Effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis_West China Medical Journal

Authors：

PAN Xuedong , CHEN Yi ,  QIAO Zhenguo

Department of Gastroenterology, Affiliated Wujiang Hospital of Nantong University, Suzhou, Jiangsu 215200, P. R. China;

Corresponding author：

QIAO Zhenguo, Email: qzg66666666@163.com

Keywords：

Hemoperfusion; Hemofiltration; Hyperlipidemia; Pancreatitis; Inflammatory mediators

DOI：

10.7507/1002-0179.201509202

Video：

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Objective To study the clinical protective effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis (HLSAP). Methods Thirty-seven patients with HLSAP treated between January 2012 and December 2014 were selected and divided into three groups based on different treatments. Thirteen patients were allocated into hemoperfusion combined with continuous veno-venous hemofiltration group (HP+CVVH group) and treated with hemoperfusion combined with hemofiltration; 11 patients were allocated into continuous veno-venous hemofiltration group (CVVH group) and treated with hemofiltration; and all the other patients were allocated into control group and treated with conventional treatment. The levels of blood triglyceride, C-reactive protein, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) and acute physiology and chronic health evaluation (APACHE)Ⅱ score of the patients after treatment were observed. The hospital stay, organ dysfunction rate and mortality of the patients were measured. Results Compared with the control group, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group and CVVH group were both significantly reduced 72 hours after therapy (P<0.05). However, the levels of blood triglyceride, C-reactive protein, TNF-α, IL-6, IL-8 and APACHE Ⅱ score of the patients in the HP+CVVH group were significantly lower than those in the CVVH group at the same time point (P<0.05). The hospital stay of the patients in the HP+CVVH group and CVVH group was significantly shorter than that in the control group (P<0.05). Compared with the CVVH group, the hospital stay of patients in the HP+CVVH group was significantly shorter (P<0.05). There was no statistical difference in organ dysfunction rate and mortality among the three groups (P>0.05). Conclusion Hemoperfusion combined with hemofiltration is an effective method for HLSAP by cleaning the inflammatory mediators availably and inhibiting the excessive inflammatory reaction.

Citation： PANXuedong, CHENYi, QIAOZhenguo. Effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis. West China Medical Journal, 2017, 32(2): 169-173. doi: 10.7507/1002-0179.201509202 Copy

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4.	中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编辑委员会, 《中华消化杂志》编辑委员会. 中国急性胰腺炎诊治指南 (2013 年, 上海). 临床肝胆病杂志, 2013, 29(9): 656-660.
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6.	Sun S, He L, Bai M,et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study. Ann Saudi Med, 2015, 35(5): 352-358.
7.	Tang Y, Zhang L, Fu P,et al. Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report. Int Urol Nephrol, 2012, 44(3): 987-990.
8.	方步武, 邱奇, 吴咸中, 等. 急腹症并发多器官功能障碍综合征细胞因子及炎症介质与肽类激素的变化. 中国危重病急救医学, 2003, 15(1): 19-22.
9.	Kirchhoff C, Biberthaler P, Mutschler WE,et al. Early down-regulation of the pro-inflammatory potential of monocytes is correlated to organ dysfunction in patients after severe multiple injury: a cohort study. Crit Care, 2009, 13(3): R88.
10.	Ramudo L, Manso A, Sevillano S,et al. Kinetic study of TNF-alpha production and its regulatory mechanisms in acinar cells during acute pancreatitis induced by bile-pancreatic duct obstruction. J Pathol, 2005, 206(1): 9-16.
11.	祝建红, 陈卫昌, 叶建新. 沙利度胺对大鼠急性坏死性胰腺炎保护作用的实验研究. 中华胰腺病杂志, 2011, 11(3): 203-206.
12.	Hong B, Ling Z, Songmin H,et al. Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis. Ren Fail, 2012, 34(3): 383-386.
13.	Kielstein T, Burkhardt O. Dosing of antibiotics in critically ill patients undergoing renal replacement therapy. Curr Pharm Biotechnol, 2011, 12(12): 2015-2019.
14.	Malmstrøm ML, Hansen MB, Andersen AM,et al. Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis. Pancreas, 2012, 41(2): 271-277.
15.	张远超, 喻莉, 耿峰, 等. 血液灌流联合血液滤过治疗高脂血症性胰腺炎的效果观察. 中华肝胆外科杂志, 2014, 20(4): 274-276.
16.	Yekebas F, Eisenberger F, Ohnesorge H,et al. Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis. Crit Care Med, 2001, 29(7): 1423-1430.

1. Xu C, Qiao Z, Lu Y,et al. Influence of fatty liver on the severity and clinical outcome in acute pancreatitis. PLoS One, 2015, 10(11): e0142278.
2. 黄忠, 李智. 胸腔积液及高脂血症对重症急性胰腺炎发生的预测作用. 华西医学, 2016, 31(1): 103-105.
3. Tsuang W, Navaneethan U, Ruiz L,et al. Hypertriglyceridemic pancreatitis: presentation and management. Am J Gastroenterol, 2009, 104(4): 984-991.
4. 中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编辑委员会, 《中华消化杂志》编辑委员会. 中国急性胰腺炎诊治指南 (2013 年, 上海). 临床肝胆病杂志, 2013, 29(9): 656-660.
5. 苏军凯, 李兆申. 血液净化治疗高脂血症性胰腺炎研究进展. 胰腺病学, 2006, 6(5): 310-312.
6. Sun S, He L, Bai M,et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study. Ann Saudi Med, 2015, 35(5): 352-358.
7. Tang Y, Zhang L, Fu P,et al. Hemoperfusion plus continuous veno-venous hemofiltration in a pregnant woman with severe acute pancreatitis: a case report. Int Urol Nephrol, 2012, 44(3): 987-990.
8. 方步武, 邱奇, 吴咸中, 等. 急腹症并发多器官功能障碍综合征细胞因子及炎症介质与肽类激素的变化. 中国危重病急救医学, 2003, 15(1): 19-22.
9. Kirchhoff C, Biberthaler P, Mutschler WE,et al. Early down-regulation of the pro-inflammatory potential of monocytes is correlated to organ dysfunction in patients after severe multiple injury: a cohort study. Crit Care, 2009, 13(3): R88.
10. Ramudo L, Manso A, Sevillano S,et al. Kinetic study of TNF-alpha production and its regulatory mechanisms in acinar cells during acute pancreatitis induced by bile-pancreatic duct obstruction. J Pathol, 2005, 206(1): 9-16.
11. 祝建红, 陈卫昌, 叶建新. 沙利度胺对大鼠急性坏死性胰腺炎保护作用的实验研究. 中华胰腺病杂志, 2011, 11(3): 203-206.
12. Hong B, Ling Z, Songmin H,et al. Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis. Ren Fail, 2012, 34(3): 383-386.
13. Kielstein T, Burkhardt O. Dosing of antibiotics in critically ill patients undergoing renal replacement therapy. Curr Pharm Biotechnol, 2011, 12(12): 2015-2019.
14. Malmstrøm ML, Hansen MB, Andersen AM,et al. Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis. Pancreas, 2012, 41(2): 271-277.
15. 张远超, 喻莉, 耿峰, 等. 血液灌流联合血液滤过治疗高脂血症性胰腺炎的效果观察. 中华肝胆外科杂志, 2014, 20(4): 274-276.
16. Yekebas F, Eisenberger F, Ohnesorge H,et al. Attenuation of sepsis-related immunoparalysis by continuous veno-venous hemofiltration in experimental porcine pancreatitis. Crit Care Med, 2001, 29(7): 1423-1430.

West China Medical Journal

Effect of hemoperfusion combined with hemofiltration on inflammatory reaction of hyperlipidemia severe acute pancreatitis

Abstract Full text Figures/Tables Video References Cited by

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