Meta Analysis Of Effective Of Hypertriglyceridemic Acute Pancreatitis With Plasma Exchange

Background:The incidence of hypertriglyceridemic acute pancreatitis(HTG-AP)is increasing year by year,and is currently the second leading cause of AP in China.As one of the treatment methods for HTG-AP,the true efficacy of plasma exchange(PE)is still controversial,and there is a lack of evidence from multi-center,randomized,controlled clinical studies.The meta analysis of multiple small samples can be regarded as a complementary means to accumulate relevant data and guide clinical practice.Objective:The clinical efficacy of plasma exchange in HTG-AP was evaluated by metaanalysis to provide scientific reference for clinical treatment.Methods:Literature was collected by searching Chinese Bio Medical(CBM),CNKI,VIP,Wanfang,Pub Med,Embase,Cochrane Library and Web of Science databases.The literature retrieval period was from the establishment of the database to December 2021.The retrieval results were screened according to inclusion criteria and exclusion criteria.Quality evaluation and data extraction were performed in randomized controlled studies of the plasma exchange based on using with drug therapy(PE group)and drug therapy(drug therapy group).Finally,meta analysis was performed using Revman5.4.Results:After screening,23 literatures were included in this study,with a total sample size of 1368 cases,including 672 cases in the PE group and 696 cases in the drug therapy group.Meta analysis results showed that: Compared with the drug therapy group,TG decreased significantly in PE group(MD=7.84,95%CI=[4.99,10.69],P <0.00001),CRP level was lower(MD=-17.20,95%CI=[-26.07,-8.32].P=0.00001),A PACHE-II score was better(MD=-1.92,95%CI=[-2.60,-1.24],P < 0.00001),Balthazar CT score was better(MD=-0.65,95%CI=[-0.81,-0.50],P < 0.00001),abdominal pain relief time was shorter(MD=-2.49,95%CI=[-3.56,1.41],P < 0.00001),length of hospital stay was shorter(MD=-7.24,95%CI=[-10.05,-4.43],P <0.00001),effective rate was higher(RR=1.38,95%CI=[1.11,1.55],P < 0.00001)and fatality rate lower(RR=0.39,95%CI=[0.23,0.66],P=0.0004).The effect of combined use of PE on improving oxygenation index was not determined.Conclusion:(1)In HTG-AP patients,compared with drug therapy alone,in the PE group,TG could be removed more significantly,serum CRP value was lower,APACHE-II score and balthazar CT score were better,abdominal pain relief time and length of hospital stay was shorter,treatment efficiency and mortality was improved.(2)At present,it has not been fully proved that in HTG-AP patients,compared with drug therapy alone,combined with PE can improve the oxygenation index.