The Study On Blood Purification Therapy For Hyperlipidemia Acute Pancreatitis

Objectives: To guide clinical practice in different severity of hyperlipidemia acute pancreatitis(HTG-AP),we retrospectively analyzed the diagnosis and therapeutic characteristics of the disease.Methods: We retrospectively analyzed 90 patients with HTG-AP patients who were admitted to Central Hospital affiliated to Dalian Medical University in the period of June 2011 to December 2017.The data were integrated and met with the inclusion criteria.A total of 60 patients were analyzed.According to the classification of Atlanta criterion for acute pancreatitis in 2012,the patients were divided into mild acute pancreatitis(MAP,30 cases),moderately severe acute pancreatitis(MSAP,18 cases),severe acute pancreatitis(SAP,9 cases).According to treatment methods that divided into routine treatment and blood purification which was divided into plasmapheresis(DFPP/PE,38 cases)and continuous renal replacement therapy(CRRT,7 cases).Recording patients gender,age,body mass index(BMI),vital signs,WBC,PLT,HCT%,Glu,Ca +,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),BUN,Alb,ALT,Scr,total bilirubin(TBil),serum amylase(AMY),abdominal CT or ultrasound,APACHE II score,Ranson score,BISAP score,MCTSI score,modified Marshall score,and hospital stay.The data were statistically analyzed.Results:1.The mean decreased TG was [(12.12 ± 4.65)mmol/L VS(15.57 ± 7.69)mmol/L] in the routine group and the plasmapheresis group respectively.There was no statistical difference between the two groups in decreasing TG(P=0.078).2.The decreased TG in the routine therapy of MAP and CRRT therapy of SAP were [(12.12 ± 4.65)mmol/L VS(4.89 ± 3.06)mmol/L] which have significant difference(p=0.000).3.The decreased triglyceride levels in the plasmapheresis group and the CRRT group were [(15.57±7.69)mmol/L 4.VS(4.89±3.06)mmol/L] which have significant difference(p=0.000).4.The levels of TG after treatment in the routine subgroup and plasmapheresis subgroup of the MAP group were [(12.12±4.65)mmol/L VS(16.72±9.14)mmol/L]respectively which have no statistical difference(p=0.077).There was 1 patient who's TG had no significant change on the second day of admission(21.03 VS 20.35)mmol/L.New clinical symptoms such as breathing difficulties,low pulse oxygen have appeared who was transfer into the ICU for plasmapheresis.After treatment,the level of TG was significantly decreased(20.35 VS 8.9)mmol/L.5.There was no significant difference in APECHEII scores after plasmapheresis treatment in MAP(P>0.05).However,the APECHEII scores in the MSAP and SAP groups were significantly decreased after plasma exchange(P<0.05).6.The average TG level in SAP patients was(17.28±5.02)mmol/L.After CRRT treatment the TG was(19.18±2.89)mmol/L(P>0.05).Patients' clinical symptoms did not improve and even worsen.Following give plasmapheresis treatment,then the mean TG was(6.74±2.64)mmol/L and clinical symptoms were significantly improved.7.5 SAP patients with AKI who treated with CRRT,the serum creatinine was significantly lower [(166.00±48.99)mmol/L VS(75.40±14.72)mmol/L](P=0.001).Conclusions:1.For mild hyperlipidemia acute pancreatitis,plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis.2.For MAP,we can consider routine treatment firstly.However,for MSAP or SAP,we should consider plasmaphresis which can clear TG as soon as possible to prevent deterioration.3.There was no obvious decrease,even increase of TG in some HLAP patients after routine therapy or blood purification therapy which may be the reasons for adverse prognosis or increased complications.And then,plasmapheresis was needed to reduce TG as soon as possible.4.In terms of serum TG clearance rate,DFPP / PE is higher than CRRT.For SAP patients who combined with AKI can take CRRT therapy to protect renal function.However,in the reduction of TG maybe ineffective which need to be combined with plasmapheresis.