Luo Xiang, Li Xiaoling, Lai Xiaoyan, Mao Wenjian, Ke Lu, Fu Lingyan, Gao Lin, Liu Yaolu
Department of Critical Care Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
BMJ Open Gastroenterol. 2025 Jan 22;12(1):e001620. doi: 10.1136/bmjgast-2024-001620.
It is controversial whether rapid lowering of triglyceride (TG) levels is associated with clinical benefits in patients with hypertriglyceridaemia-associated acute pancreatitis (HTG-AP). In particular, patients with different severity of disease may respond differently to TG-lowering therapy. In this study, we aimed to explore the association between rapid decline in serum TG levels and organ failure in patients with different severities of HTG-AP.
This is a secondary analysis of data from a multicentre, prospective registry recruiting HTG-AP patients admitted within 72 hours from the onset of symptoms. Patients were dichotomised into either target reaching (TG≤5.65 mmol/L on study day 3) or not. The primary outcome was the presence of organ failure at day 14. The association between target-reaching and the primary outcome was modelled. Furthermore, subgroup analyses were conducted based on the disease severity of HTG-AP patients at enrolment.
Overall, 413 patients were included for analysis, of whom 192 (46.5%) reached the target on day 3. For the overall study cohort, there was no significant difference in presence of organ failure at day 14 between patients reaching the target or not (3.1% vs 6.8%, p=0.091). In the subgroup of HTG-AP patients with organ failure at enrolment, compared with patients with TG>5.65 mmol/L on day 3, patients who reached the target had significantly lower presence of organ failure at day 14 (7.8% vs 22%, p=0.039) and lower incidence of infected pancreatic necrosis within 60 days (3.1% vs 11.9%, p=0.049). Similar findings were seen in the subgroup with more severe HTG-AP (APACHE II ≥8 at enrolment).
More rapid decline of serum TG levels was associated with decreased presence of organ failure at day 14 in patients with more severe HTG-AP.
The Chinese Clinical Trial Registry, number ChiCTR2000039541.
对于高甘油三酯血症相关性急性胰腺炎（HTG-AP）患者，快速降低甘油三酯（TG）水平是否具有临床益处存在争议。特别是，不同疾病严重程度的患者对TG降低治疗的反应可能不同。在本研究中，我们旨在探讨HTG-AP不同严重程度患者血清TG水平的快速下降与器官衰竭之间的关联。
这是一项对多中心前瞻性登记数据的二次分析，该登记纳入了症状发作后72小时内入院的HTG-AP患者。患者被分为达标组（研究第3天TG≤5.65 mmol/L）和未达标组。主要结局是第14天时器官衰竭的存在情况。对达标与主要结局之间的关联进行建模。此外，根据入组时HTG-AP患者的疾病严重程度进行亚组分析。
总体而言，413例患者纳入分析，其中192例（46.5%）在第3天达标。对于整个研究队列，达标患者与未达标患者在第14天时器官衰竭的存在情况无显著差异（3.1%对6.8%，p = 0.091）。在入组时存在器官衰竭的HTG-AP患者亚组中，与第3天TG>5.65 mmol/L的患者相比，达标患者在第14天时器官衰竭的存在情况显著更低（7.8%对22%，p = 0.039），且60天内感染性胰腺坏死的发生率更低（3.1%对11.9%，p = 0.049）。在HTG-AP更严重（入组时急性生理与慢性健康状况评分系统II≥8）的亚组中也观察到类似结果。
在更严重的HTG-AP患者中，血清TG水平更快下降与第14天时器官衰竭存在情况的降低相关。
中国临床试验注册中心，注册号ChiCTR2000039541。
