Clinical Prognosis Of Hyperlipidemic Severe Acute Pancreatitis Treated With Plasma Exchange

Research background and purpose:The main causes of acute pancreatitis are cholelithiasis,alcohol consumption,hypertriglyceridemia.Pancreatitis caused by hypertriglyceridemia(HTG)is more serious than AP caused by other causes,and the mortality rate is very high once it develops into severe disease.The exact pathophysiology of HTG-induced AP remains unclear.At present,the most recognized mechanism is the hydrolysis of Triglyceride(TG)by pancreatic lipase into Free Fatty Acid(FFA),which produces toxic effects on pancreatic epithelial cells and glandular cells.Therefore,it develops into Hyperlipidemia Acute Pancreatitis(HLAP).The most important treatment for HLAP is to reduce the level of blood lipids,and the general treatment measures have a slow effect on lowering blood lipids.Among them,patients with Hyperlipidemia Severe Acute Pancreatitis(HLSAP)develop rapidly,often accompanied by organ failure,and the mortality rate is extremely high.Previous studies have shown that plasma exchange can rapidly reduce TG,but the cost of plasma exchange is high and expensive.There are few relevant studies on plasma exchange in the treatment of HLSAP,most of which are retrospective case reports and lack of prospective randomized controlled trials.Therefore,this study mainly conducted a prospective randomized controlled trial to understand the effect of plasma exchange on the prognosis of HLSAP,in order to provide valuable information for clinical practice.Materials and Methods:Using the prospective study method,patients with Hyperlipidemia Acute Pancreatitis(HLAP)admitted to our hospital from August 2020 to January 2023 were randomly divided into two groups: experimental group and control group.A total of 58 patients who met the inclusion and exclusion criteria and agreed to participate in the study were enrolled by January 2023.Patients in the control group were given conventional standard conservative treatment(diet control,analgesia,fluid resuscitation,lipid-lowering drugs,heparin,insulin),and patients in the experimental group were treated with plasma exchange on the basis of conventional standard conservative treatment.The clinical indicators,incidence of complications,length of hospital stay,cost and mortality of the two groups were compared and analyzed.Results:1.A total of in 58 patients with HLAP were included in this study,of which 24 cases were in the experimental group and 34 cases were in the control group.In the experimental group: 19 patients with severe acute pancreatitis and 5 patients with nonsevere acute pancreatitis,and in the control group there were 14 patients with severe disease and 20 patients with non-severe disease.There were no statistical differences between the patients in the experimental and control groups in terms of age,gender,incidence of SIRS at admission,APACHE II score,blood AMY,blood LPS,blood glucose,TG,serum calcium ion,WBC,PCT,lactate,and LDL.2.There was no significant difference in mortality,length of hospital stay and incidence of complications between conventional treatment and combined plasma exchange treatment for HLAP patients.The clinical hospitalization cost of combined plasma exchange group was significantly higher,and the length of ICU stay was also increased.3.In non-severe HLAP patients,the hospitalization cost and ICU stay days in the combined plasma exchange group were significantly higher than those in the conventional treatment group,and the difference was statistically significant.However,there were no significant differences in mortality,clinical complications,and total length of hospital stay between the two groups.4.There were no significant differences in mortality,length of hospital stay,length of ICU stay,and incidence of complications between conventional treatment and combined plasma exchange treatment for HLSAP patients with different treatment regimens,but the clinical hospitalization cost of combined plasma exchange group was significantly higher,and the difference was statistically significant.5.By comparing the blood lipid levels 1 day after the first plasma exchange in the experimental group with those in the control group after conventional standard conservative treatment,it can be concluded that the two treatment schemes can significantly reduce the level of TG in plasma,but the experimental group has more advantages in reducing blood lipids(TG reduction rate before and after treatment:Experimental group 80.49%±12.4%,control group 71.13%±16.27%,P<0.05).Conclusion:Combined plasma exchange does not significantly improve clinical prognosis in either HLSAP or non-surgical HLAP,and it also increases clinical costs and causes prolonged ICU stay in non-surgical HLAP patients.Both conventional standard conservative therapy and combined plasma exchange can reduce TG levels in patients with HLAP,but combined plasma exchange is more advantageous in terms of lipid lowering rate.