In recent years, the incidence of hyperlipidemia acute pancreatitis (HLAP) has been increasing year by year, but its pathogenesis has not been completely clear. There are many clinical treatment methods for HLAP, such as lipid-lowering drugs, low molecular weight heparin, insulin, and plasma exchange. Actively reducing serum triglyceride is the core of treatment. Plasma exchange can quickly and effectively reduce the level of triglyceride, and its application in the treatment of HLAP is gradually increasing. This article reviews the recent advances in the pathogenesis, clinical characteristics, diagnosis, and treatment of HLAP, focusing on the mechanism, indications, timing, and disadvantages of plasma exchange therapy for HLAP.
Objective To study the influence of hyperlipemia on rats with acute pancreatits during pregnancy and its mechanism. Methods Seventy two pregnant Sprague-Dawley rats were randomly divided into the test group and the control group， and then they were fed with high fat diet and balanced diet for 16 days separately. Pregnant rats were given intraperitoneal injection with L-arginine for 2 times (one time is 250 mg/100 g, the other is 200 mg/100 g) at an interval of 1 h. The serum triglyceride (TG), serum amylase (AMS), and lipase (LPS) from blood samples were tested just after injection, and 12 h， 18 h， 24 h， 30 h and 48 h after injection respectively, and wet/dry ratio of pancreas were measured. The histopathological score of pancreatic tissue was evaluated based on microscopic changes, and the expression of TNF-α protein was determined by SP immunohistochemical technique. Results After the last injection, the level of TG in the test group was obviously higher than that in the control group in each time (P＜0.05). The peak values of AMS and LPS in the test group appeared at 24， 18 h respectively, while the peaks appeared at 30， 24 h in the control group, respectively, which were significantly lower than those in the test group (P＜0.05). Compared with the control group, the wet/dry ratio of pancreas in the test group increased at 12, 18 and 24 h after injection (P＜0.05); The pathological changes of pancreas in test group was more serious with higher histopathological score at 0, 12, 18 and 24 h (P＜0.05), and expression of the TNF-α protein was higher at 12, 18 and 24 h (P＜0.05), too. Conclusion Hyperlipemia can make L-arginine-induced-acute-pancreatitis during pregnancy earlier occur and lead to more serious injury in pancreas. This study demonstrates that hyperlipemia may be a high risk factor for acute pancreatitis during pregnancy, making a great amount of free fatty acid released from TG and up-regulated the expression of TNF-α.
ObjectiveTo systematically review the effect and safety of continuous veno-venous hemofiltration (CVVH) on patients with hyperlipidemic pancreatitis. MethodsDatabases including the Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI and WanFang Data were electronically searched for randomized controlled trials (RCTs) about CVVH on patients with hyperlipidemic pancreatitis till Feb. 12, 2014. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 7 trials met eligibility criteria, involving 360 cases, including 183 cases of CVVH group and 177 cases of control group. The results of meta-analysis showed that compared with only routine medical treatment, CVVH significantly reduced the levels of lipid (WMD=-4.63, 95%CI-5.98 to-3.27, P < 0.000 01), levels of IL-6 (WMD=-29.59, 95%CI-34.30 to-24.89, P < 0.000 01), overall mortality (RR=0.39, 95%CI 0.18 to 0.84, P=0.02), and APACHE II score (WMD=-3.34, 95%CI-5.12 to-1.56, P=0.000 2) after treatment. ConclusionCVVH is more effective for hyperlipidemic pancreatitis than only routine medical treatment. Due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are required to verify the above conclusion.
Objective To systematically review the effectiveness and safety of Zhibitai vs. atorvastatin in the treatment of hyperlipidemia. Methods Randomized controlled trials (RCTs) about Zhibitai vs. atorvastatin for hyperlipidemia were electronically retrieved in databases of PubMed, CENTRAL (Issue 7, 2010), CBM,CNKI, VIP and WanFang Data from inception to July, 2012. Two reviewers independently screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results A total of 4 RCTs involving 519 cases were included. The results of meta-analysis showed, Zhibitai was superior to atorvastatin in reducing TG levels after 8-week treatment (MD= −0.12, 95%CI −0.23 to −0.01, P=0.03) and increasing HDL-C levels after 8-week treatment (MD= −0.16, 95%CI −0.22 to −0.11, P=0.000 01). But there was no significant difference in decreasing TC levels and LDL-C levels after 4-week treatment and 8-week treatment as well as decreasing TG levels after 4-week treatment between the two groups. No obvious adverse reaction occurred in the two groups, but atorvastatin may impair liver function. Conclusion Current evidence with weak strength shows that, Zhibitai is superior to atorvastatin in reducing TG levels, and increasing HDL-C levels after 8 weeks. However, they are alike in other blood-fat index and safety. Due to the limited quantity and quality of the included studies, more high quality RCTs are needed to verify the above conclusion.
目的:比较伴或不伴高脂血症的系统性红斑狼疮(SLE)患者的狼疮性肝损害的构成比例,了解高脂血症与狼疮性肝损害的相关性。方法:收集SLE患者100例,根据高脂血症和狼疮性肝损害的诊断标准,将患者分为高脂血症组,非高脂血症组和肝损害组,非肝损害组,收集其相关临床数据进行比较分析。结果:1高脂血症组发生肝损害的比例高于非高脂血症组(χ2=9.908,P=0.002);2血脂水平中甘油三酯与γGT(r=0366,P=0.000),碱性磷酸酶(r=0.241,P=0.018),强的松剂量(r=0.31,P=0.006),24h尿蛋白定量(r=0.273,P=0.007)相关;TC与24h尿蛋白定量(r=0.273,P=0.007)相关;HDL与γ谷氨酸转肽酶(r=0.233,P=0.022),碱性磷酸酶(r=0.265,P=0.009)相关;3-SLE活动组出现高脂血症的比例高于非活动组(χ2=6.986,P=0.008)。结论:长期的高脂血症可导致或加重SLE患者肝功能损害,高脂血症是狼疮性肝损害的危险因素之一。
ObjectiveTo use the evidence map system to search and sort out the clinical research on the prevention and treatment of hyperlipidemia with proprietary Chinese medicine, and to understand the distribution of evidence in this field. MethodsThe literature on the treatment of hyperlipidemia with proprietary Chinese medicines was retrieved from CNKI, WanFang Data, VIP, SinoMed, PubMed, Cochrane Library, Embase and Web of Science databases from inception to December 2022. The distribution characteristics of evidence were analyzed and presented by means of text and graph. ResultsA total of 865 articles were included and 79 kinds of proprietary Chinese medicines were obtained. The Xuezhikang tablets or capsules were the most frequently used. In recent years, the number of published articles showed a downward trend, and the literature quality was generally low. Most of the research intervention programs only used Chinese patent medicine, and the sample size of a single study was mostly 60-100 patients, and the study course was 4-8 weeks. Clinical studies did not highlight the characteristics of traditional Chinese medicine, and only 12.7% of the studies limited the syndrome type of traditional Chinese medicine in the study population. In terms of the selection of outcome indicators, more attention was paid to blood lipid levels and safety indicators, while less attention was paid to indicators such as traditional Chinese medicine syndrome scores. ConclusionThe results show that Chinese patent medicine has certain advantages in the prevention and treatment of hyperlipidemia, but there are some deficiencies in the reports of methodology and clinical characteristics, and the overall quality of the research is low.
ObjectTo observe the clinical efficacy and safety of the combination therapy of atorvastatin and JiangZhi Decoction (ZJD) for primary hyperlipidemia (Tan Zhuo Zu E Zheng) and to analyze the interactions of drugs in hypolipidemic effect. MethodsA 2*2 factorial design, single-blind, stratified randomized controlled trial according to the level of lipid was conducted. Primary hyperlipidemia (Tan Zhuo Zu E Zheng) patients met the inclusion criteria were divided into 5 groups:ATV 10 mg group (group A), ATV 20 mg group (group B), ATV 10 mg+JZD group (group C), ATV 20 mg+JZD group (group D), JZD group (group E). After two weeks treatment, the efficacy and safety among the 5 groups were compared. ResultsA total of 92 patients were included, of which, 20 were in group A, 25 in group B, 21 in group C, 17 in group D, and 9 in group E. The results showed that:(1) There was no significant difference between group C and group B in the reduction of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) (PTC=0.226, PLDL-C=0.818). (2) The results of 2*2 factorial analysis showed that, there was no significant interaction between TCM factor and western medicine factor (PTC=0.605, PLDL-C=0.843). (3) There were no significant differences in safety outcomes among 5 groups (all P values >0.05). ConclusionATV 10 mg+JZD and ATV 20 mg have a similar efficacy in reducing TC and LDL-C. There is no obvious interaction between JZD and ATV in hypolipidemic effect, and the combination therapy of ATV and JZD is safe.
Objective To assess the efficacy and safety of Xuezhikang capsule (XZK) for hyperlipidemia. Methods MEDIINE，EMBASE, Cochrane Central Register of Controlled Trials(CCTR), Cochrane Metabolic and Endocrine Disorders Group data bank, and Chinese Biomedical Database(CBM), China Hospital Knowledge Database(CHKD) were searched，and the published/unpublished information was handsearched (updated to Dec., 2005) to identify randomized controlled trials (RCTs) or quasi-RCT of XZK versus statins or other lipid lowering drugs in treating hyperlipidemia patients. The quality evaluation, data extraction and analysis were conducted by the method recommended in Cochrane Reviewer’s Handbook 4.2.2. Data were analyzed using Review Manager (Version 4.2). Results Eleven trials (conducted in China) were identified, including 1 073 patients with hyperlipidemia met the inclusion criteria. All the included RCTs were graded as B or C. ① The effect of XZK in reducing TC: There were no significant differences between XZK and statins ( WMD 0.06, 95%CI-0.09 to 0.20 and RR1.02, 95%CI 0.93 to 1.12), XZK and fibrates (WMD 0.05, 95%CI -0.22 to 0.31) and XZK and probucol(WMD 0.42, 95%CI -0.01 to 0.85). XZK was superior to hexanicit (WMD 0.96, 95%CI 0.73 to 1.18). ② The effect of XZK in reducing TG: XZK had the same effect as statins (WMD 0.02, 95%CI -0.10 to 0.14 and RR 1.17, 95%CI 0.92 to 1.49) and hexanicit (WMD 0.28, 95%CI -0.17 to 0.73 ).Meanwhile, XZK was superior to probucol (WMD 0.71, 95%CI 0.22 to 1.20), but it was not as good as fibrates (WMD -0.81, 95%CI -1.40 to -0.23). ③ The effect of XZK in increasing HDL-C：XZK had the same effect as that of statins (WMD -0.03, 95%CI -0.10 to 0.04 and RR 1.03, 95% CI 0.80 to 1.33). The effect of XZK was better than that of hexanicit (WMD 0.15, 95%CI 0.01 to 0.29). XZK had the same effect of fibrates (WMD 0.03, 95%CI -0.08 to 0.15) and probucol (WMD 0.04, 95%CI -0.16 to 0.24). ④ The effect of XZK in reducing LDL-C：The effects of XZK and statins were the same (WMD -0.23, 95%CI -0.61 to 0.15 and RR 1.15, 95%CI 0.75 to 1.77). The effect of XZK was better than that of hexanicit (WMD 0.53, 95%CI 0.16 to 0.90). Meanwhile, XZK had the same effect as those of fibrates (WMD 0.19, 95%CI -0.12 to 0.50) and probucol (WMD 0.35, 95%CI -0.03 to 0.73). ⑤ The adverse reactions of XZK were mainly the gastrointestinal tract reaction, while liver function abnormality and myalgia were scarcely found. Conclusion Xuezhikang capsule have the same effects as those of statins in reducing the levels of TC, TG, LDL-C and raising HDL-C in patients with hyperlipidemia. No obvious adverse reactions are found during the short-term treatment. But further confirmation with clinical randomized controlled trials of high quality, large sample and long-term follow-up is needed.