Piplani Shobhit, Jain Arpit, Singh Kamaldeep, Gulati Shreya, Chaturvedi Salil, Bejugam Vishal Reddy, Brown Donclair, Asuzu Chisom, Kolli Shiny Teja, Shah Usman, Reet Jashan, Mihajlovic Milos, Jelic Vladimir, Jelic Gavro, Roberts Rosalba Santana De, Damania Dushyant, Radulovic Miroslav
Department of Internal Medicine, Jacobi Medical Center/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, Bronx, NY, USA (Shobhit Piplani, Salil Chaturvedi, Vishal Reddy Bejugam, Donclair Brown, Chisom Asuzu, Shiny Teja Kolli, Usman Shah, Jashan Reet, Milos Mihajlovic, Vladimir Jelic, Rosalba Santana De Roberts, Dushyant Damania).
Department of Emergency Medicine, All India Institute of Medical Sciences, Delhi, India (Shobhit Arpit Jain).
Ann Gastroenterol. 2024 Jan-Feb;37(1):109-116. doi: 10.20524/aog.2023.0849. Epub 2023 Dec 20.
Hypertriglyceridemia is a common cause of acute pancreatitis (AP). This literature review compared the effectiveness and adverse events of insulin therapy, with or without heparin, and plasmapheresis, in reducing triglyceride levels in patients with hypertriglyceridemia-induced AP.
Systematic reviews, meta-analyses, evidence syntheses, editorials, commentaries, protocols, abstracts, theses and preprints were excluded. Review Manager was used to conduct the meta-analysis. The literature search yielded 2765 articles, but only 5 were included in the systematic review and meta-analysis and the total number of participants in the review was 269.
From this study's analysis, insulin ± heparin was more successful in reducing triglyceride levels than plasmapheresis (standardized mean difference -0.37, 95% confidence interval [CI] 0.99 to 0.25; P=0.25). Insulin ± heparin therapy had a lower mortality rate than plasmapheresis (risk ratio [RR] 0.70, 95%CI 0.25-1.95). Hypotension, hypoglycemia, and acute renal failure were less common in the plasmapheresis therapy group than in insulin ± heparin therapy (RR 1.13, 95%CI 0.46-2.81, RR 3.90, 95%CI 0.45-33.78, and RR 0.48, 95%CI 0.02-13.98 for hypotension, hypoglycemia, and acute renal failure, respectively).
This study found no significant difference in mortality between insulin ± heparin therapy and plasmapheresis used for the reduction in triglyceride levels. It is notable that no substantial differences were observed in the most common side-effects encountered during these therapies, thus indicating non-inferiority.
高甘油三酯血症是急性胰腺炎（AP）的常见病因。本综述比较了胰岛素治疗（有无肝素）和血浆置换在降低高甘油三酯血症诱导的急性胰腺炎患者甘油三酯水平方面的有效性和不良事件。
排除系统评价、荟萃分析、证据合成、社论、评论、方案、摘要、论文和预印本。使用Review Manager进行荟萃分析。文献检索共获得2765篇文章，但只有5篇被纳入系统评价和荟萃分析，综述中的参与者总数为269人。
根据本研究的分析，胰岛素±肝素在降低甘油三酯水平方面比血浆置换更成功（标准化均数差-0.37，95%置信区间[CI]0.99至0.25；P=0.25）。胰岛素±肝素治疗的死亡率低于血浆置换（风险比[RR]0.70，95%CI 0.25-1.95）。血浆置换治疗组的低血压、低血糖和急性肾衰竭比胰岛素±肝素治疗组少见（低血压、低血糖和急性肾衰竭的RR分别为1.13，95%CI 0.46-2.81；RR 3.90，95%CI 0.45-33.78；RR 0.48，95%CI 0.02-13.98）。
本研究发现，胰岛素±肝素治疗和血浆置换在降低甘油三酯水平方面的死亡率无显著差异。值得注意的是，在这些治疗过程中遇到的最常见副作用方面未观察到实质性差异，因此表明两者非劣效。
