组合式血液净化技术在治疗重症高甘油三酯血症性急性胰腺炎中的临床应用

Clinical application of combined blood purification techniques in the treatment of severe hypertriglyceridemia-induced acute pancreatitis

摘要:

目的 探讨组合式血液净化技术在治疗重症高甘油三酯血症性急性胰腺炎（HTG-AP）中的临床应用。方法 选取2017年9月—2021年8月徐州医科大学附属医院收治的84例重症HTG-AP患者的临床资料，根据不同治疗方法将患者分为对照组和观察组，分别有45和39例。对照组患者使用传统内科治疗+血液灌流（HP）治疗，观察组患者使用传统内科治疗+HP联合CRRT治疗。比较两组患者治疗前与治疗后7 d相关指标的变化和临床疗效。结果 观察组治疗前后白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、红细胞分布宽度的差值高于对照组（P <0.05）。两组患者治疗前后血小板计数、淋巴细胞计数、血红蛋白、血小板/淋巴细胞比值的差值比较，差异无统计学意义（P >0.05）。观察组治疗前后C反应蛋白、降钙素原、白细胞介素-6的差值高于对照组（P <0.05）。两组患者治疗前后肿瘤坏死因子-α、白细胞介素-1β的差值比较，差异无统计学意义（P >0.05）。观察组治疗前后甘油三酯、血淀粉酶、血尿素氮、血肌酐的差值高于对照组（P <0.05）。两组患者治疗前后谷草转氨酶、谷丙转氨酶的差值比较，差异无统计学意义（P >0.05）。两组患者治疗前后APACHE Ⅱ评分、SOFA评分的差值比较，差异有统计学意义（P <0.05）；两组患者治疗前后BISAP评分、改良Marshall评分的差值比较，差异无统计学意义（P >0.05）。观察组肠鸣音恢复时间、腹痛缓解时间、腹胀缓解时间、ICU住院时间、总住院时间少于对照组（P <0.05）。两组患者病死率比较，差异无统计学意义（P >0.05）。结论 两种治疗方式均能清除重症HTG-AP患者炎症因子，降低甘油三酯，保护脏器功能，改善临床症状。HP联合CRRT治疗的组合式血液净化技术疗效优于单独HP治疗，值得临床推广应用。

Abstract:

Objective To investigate the efficacy of combined blood purification techniques [hemoperfusion (HP) combined with CRRT] in the treatment of severe hypertriglyceridemia-induced acute pancreatitis (HTG-AP).Methods The clinical data of 84 patients with severe HTG-AP admitted to our hospital from September 2017 to August 2021 were retrospectively analyzed. The patients were divided into the control group (n = 45) and the observation group (n = 39) according to the treatment regimens. Specifically, patients in the control group were given conventional medical treatment combined with HP therapy, while those in the observation group were additionally given CRRT. The differences in relevant indicators before and 7 days after the treatment and the clinical efficacy of the two groups were compared.Results The differences of the white blood cell (WBC) count, the neutrophil (NE) count, the neutrophil/lymphocyte ratio (NLR), and the red blood cell distribution width (RDW) before and after the treatment in the observation group were greater than those in the control group (P < 0.05). The differences of platelet count (PLT), lymphocyte count (LYM), the level of hemoglobin (HGB), and the platelet/lymphocyte ratio (PLR) before and after the treatment were not different between the two groups (P > 0.05). The differences of C-reactive protein (CRP), proealcitonin (PCT) and interleukin (IL)-6 before and after the treatment were different in the observation group (P > 0.05). The differences of the levels of tumor necrosis factor (TNF)-α and IL-1β before and after the treatment were not different between the two groups (P > 0.05). The differences of the levels of triglyceride (TG), amylase (AMY), blood urea nitrogen (BUN), and serum creatinine (Scr) before and after the treatment in the observation group were greater than those in the control group (P < 0.05). The differences of the levels of aspartate aminotransferase (GOT) and alanine aminotransferase (GPT) before and after the treatment were not different between the two groups (P > 0.05). The differences of the Acute Physiology and Chronic Health Evaluation (APACHE)Ⅱ scores and Sequential Organ Failure Assessment (SOFA) scores (P < 0.05) but not those of the Bedside Index for Severity in Acute Pancreatitis (BISAP) scores and modified Marshall scores (P > 0.05) before and after the treatment were different between the two groups. The time to borborygmus recovery, time to relief of abdominal pain and distension, the length of intensive care unit stay and the length of overall hospital stay in the observation group were shorter than those in the control group (P < 0.05). There was no significant difference in mortality between the two groups (P > 0.05).Conclusions For severe HTG-AP patients, both HP and HP combined with CRRT can be established as effective treatment regimens by eliminating inflammatory factors, reducing the level of TG, protecting the organ function, and improving clinical symptoms. The efficacy of combined blood purification techniques with both HP and CRRT is superior to that of HP alone, and is worthy of clinical application.