05).There were no statistical differences in the incidence rates of adverse reactions between groups(P>0.05).Conclusion Early PE combined with somatostatin therapy can effectively remove TG in the blood circulation of HLAP patients,promote the decreases of lactic acid,AMY and LPS levels,promote the symptom relief,shorten the hospital stay and improve the prognosis of patients.