持续静脉-静脉血液滤过伴或不伴血液灌流对高甘油三酯急性胰腺炎患者的影响。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology Pub Date : 2025-03-17 DOI:10.1016/j.clinre.2025.102572

Ying Wang , Gao-fan Dai , Wen-biao Xiao , Jing-shi Shi , Bing-wen Lin , Jian-dong Lin , Xiong-jian Xiao

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引用次数: 0

摘要

背景：持续静脉-静脉血液滤过（CVVH）和CVVH联合血液灌流（HP）在急性胰腺炎（AP）患者中的作用是多种多样的。我们假设HP+CVVH，而不是单独CVVH，可能对高甘油三酯血症(HTG)-AP患者有显著的益处。方法：这项单中心回顾性研究纳入了2020年1月至2023年12月期间接受高甘油三酯(HTH) -AP治疗的347例患者。我们评估了HP+CVVH组和CVVH组之间的短期和长期结局（包括全身和局部并发症的发生率、ICU和住院时间以及费用）的相关性。进行亚组分析以探讨异质性对严重AP （SAP）发生率的影响。结果：86例患者中，40例接受HP+CVVH治疗，46例接受CVVH治疗。亚组分析显示，在降钙素原、c反应蛋白和白细胞介素-6水平较高的患者中，HP+CVVH治疗后严重AP的发生率较低(46.4% vs. 80.0%, p = 0.019；33.3% vs. 72.7%, p = 0.010；37.5% vs. 79.2%)。HP+CVVH组的住院时间（LOS）显著降低（10.40 [8.63-12.17]vs. 15.48[13.02-17.94]天，p = 0.001）。此外，HP+CVVH显示出比CVVH更低的住院费用趋势（5128美元[4312-5943]对8168美元[6416-9920]，p = 0.001）。在全身或局部并发症的发生率、复发率或生活质量方面没有观察到显著差异。结论：对于高炎症负担的HTG-AP患者，HP+CVVH在SAP发生率方面的效果优于CVVH。

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Effects of continuous venous-venous hemofiltration with or without hemoperfusion on patients with hypertriglyceride acute pancreatitis

Background

The role of continuous venous-venous hemofiltration (CVVH) and combined CVVH with hemoperfusion (HP) in patients with acute pancreatitis (AP) is diverse. We hypothesized HP+CVVH, rather than CVVH alone, could have significant benefits in hypertriglyceridemia (HTG)-AP patients.

Methods

This single-center retrospective study included 347 patients with hypertriglyceride (HTH) -AP treated from January 2020 to December 2023. We assessed the association of short- and long-term outcomes (including incidence of systemic and local complications, length of ICU and hospital stays, and costs) between the HP+CVVH and CVVH groups. A subgroup analysis was performed to explore the effects of heterogeneity upon the incidence of severe AP (SAP).

Results

Among 86 included patients, 40 received HP+CVVH therapy, and 46 received CVVH. Subgroup analysis revealed a lower incidence of severe AP after HP+CVVH therapy in patients with high procalcitonin, C-reactive protein, and interleukin-6 levels (46.4 % vs. 80.0 %, p = 0.019; 33.3 % vs. 72.7 %, p = 0.010; 37.5 % vs. 79.2 %, respectively). A significantly decreased hospital length of stay (LOS) in the HP+CVVH group was observed (10.40 [8.63–12.17] vs. 15.48 [13.02–17.94] days, p = 0.001). Furthermore, HP+CVVH showed a tendency towards lower hospital costs than CVVH ($5128 [4312–5943] vs. $8168 [6416–9920], p = 0.001). No significant differences were observed in the incidence of systemic or local complications, recurrence rates, or quality of life.

Conclusions

The use of HP+CVVH yielded superior outcomes in terms of the incidence of SAP compared to that of CVVH, for HTG-AP patients with a high inflammatory burden.

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来源期刊

Clinics and research in hepatology and gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

4.30

自引率

3.70%

发文量

198

审稿时长

42 days

期刊介绍： Clinics and Research in Hepatology and Gastroenterology publishes high-quality original research papers in the field of hepatology and gastroenterology. The editors put the accent on rapid communication of new research and clinical developments and so called "hot topic" issues. Following a clear Editorial line, besides original articles and case reports, each issue features editorials, commentaries and reviews. The journal encourages research and discussion between all those involved in the specialty on an international level. All articles are peer reviewed by international experts, the articles in press are online and indexed in the international databases (Current Contents, Pubmed, Scopus, Science Direct). Clinics and Research in Hepatology and Gastroenterology is a subscription journal (with optional open access), which allows you to publish your research without any cost to you (unless you proactively chose the open access option). Your article will be available to all researchers around the globe whose institution has a subscription to the journal.