Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
Department of Internal Medicine, Turkish Ministry of Health, Mut State Hospital, Mersin, Turkey.
Ir J Med Sci. 2024 Oct;193(5):2259-2267. doi: 10.1007/s11845-024-03725-2. Epub 2024 Jun 3.
The use of therapeutic plasma exchange (TPE) for treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) remains controversial in the literature. This study compared the clinical outcomes of TPE versus conventional therapy in patients with HTGP.
Fifty-five patients with HTGP were included. Patients were retrospectively compared in pairs: those who received TPE treatment and those who did not, those whose triglyceride level fell below 500 mg/dL within 48 h, and those who did not, those with and without persistent organ failure. The primary outcome was the percentage of triglyceride reduction within 48 h. Secondary outcomes were the length of hospital stay, mortality, cost-effectiveness, and persistent organ failure.
Percentage decrease in triglyceride levels, medical hospitalization costs, and length of hospital stay were higher in the TPE group compared to the non-TPE group (p < 0.05, for each). However, there was no difference regarding persistent organ failure and mortality (p > 0.05, for each). The length of hospital stay, average cost, persistent organ failure, and mortality were similar in both groups whose triglyceride level fell below 500 mg/dL within 48 h and those who did not (p > 0.05, for each). Among patients with persistent organ failure, average cost was higher in the TPE group compared to the non-TPE group (p < 0.05). An independent relation was found between the average cost and persistent organ failure, TPE, length of hospital stay, albumin, and urea values in all patients (p < 0.05, for each).
The approach of using TPE for treatment of HTGP was not found to be superior to the conventional treatment. Randomized controlled studies with larger number of patients are needed to gain better understanding of this issue.
文献中对于治疗性血浆置换（TPE）治疗高三酰甘油血症性胰腺炎（HTGP）的效果仍存在争议。本研究比较了 TPE 与常规治疗用于 HTGP 患者的临床结局。
纳入 55 例 HTGP 患者。将患者按配对回顾性比较：接受 TPE 治疗的患者与未接受治疗的患者、48 小时内三酰甘油水平降至 500mg/dL 以下的患者与未降至 500mg/dL 以下的患者、发生持续性器官衰竭的患者与未发生持续性器官衰竭的患者。主要结局为 48 小时内三酰甘油降低的百分比。次要结局为住院时间、死亡率、成本效益和持续性器官衰竭。
与非 TPE 组相比，TPE 组的三酰甘油水平降低百分比、医疗住院费用和住院时间均更高（p<0.05，各指标）。然而，两组持续性器官衰竭和死亡率无差异（p>0.05，各指标）。48 小时内三酰甘油水平降至 500mg/dL 以下的两组患者和未降至 500mg/dL 以下的两组患者的住院时间、平均费用、持续性器官衰竭和死亡率相似（p>0.05，各指标）。在发生持续性器官衰竭的患者中，TPE 组的平均费用高于非 TPE 组（p<0.05）。所有患者的平均费用与持续性器官衰竭、TPE、住院时间、白蛋白和尿素值之间存在独立关系（p<0.05，各指标）。
使用 TPE 治疗 HTGP 的方法并不优于常规治疗。需要开展纳入更多患者的随机对照研究以更好地了解这一问题。
