Objective: To investigate the clinical effect of plasma exchange in the treatment of acute pancreatitis complicated with hyperlipidemia. Methods: The clinical data of 15 patients with acute pancreatitis complicated with acute pancreatitis treated with plasma exchange in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to December 2017 were retrospectively analyzed, including serum triacylglycerol (TG), total cholesterol (TC), blood amylase (AMS), tumor necrosis factor-α (TNF-α), white blood cell count (WBC), C-reactive protein (24 h, 48 h, 72 h after treatment) CRP), calcium ion (Ca2+) and the time required for TG to fall to 5.65 mmol·L-1, the number of plasma exchanges, changes of vital signs, and changes of observed complications,length of hospital stay, maternal and fetal outcomes,changes in acute physiology and chronic health (APACHE) II scores. Results: In pregnant women with hyperlipidemia pancreatitis, plasma exchange significantly reduced TG and TC after 24 hours of treatment, compared with the pre-treatment, the difference was statistical; along with the treatment time extending, TG and TC fell to the normal range after 72 hours of treatment; the rate of TG and TC decreased at each time point after treatment, the difference was statistically significant, after the first treatment the rate of decline was the biggest, and the degree of TG decreased more significantly than TC. After averaging (2.5±1.19) plasma exchange, TG could be restored to a safe level (TG<5.65 mmol·L-1),the safety level of TG recovered before and after treatment (TG<5.65 mmol·L-1), APPACHEII score decreased, and there was a statistical significance before and after treatment, the inflammatory response index TNF-α decreased significantly after treatment for 24 hours, and the difference was statistically significant. The infection index CRP and WBC decreased significantly 24 hours and 72 hours after treatment compared with before treatment, and the difference was statistically significant. The blood amylase and Ca2+ recovered to the normal range after 72 hours of treatment, and the vital signs of the patient stabilized 48 hours after plasma exchange. Conclusion: Plasma exchange therapy can quickly and effectively remove TG from the blood in a short period of time, and at the same time reduce the inflammatory response and improve the disease. |
[1] DUCARME G,MAIRE F,CHATEL P,et al.Acute pancreatitis during pregnancy:a review[J].Journal of Perinatology,2014,34(2):87-94.
[2] LUO LINGYU,ZEN HAO,XU HONGRONG,et al.Clinical characteristics of acute pancreatitis in pregnancy:experience based on 121 cases[J].Arch Gynecol Obstet,2018,297(2):333-339.
[3] WASSAY S A,DAR F J,SALEH A K,et al.Role of therapeutic plasma exchange in the treatment of severe hypertriglyceridemia:an experience[J].Ther Adv Endocrinol Metab,2017,8(12):169-172.
[4] S S S,WINTERS J L.PADMANABHAN A,et al.Guidelines on the use of therapentie apheresis in clinical pratie-evjdenr-based approach from the writing committee of the American society for Apheresis:the sixth special issue[J].J Clin Apher,2013,28(3):145-284.
[5] HAN DONG-HEE,MOH I H,KIM D M,et al.Gestational hyperlipidemia and acute pancreatitis with underlying partial lipoprotein lipase deficiency and apolipoprotein E3/E2 genotype[J].Korean J Intern Med,2013,28(5):609-613.
[6] WONG B,OOI T C,KEELY E.Severe gestational hypertriglyceridemia:a practical approach for clinicians[J].Obstetric medicine,2015,8(4):158-167.
[7] VIPPERLA K,SOMERVILLE C,FURLAN A,et al.Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis[J].J Clin Gastroenterol,2017,51(1):77-85.
[8] KADIKOYLU G,YUKSELEN V,YAVASOGLU I,et al.Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia[J].Transfus Apher Sci,2010,43(3):285-289.
[9] STEFANUTTI C,LABBADIA G,MOROZZI C.Severe hypertriglyceridemia-related acute pancreatitis[J].Ther Apher Dial,2013,17(2):130-137.
[10] SYED H,BILUSIC M,RHONDLA C,et al.Plasmapheresis in the treatment of hypertriglyceridemia-induced pancreatitis:a community hospital's experience[J].J Clin Apher,2010,25(4):229-234.
[11] GAVVA C,SARODE R,AGRAWAL D,et al.Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis:a rapid and practical approach[J].Transfus Apher Sci,2016,54(1):99-102.
[12] SEDA G,MEYER J M,AMUNDSON D E,et al.Plasmapheresis in the management of severe hypertriglyceridemia[J].Crit Care Nurse,2013,33(4):18-23; quiz 24.
[13] JOGLEKAR K,BRANNICK B,KADARIA D,et al.Therapeutic plasmapheresis for hypertriglyceridemia-associated acute pancreatitis:case series and review of the literature[J].Ther Adv Endocrinol Metab,2017,8(4):59-65.
[14] SZCZEKLIK W,WAWRZYCKA K,WLUDARCZYK A,et al.Complications in patients treated with plasmapheresis in the intensive care unit[J].Anaesthesiol Intensive Ther,2013,45(1):7-13.
[15] 谈定玉,徐继扬.床边血浆置换治疗重症高脂血症性急性胰腺炎疗效观察[J].实用医学杂志,2012,28(11):1832-1834.
[16] Wu Yumin,Zhao Zhihong.The application of plasma exchange therapy in patients with hyperlipidemie panereatitis and its efect on the levels of inflammatory factors[J],IMHGN,2017,23(6):820-822.
[17] JEON H R,KIM S Y,CHO Y J,et al.Hypertriglyceridemia-induced acute pancreatitis in pregnancy causing maternal death[J].Obstetrics&Gynecology Science,2016,59(2):148-151. |