Intensive Care Unit, The First Affiliated Hospital of Xiamen University, NO. 55, Zhenhai Road, Siming District, Xiamen City, Fujian, 361003, People's Republic of China.
Xiamen Blood Center, NO. 121, Hubin South Road, Siming District, Xiamen City, Fujian, 361004, People's Republic of China.
BMC Gastroenterol. 2021 Jan 6;21(1):3. doi: 10.1186/s12876-020-01572-w.
What kind of patients with hypertriglyceridemic acute pancreatitis (HLAP) might benefit from plasmapheresis (PP) remains unknown. The objective of this study is to determine the predict function of total cholesterol (TC) on the Triglyceride (TG)-lowing effect in patients on either non-PP or PP therapy.
Patients were categorized into high total cholesterol (HTC)/low total cholesterol (LTC) groups based on TC level of 12.4 mmol/L. The primary outcome was TG reduction to below 500 mg/dL within 48 h. Linear mixed-effect model and logistic regression analyses were used to assess the association of TC level and TG-lowing efficacy in different therapy groups.
Compared with LTC group, patients with HTC showed more severe imaging manifestations (p < 0.001) and higher APACH II scores (p = 0.036). Deaths occurred only in HTC groups. Significant interaction of time sequence with the 2 TGs-lowing therapy groups on TG level was only found in HTC group (p < 0.001). In patients with elevated TC level, primary outcome occurred in 66.67% of patients in the PP group, and 27.91% in the non-PP group. After adjustment for age, gender, CT grade and APACH II score, the odd ratio remain significant (OR 5.47, 95% confidence interval [CI] 1.84-16.25, p = 0.002). Furthermore, in patients with lower TC level, no significant difference was found in primary outcome between PP group and non-PP group (81.25% versus 62.30%, adjusted OR 2.05; 95% CI 0.45-9.40; p = 0.353).
TC could be a potential biomarker to predict the effects of TG-lowing therapy in patients with HLAP.
高甘油三酯血症性急性胰腺炎（HLAP）患者中，哪些患者可能从血浆置换（PP）中获益尚不清楚。本研究旨在确定总胆固醇（TC）水平对非 PP 或 PP 治疗患者 TG 降低效果的预测作用。
根据 TC 水平 12.4mmol/L，患者分为高总胆固醇（HTC）/低总胆固醇（LTC）组。主要结局是在 48 小时内 TG 降低至 500mg/dL 以下。采用线性混合效应模型和逻辑回归分析评估 TC 水平与不同治疗组 TG 降低效果的关系。
与 LTC 组相比，HTC 组患者的影像学表现更严重（p<0.001），APACH II 评分更高（p=0.036）。死亡仅发生在 HTC 组。仅在 HTC 组中，时间序列与两种 TG 降低治疗组之间的 TG 水平存在显著交互作用（p<0.001）。在 TC 水平升高的患者中，PP 组的主要结局发生率为 66.67%，非 PP 组为 27.91%。调整年龄、性别、CT 分级和 APACH II 评分后，比值比仍有显著性（OR 5.47，95%置信区间[CI]1.84-16.25，p=0.002）。此外，在 TC 水平较低的患者中，PP 组和非 PP 组的主要结局无显著差异（81.25%与 62.30%，调整 OR 2.05；95%CI 0.45-9.40；p=0.353）。
TC 可能是预测 HLAP 患者 TG 降低治疗效果的潜在生物标志物。
