Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Dig Dis. 2018 Dec;19(12):766-772. doi: 10.1111/1751-2980.12659. Epub 2018 Dec 17.
Acute triglyceride-lowering therapy is crucial in the early treatment of hypertriglyceridemia-induced pancreatitis. This study aimed to compare the efficacy of continuous i.v. infusion of insulin and heparin therapy (IHT) and plasma exchange to lower triglyceride levels in the acute phase of hypertriglyceridemia-induced pancreatitis.
A retrospective observational study was conducted in a tertiary teaching hospital. Patients with hypertriglyceridemia-induced pancreatitis were consecutively enrolled from 2012 to 2017. Serum triglyceride levels and clinical data during hospitalization were collected. The primary outcome was the rapid reduction of triglyceride levels.
Of the 62 patients enrolled, 34 (54.8%) were treated with IHT and the others with plasma exchange. A reduced triglyceride level of (66.9 ± 21.5)% after the first plasma exchange session and that of (75.0 ± 14.6)% after the first day of IHT were observed. There were no significant differences in the reduction of triglyceride (F = 0.334), high sensitivity C-reactive protein (F = 0.127) and the acute physiology and chronic health evaluation II score (F = 2.589) between the two groups (all P > 0.05). The medical cost during hospitalization was significantly lower in the IHT group than in the plasma exchange group (RMB [59 512.4 ± 23 645.1] vs RMB [89 461.9 ± 48 324.0], P < 0.05). Adverse effects were observed in six patients in the plasma exchange group but none in the IHT group.
As a minimally invasive and economical strategy, IHT is effective and non-inferior to plasma exchange in achieving a rapid reduction of triglyceride levels.
急性甘油三酯降低治疗在治疗高甘油三酯血症诱导的胰腺炎中至关重要。本研究旨在比较连续静脉输注胰岛素和肝素治疗（IHT）与血浆置换降低高甘油三酯血症诱导的胰腺炎急性期甘油三酯水平的疗效。
在一家三级教学医院进行了一项回顾性观察性研究。2012 年至 2017 年连续纳入高甘油三酯血症诱导的胰腺炎患者。收集住院期间的血清甘油三酯水平和临床数据。主要结局是甘油三酯水平的快速降低。
62 例患者中，34 例（54.8%）接受 IHT 治疗，其余接受血浆置换治疗。第一次血浆置换后甘油三酯水平降低（66.9±21.5）%，第一次 IHT 后降低（75.0±14.6）%。两组间甘油三酯（F=0.334）、高敏 C 反应蛋白（F=0.127）和急性生理和慢性健康评估 II 评分（F=2.589）的降低无显著差异（均 P>0.05）。IHT 组住院期间的医疗费用明显低于血浆置换组（人民币[59512.4±23645.1]比人民币[89461.9±48324.0]，P<0.05）。血浆置换组有 6 例出现不良反应，而 IHT 组无不良反应。
作为一种微创且经济的策略，IHT 在实现甘油三酯水平的快速降低方面与血浆置换同样有效且不劣于后者。
