二重血浆分离治疗高脂血症性胰腺炎
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摘要
【目的】
探讨二重血浆分离治疗高脂血症性胰腺炎的临床效果。主要通过回顾分析治疗前后患者症状、血脂水平、血清淀粉酶水平、APACHEⅡ评分的变化和最终转归进行研究。
【方法】
运用Plasauto IQ血液净化机对16例高脂血症性胰腺炎患者进行二重血浆分离治疗,血液首先经过血浆分离器,从全血中分离出血浆,然后血浆再经过血浆成分分离器,将脂蛋白与血浆中其他分子量较小的成分分离,脂蛋白成为弃浆排出,从而达到治疗作用。观察患者治疗前后的症状变化和最终转归,检测治疗前后即刻血清甘油三脂、胆固醇水平,检测治疗前24小时内和治疗后24小时内的血淀粉酶水平。评价和比较治疗前24小时内和治疗后24小时内的APACHEⅡ评分。
【结果】
16例高脂血症患者总共接受二重血浆分离治疗19次,治疗后临床症状改善显著,14例最终治愈,2例死亡。单次治疗血清甘油三脂平均下降52.25%,血清胆固醇平均下降48.33%,血清淀粉酶平均下降71.60%,每次治疗后24小时内的最高APACHEⅡ评分较治疗前平均下降29.48%。除血清白蛋白轻度下降外无明显副反应出现。
【结论】
二重血浆分离在高脂血症性胰腺炎的治疗中能显著地降低血脂水平,对胰腺炎病情有改善作用,安全性好,用其早期干预对改善预后可能有重要意义。
[Objective]
To investigate the therapeutic effect of double filtration plasmapheresis for acute hyperlipidemic pancreatitis,we analysis the symptoms,the levels of plasma lipids,the APACHEⅡscores and the clinical outcomes of patients retrospectively.
[Methods]
16 patients of acute hyperlipidemic pancreatitis received the treatments of double filtration plasmapheresis patients with Plasauto IQ blood purification machine(made by Asahi Kasei Corporation,Japan).The plasma separated from whole blood with a plasma separator,passes through the plasma component separator.Large molecular-weight lipoproteins are discarded and small molecular-weight substances return to the patient.The change of symptoms and the clinical outcomes were observed. We detected the levels of serumal triglyceride,cholesterol and amylase.Furthermore, pre-therapeutic and post- therapeutic APACHEⅡscores were evaluated respectively.
[Results]
16 patients were treated for 19 times at all.The symptoms released observably.14 patients recovered and 2 patients died at last.After treatment,the mean serum concentrations of triglyceride and cholesterol fell significantly by 52.25%and 48.33%respectively,and the APACHEⅡscores decreased by 29.48%.Except mild hypoalbuminemia,no complication was observed.
[Conclusion]
Double filtration plasmapheresis is an effective and safe therapy for hyperlipidemic pancreatitis,and can be valuable for early treatment.
探讨二重血浆分离治疗高脂血症性胰腺炎的临床效果。主要通过回顾分析治疗前后患者症状、血脂水平、血清淀粉酶水平、APACHEⅡ评分的变化和最终转归进行研究。
【方法】
运用Plasauto IQ血液净化机对16例高脂血症性胰腺炎患者进行二重血浆分离治疗,血液首先经过血浆分离器,从全血中分离出血浆,然后血浆再经过血浆成分分离器,将脂蛋白与血浆中其他分子量较小的成分分离,脂蛋白成为弃浆排出,从而达到治疗作用。观察患者治疗前后的症状变化和最终转归,检测治疗前后即刻血清甘油三脂、胆固醇水平,检测治疗前24小时内和治疗后24小时内的血淀粉酶水平。评价和比较治疗前24小时内和治疗后24小时内的APACHEⅡ评分。
【结果】
16例高脂血症患者总共接受二重血浆分离治疗19次,治疗后临床症状改善显著,14例最终治愈,2例死亡。单次治疗血清甘油三脂平均下降52.25%,血清胆固醇平均下降48.33%,血清淀粉酶平均下降71.60%,每次治疗后24小时内的最高APACHEⅡ评分较治疗前平均下降29.48%。除血清白蛋白轻度下降外无明显副反应出现。
【结论】
二重血浆分离在高脂血症性胰腺炎的治疗中能显著地降低血脂水平,对胰腺炎病情有改善作用,安全性好,用其早期干预对改善预后可能有重要意义。
[Objective]
To investigate the therapeutic effect of double filtration plasmapheresis for acute hyperlipidemic pancreatitis,we analysis the symptoms,the levels of plasma lipids,the APACHEⅡscores and the clinical outcomes of patients retrospectively.
[Methods]
16 patients of acute hyperlipidemic pancreatitis received the treatments of double filtration plasmapheresis patients with Plasauto IQ blood purification machine(made by Asahi Kasei Corporation,Japan).The plasma separated from whole blood with a plasma separator,passes through the plasma component separator.Large molecular-weight lipoproteins are discarded and small molecular-weight substances return to the patient.The change of symptoms and the clinical outcomes were observed. We detected the levels of serumal triglyceride,cholesterol and amylase.Furthermore, pre-therapeutic and post- therapeutic APACHEⅡscores were evaluated respectively.
[Results]
16 patients were treated for 19 times at all.The symptoms released observably.14 patients recovered and 2 patients died at last.After treatment,the mean serum concentrations of triglyceride and cholesterol fell significantly by 52.25%and 48.33%respectively,and the APACHEⅡscores decreased by 29.48%.Except mild hypoalbuminemia,no complication was observed.
[Conclusion]
Double filtration plasmapheresis is an effective and safe therapy for hyperlipidemic pancreatitis,and can be valuable for early treatment.
引文
[1]赵文华,张坚,由悦,等.中国18岁及以上人群血脂异常流行特点研究[J].中华预防医学杂志,2005,39:306-310
[2]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[3]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[4]Navarro S,Cubfiella J,Feu F,et al.Hypertriglyceridemic acute pancreatitis:Is its clinical course diferent from lithiasic acute pancreatitis[J].Med Clin(Bare),2004,123(15):567-570.
[5]Kimura W,Mossner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J pancreatol,1996,20:177-184
[6]Havel RJ.Pathogenesis,differentiation and management of hypertriglyceridemia [J].Adv Intern Med,1969,15(1):117.
[7]Fumya T,Komatsu M,Takahashi K,et al.Plasma exchange for hypertriglyceridemic acute necrotizining pancreatitis:repot of two cases[J].Ther Apher,2002,6(6):454.
[8]王刚.高脂血症急性胰腺炎的研究进展[J].中国普通外科杂志,2005,19(11):777-779
[9]Zhao T,Guo J,Ⅱ H.Hemorheological abnormalities in lipoprotein lipase deficient mice with severe hypertriglyceridemia[J].Biochem Biophy Res Conmaun,2006,341(14):1066-1071.
[10]Ooijen B,Kort WJ,Tinga CJ,et al.Significance of thromboxane A_2 and Prostaglandin I_2 in acute neerotizing pancreatltls in rats[J].Dig Dis Sci,1990,35(9):1078-1084.
[11]Toskes PP.Hypedipidemic panereatitis[J].Gastroenterol Clin North Am, 1990,19(4):783.
[12]Mao EQ,Tang YQ,Zhang SD.Formalized therapeutic guideline for hyperlipidemic severe actue pancreatitis[J].World J Gastroenterol,2003,9(11):2622—2626.
[13]Yeh JH,Chen JH,Chiu HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J ClinApher,2003,18:181-185.
[14]Kyriakids AV,Karydakis P,et al.Plasmapheresis in the managment of acute severe hyperlipidemic pancreatitis:report of 5 cases[J].Pancreatology,2005,5:201-204
[15]Miller JP.Serum triglycerides,the liver and the pancreas[J].Curr Opin Lipidol.2000,11:377-382.
[16]Iskandar SB,Olive KE.Plasmapheresis as an adjuvant therapy for hypertriglydemia-induced pancreatitis[J].Am J Med Sci,2004,328:290-294.
[1]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[2]Searles GE,Ooi TC.Underrecognition of chylomicronemiaas a cause of acute pancreatitis[J].CMAJ,1992,147:1806
[3]周亚魁,扬体雄,何跃明.高脂血症性胰腺炎[J].临床外科杂志,2002,10(1):52-53
[4]Berger Z,Quers.R,Poniachik J,et al.Heparin and insulin treatment of acute pancreatitis caused by hypeertriglycefidemia experience of 5 cases[J].Rev Med Chil,2001,1299(12):1373-1378
[5]Keilson LM,Vary CP,Sprecher DL,et al.Hyperlipidemia and pancreatitis during pregnancy in two sister with a mutation in the lipoprotein lipase gene[J].Ann Intern,Med,1996,124(4):425-428.
[6]Kinmm W,Messner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
[7]Havel RJ.Pathogenesis,differentiation and management of hypertriglyceridemia[J].Adv Intern Med,1969,15(1):117.
[8]Fumya T,Komatsu M,Takahashi K,et al.Plasma exchange for hypertriglyceridemic acute necrotizining pancreatitis:repot of two cases[J].Ther Apher,2002,6(6):454.
[9]王刚.高脂血症急性胰腺炎的研究进展[J].中国普通外科杂志,2005,19(11):777-779
[10]Zhao T,Guo J,et al.Hemorheological abnormalities in lipoprotein lipase deficient mice with severe hypertriglyceridemia[J].Biochem Biophy Res Conmaun,2006,341(14):1066-1071.
[11]FortsonMR,Freedman SN,Webster PD,et.Clinical assessment of hyperlipidemic pancreatifis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[12]Okura Y,Hayashi K,Shingu T,et 01.Diagnostic evaluation of actue pancreatitis in two patients with hypertriglycefidemia[J].World J Gastroenterol,2004,10(24):3691-3695.
[13]钟燕敏.高甘油三酯血症对急性胰腺炎诊断的影响[J].浙江实用医学,2004,9(5):320-321.
[14]Yadav D,Pil.chumoni CS.Issues in hyperlipidemic panereatitis[J].J Clin Gasl.roenl,erol,2003,36(1):54.
[15]Navarro S,Cubfiella J,Feu F,et al.Hypertriglyceridemic acute pancreatitis.Is its clinical course diferent from lithiasic acute pancreatitis[J].Med Clin(Bare),2004,123(15):567-570.
[16]袁苏徐,蔡衍郎.高脂血症性急性胰腺炎的临床特点[J].江苏医药杂志,2003,29(1):58.59.
[17]Fortson MR,Freedman SN,Webster PD,et al.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[18]Mao EQ,Tang YQ,Zhang SD.Formalized therapeutic guideline for hyperlipidemic severe actue pancreatitis[J].World J Gastroenterol,2003,9(11):2622-2626.
[19]Huang DB,Raskin P,Diabetic hypertriglyceridemia-induced acute pancreatitis masquerading as biliary pancreatitis[J].J Diabetes Complications,2002,16(2):180-182.
[20]Toskes PP.Hypedipidemic panereatitis[J].Gastroenterol Clin North Am,1990,19(4):783.
[21]Berger Z,Quera.R,Poniachik J,et al.Heparin and insulin treatment of acute pancreatitis caused by hypeertriglycefidemia experience of 5 cases[J].Rev Med Chil,2001,1299(12):1373-1378.
[22]Yeh.JH,Chen JH,Chin HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J Clin.Apher.2003,18:181-185
[23]Kyridkidis AV,Karydakis P,Neofytou N,et al.Plasmapheresis in the management of acute severe hyperlipidemic pancreatitis[J].Pancreatology,2005,5:201-204
[24]Miller JP.Serum triglycerdes,the liver and the pancrease.Curr Opin Lipidol.2000,11:377-382
[25]Chen JH,Yeh JH,Lai HW,et al.Therapeutic plasma exchange in patients with hypertipidemic pancreatitis[J].World J Gastroenterol.2004.10:2272 2274.
[26]Majlis S,Anguita T,Weishaupt R,et al.Plasmapheresis in acute pancreatitis secondary to familial hyperlipidemia in a pregnant woman[J].Rev Med Chil.1989 Nov,117(11):1275-8.
[27]Exbrayat V,Morel J,De Filippis JP,et al.Hypertriglyceridemia-induced pancreatitis in pregnancy.A case report[J].Ann Fr Anesth Reanim.2007Jul-Aug;26(7-8):677-9.
[28]Sattler AM,Bock K,Schmidt S,et al.Excessive hyperchylomicronemia-a rare cause of acute retrosternal and epigastric pain in pregnancy[J].Herz.2003May;28(3):257-61.
[29]Saravanan P,Blumenthal S,Anderson C,et al.Plasma exchange for dramatic gestational hyperlipidemic pancreatitis[J].J Clin Gastroenterol.1996Jun;22(4):295-8.
[30]张道理,李广兰,贾勤惠.妊娠晚期并高脂血症性胰腺炎一例[J].临床内科杂,2005.22:291
[31]朱长举,王万鹏,刘保池.血液透析滤过联合血浆置换治疗妊娠并重度高脂血症性胰腺炎效果观察[J].郑州大学学报(医学版),2007,42:276-278
[32]Piolot A,Nadler F,Cavallero E,et al.Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia:value of regular plasmapheresis [J].Pancreas.1996 Jul;13(1):96-9
[33]陆明晰,胡卫民,冯剑等.二重血浆分离治疗高脂血症及急性高脂血症性胰腺炎[J].全科医学临床与教育,2007,5(5):372-374
[34]Yekebas EF,Ersenberger CF,OhnesorgeH et al.Attenution Of sepsis related to immunoparalysis by continuous veno-venous hemofiitration in experimental porcine pancreatitis[J].Crit Care Med,2001,29:1423
[35]陶京,王春友,杨智勇.血液滤过治疗对重症急性胰腺炎患者血浆炎性细胞因子水平的影响[J].中华普通外科杂志,2004,19(4):233-235
[36]曾振国,夏亮,王联群等.血液滤过在高脂血症性重症胰腺炎中的应用[J].江西医药,2007,42:521-523
[37]魏晓霞.CRRT在治疗重症急性胰腺炎中的应用[J].中华现代临床医学志,2007,5:878
[2]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[3]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[4]Navarro S,Cubfiella J,Feu F,et al.Hypertriglyceridemic acute pancreatitis:Is its clinical course diferent from lithiasic acute pancreatitis[J].Med Clin(Bare),2004,123(15):567-570.
[5]Kimura W,Mossner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J pancreatol,1996,20:177-184
[6]Havel RJ.Pathogenesis,differentiation and management of hypertriglyceridemia [J].Adv Intern Med,1969,15(1):117.
[7]Fumya T,Komatsu M,Takahashi K,et al.Plasma exchange for hypertriglyceridemic acute necrotizining pancreatitis:repot of two cases[J].Ther Apher,2002,6(6):454.
[8]王刚.高脂血症急性胰腺炎的研究进展[J].中国普通外科杂志,2005,19(11):777-779
[9]Zhao T,Guo J,Ⅱ H.Hemorheological abnormalities in lipoprotein lipase deficient mice with severe hypertriglyceridemia[J].Biochem Biophy Res Conmaun,2006,341(14):1066-1071.
[10]Ooijen B,Kort WJ,Tinga CJ,et al.Significance of thromboxane A_2 and Prostaglandin I_2 in acute neerotizing pancreatltls in rats[J].Dig Dis Sci,1990,35(9):1078-1084.
[11]Toskes PP.Hypedipidemic panereatitis[J].Gastroenterol Clin North Am, 1990,19(4):783.
[12]Mao EQ,Tang YQ,Zhang SD.Formalized therapeutic guideline for hyperlipidemic severe actue pancreatitis[J].World J Gastroenterol,2003,9(11):2622—2626.
[13]Yeh JH,Chen JH,Chiu HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J ClinApher,2003,18:181-185.
[14]Kyriakids AV,Karydakis P,et al.Plasmapheresis in the managment of acute severe hyperlipidemic pancreatitis:report of 5 cases[J].Pancreatology,2005,5:201-204
[15]Miller JP.Serum triglycerides,the liver and the pancreas[J].Curr Opin Lipidol.2000,11:377-382.
[16]Iskandar SB,Olive KE.Plasmapheresis as an adjuvant therapy for hypertriglydemia-induced pancreatitis[J].Am J Med Sci,2004,328:290-294.
[1]Fortson MR,Freedman SN,Webster PD.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[2]Searles GE,Ooi TC.Underrecognition of chylomicronemiaas a cause of acute pancreatitis[J].CMAJ,1992,147:1806
[3]周亚魁,扬体雄,何跃明.高脂血症性胰腺炎[J].临床外科杂志,2002,10(1):52-53
[4]Berger Z,Quers.R,Poniachik J,et al.Heparin and insulin treatment of acute pancreatitis caused by hypeertriglycefidemia experience of 5 cases[J].Rev Med Chil,2001,1299(12):1373-1378
[5]Keilson LM,Vary CP,Sprecher DL,et al.Hyperlipidemia and pancreatitis during pregnancy in two sister with a mutation in the lipoprotein lipase gene[J].Ann Intern,Med,1996,124(4):425-428.
[6]Kinmm W,Messner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
[7]Havel RJ.Pathogenesis,differentiation and management of hypertriglyceridemia[J].Adv Intern Med,1969,15(1):117.
[8]Fumya T,Komatsu M,Takahashi K,et al.Plasma exchange for hypertriglyceridemic acute necrotizining pancreatitis:repot of two cases[J].Ther Apher,2002,6(6):454.
[9]王刚.高脂血症急性胰腺炎的研究进展[J].中国普通外科杂志,2005,19(11):777-779
[10]Zhao T,Guo J,et al.Hemorheological abnormalities in lipoprotein lipase deficient mice with severe hypertriglyceridemia[J].Biochem Biophy Res Conmaun,2006,341(14):1066-1071.
[11]FortsonMR,Freedman SN,Webster PD,et.Clinical assessment of hyperlipidemic pancreatifis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[12]Okura Y,Hayashi K,Shingu T,et 01.Diagnostic evaluation of actue pancreatitis in two patients with hypertriglycefidemia[J].World J Gastroenterol,2004,10(24):3691-3695.
[13]钟燕敏.高甘油三酯血症对急性胰腺炎诊断的影响[J].浙江实用医学,2004,9(5):320-321.
[14]Yadav D,Pil.chumoni CS.Issues in hyperlipidemic panereatitis[J].J Clin Gasl.roenl,erol,2003,36(1):54.
[15]Navarro S,Cubfiella J,Feu F,et al.Hypertriglyceridemic acute pancreatitis.Is its clinical course diferent from lithiasic acute pancreatitis[J].Med Clin(Bare),2004,123(15):567-570.
[16]袁苏徐,蔡衍郎.高脂血症性急性胰腺炎的临床特点[J].江苏医药杂志,2003,29(1):58.59.
[17]Fortson MR,Freedman SN,Webster PD,et al.Clinical assessment of hyperlipidemic pancreatitis[J].Am J Gastroenterol,1995,90(12):2134-2139.
[18]Mao EQ,Tang YQ,Zhang SD.Formalized therapeutic guideline for hyperlipidemic severe actue pancreatitis[J].World J Gastroenterol,2003,9(11):2622-2626.
[19]Huang DB,Raskin P,Diabetic hypertriglyceridemia-induced acute pancreatitis masquerading as biliary pancreatitis[J].J Diabetes Complications,2002,16(2):180-182.
[20]Toskes PP.Hypedipidemic panereatitis[J].Gastroenterol Clin North Am,1990,19(4):783.
[21]Berger Z,Quera.R,Poniachik J,et al.Heparin and insulin treatment of acute pancreatitis caused by hypeertriglycefidemia experience of 5 cases[J].Rev Med Chil,2001,1299(12):1373-1378.
[22]Yeh.JH,Chen JH,Chin HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J Clin.Apher.2003,18:181-185
[23]Kyridkidis AV,Karydakis P,Neofytou N,et al.Plasmapheresis in the management of acute severe hyperlipidemic pancreatitis[J].Pancreatology,2005,5:201-204
[24]Miller JP.Serum triglycerdes,the liver and the pancrease.Curr Opin Lipidol.2000,11:377-382
[25]Chen JH,Yeh JH,Lai HW,et al.Therapeutic plasma exchange in patients with hypertipidemic pancreatitis[J].World J Gastroenterol.2004.10:2272 2274.
[26]Majlis S,Anguita T,Weishaupt R,et al.Plasmapheresis in acute pancreatitis secondary to familial hyperlipidemia in a pregnant woman[J].Rev Med Chil.1989 Nov,117(11):1275-8.
[27]Exbrayat V,Morel J,De Filippis JP,et al.Hypertriglyceridemia-induced pancreatitis in pregnancy.A case report[J].Ann Fr Anesth Reanim.2007Jul-Aug;26(7-8):677-9.
[28]Sattler AM,Bock K,Schmidt S,et al.Excessive hyperchylomicronemia-a rare cause of acute retrosternal and epigastric pain in pregnancy[J].Herz.2003May;28(3):257-61.
[29]Saravanan P,Blumenthal S,Anderson C,et al.Plasma exchange for dramatic gestational hyperlipidemic pancreatitis[J].J Clin Gastroenterol.1996Jun;22(4):295-8.
[30]张道理,李广兰,贾勤惠.妊娠晚期并高脂血症性胰腺炎一例[J].临床内科杂,2005.22:291
[31]朱长举,王万鹏,刘保池.血液透析滤过联合血浆置换治疗妊娠并重度高脂血症性胰腺炎效果观察[J].郑州大学学报(医学版),2007,42:276-278
[32]Piolot A,Nadler F,Cavallero E,et al.Prevention of recurrent acute pancreatitis in patients with severe hypertriglyceridemia:value of regular plasmapheresis [J].Pancreas.1996 Jul;13(1):96-9
[33]陆明晰,胡卫民,冯剑等.二重血浆分离治疗高脂血症及急性高脂血症性胰腺炎[J].全科医学临床与教育,2007,5(5):372-374
[34]Yekebas EF,Ersenberger CF,OhnesorgeH et al.Attenution Of sepsis related to immunoparalysis by continuous veno-venous hemofiitration in experimental porcine pancreatitis[J].Crit Care Med,2001,29:1423
[35]陶京,王春友,杨智勇.血液滤过治疗对重症急性胰腺炎患者血浆炎性细胞因子水平的影响[J].中华普通外科杂志,2004,19(4):233-235
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