Objective  To investigate the clinical efficacy of low molecular weight heparin (LMWH)-assisted plasma exchange (PE) in the treatment of patients with hyperlipidemic severe acute pancreatitis (HLSAP).

Methods  Patients with HLSAP diagnosed and treated in Leshan People's Hospital were retrospectively selected from January 2023 to April 2024 and their clinical data were analyzed. According to the diagnosis and treatment plans, they were divided into the control group (PE) and the study group (LMWH-assisted PE). The coagulation function [fibrinogen (Fib), thrombin time (TT), activated partial thromboplastin time (APTT) and prothrombin time (PT)], plasma specific viscosity, lipid levels [total cholesterol (TC), triglyceride (TG)], inflammatory factors [white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), amylase (AMY) and lipase (LYP)] were compared before and after treatment between the two groups. The duration of continuous renal replacement therapy (CRRT), length of hospitalization and incidence of new organ dysfunction were compared between the two groups.

Results  A total of 105 HLSAP patients were included in the study, with 50 in the control group and 55 in the study group. Before treatment, there was no statistically significant difference in coagulation function, lipid levels, plasma specific viscosity and inflammatory factors between the two groups (P>0.05). After treatment, Fib, TC, TG, plasma specific viscosity, WBC, ESR, CRP, AMY and LYP were significantly lower in the study group than in the control group (P<0.05), while TT, APTT and PT were significantly higher than in the control group (P<0.05). The duration of CRRT, hospitalization time and incidence of new organ dysfunction were lower in the study group than in the control group (P<0.05). In terms of adverse reactions, no transfusion adverse reactions and serious complications occurred in both groups during the treatment period.

Conclusion  LMWH-assisted PE has a better effect in the treatment of HLSAP, which can improve the coagulation function, blood lipid levels and inflammatory factors of HLSAP patients, shorten the hospital stay and the duration of CRRT, and reduce the incidence of new organ dysfunction.

1.聂群, 林香, 周倩雯,等. 益生菌治疗联合知信行理论模型管理对重症急性胰腺炎患者机体恢复情况及生活质量的影响[J]. 中国药师, 2024, 27(4): 640-647. [Nie Q, Lin X, Zhou QW, et al. The influence of probiotic treatment combined with the knowledge-attitude-practice theoretical model management on the recovery and quality of life of patients with severe acute pancreatitis[J]. China Pharmacist, 2024, 27(4): 640-647.] DOI: 10.12173/j.issn.1008-049X.202401230.

2.何海涛, 周泽, 魏志力, 等. 糖皮质激素对急性重症胰腺炎患者预后及炎症指标的影响[J]. 中国药师, 2023, 26(12): 435-441. [He HT, Zhou Z, Wei ZL, et al. The effect of glucocorticoids on the prognosis and inflammatory indicators of patients with acute severe pancreatitis[J]. China Pharmacist, 2023, 26(12): 435-441.] DOI: 10.12173/j.issn.1008-049X.202311196.

3.王琦琦, 程亚丽, 周灿灿, 等. 急性胰腺炎患者的临床特征分析[J]. 中华消化外科杂志, 2023, 22(S1): 38-43. [Wang QQ, Cheng YL, Zhou CC, et al. Analysis of the clinical characteristics of patients with acute pancreatitis[J]. Chinese Journal of Digestive Surgery, 2023, 22(S1): 38-43.] DOI: 10.3760/cma.j.cn115610-20230908-00073.

4.Wang YH, Xu ZH, Zhou YH, et al. The clinical characteristic of biliary-hyperlipidemic etiologically complex type of acute pancreatitis: a retrospective study from a tertiary center in China[J]. Eur Rev Med Pharmacol Sci, 2021, 25(3): 1462-1471. DOI: 10.26355/eurrev_202102_24854.

5.《高甘油三酯血症性急性胰腺炎诊治急诊专家共识》专家组. 高甘油三酯血症性急性胰腺炎诊治急诊专家共识[J]. 中国全科医学, 2021, 24(30): 3781-3793. DOI: 10.12114/j.issn.1007-9572.2021.02.028.

6.林婷婷. 血浆置换联合血液透析治疗高脂血症性重症急性胰腺炎患者的效果[J]. 中国民康医学, 2023, 35(11): 37-40. [Lin TT. The effect of plasma exchange combined with hemodialysis in the treatment of patients with hyperlipidemic severe acute pancreatitis[J]. Chinese Journal of Minkang Medicine, 2023, 35(11): 37-40.] DOI: 10.3969/j.issn.1672-0369.2023.11.012.

7.张文龙. 血浆置换治疗高脂血症性急性胰腺炎临床疗效的研究分析[D]. 合肥: 安徽医科大学, 2020. DOI: 10.26921/d.cnki.ganyu.2020.000986.

8.李丽飞, 向茜. 高脂血症性胰腺炎的发病机制研究进展[J]. 黑龙江医学, 2023, 47(15): 1913-1915. [Li  LF, Xiang Q. Progress in the pathogenesis of hyperidemic pancreatitis[J]. Heilongjiang Medical Science Center, 2023, 47(15): 1913-1915.] DOI: 10.3969/j.issn.1004-5775. 2023.15.037.

9.Tran A, Fernando SM, Gates RS, et al. Efficacy and safety of anti-Xa-guided versus fixed dosing of low molecular weight heparin for prevention of venous thromboembolism in trauma patients: a systematic review and meta-analysis[J]. Ann Surg, 2023, 277(5): 734-741. DOI: 10.1097/SLA.0000000000005754.

10.李洁, 宋恒文, 杨能, 等. 国产那屈肝素钙注射液在中国健康受试者中的生物等效性及安全性研究[J]. 中国药房, 2022, 33(16): 2017-2021. [Li J, Song HW, Yang N, et al. Bioequivalence and safety study of domestic nadheparin calcium injection in Chinese healthy subjects[J]. China Pharmacy, 2022, 33(16): 2017-2021.] DOI: 10.6039/j.issn.1001-0408.2022.16.18.

11.萧志勇, 梁兴, 俞灿. 低分子肝素辅助治疗高脂血症性重症急性胰腺炎的效果及对患者凝血功能指标的影响 [J]. 中外医学研究, 2020, 18(16): 48-50. [Xiao ZY, Liang  X, Yu C. The effect and influence on coagulation function indicators of low molecular weight heparin adjuvant therapy in patients with hyperlipidemic severe acute pancreatitis[J]. Chinese and Foreign Medical Research, 2020, 18(16): 48-50.] DOI: 10.14033/j.cnki.cfmr.2020.16.019.

12.林山. 大样本数据回顾性分析急性胰腺炎的发病学特点、治疗及转归[D]. 广州: 南方医科大学, 2022. DOI: 10.27003/d.cnki.gojyu.2022.000908.

13.张中伟, 郑晓博. COVID-19患者静脉血栓栓塞症的诊治进展[J]. 西部医学, 2023, 35(12): 1717-1722. [Zhang  ZW, Zheng XB. Progress in the diagnosis and treatment of venous thromboembolism in patients with COVID-19[J]. Western Medicine, 2023, 35(12): 1717-1722.] DOI: 10.3969/j.issn.1672-3511.2023.12.001.

14.陈林华, 马万君, 王婉玉. 不同低分子肝素改善反复流产患者妊娠结局的网状Meta分析[J].中国循证医学杂志, 2023, 23(7): 790-796. [Chen LH, Ma WJ, Wang WY. Reticular Meta-analysis of different low molecular weight heparin improving pregnancy outcomes in patients with repeated abortions[J]. Chinese Journal of Evidence-based Medicine, 2023,23(7): 790-796.] DOI: 10.7507/1672-2531.202211001.

15.陈锋, 林国良. 低分子肝素与普通肝素治疗高脂血症性胰腺炎的疗效对比[J]. 北方药学, 2022, 19(9): 117-119, 128. [Chen F, Lin GL. Comparison of the efficacy of low molecular weight heparin and ordinary heparin in the treatment of hyperlipidemic pancreatitis[J]. Journal of North Pharmacy, 2022, 19(9): 117-119, 128.] DOI: 10.3969/j.issn.1672-8351.2022.09.037.

16.张荣, 程贤文, 徐长飞. 大承气汤联合低分子肝素钙配合双重血液滤过治疗高脂血症性重症急性胰腺炎 [J]. 长春中医药大学学报, 2023, 39(9): 989-992. [Zhang R, Cheng XW, Xu CF. Treatment of hyperlipidemic severe acute pancreatitis with Dachengqi decoction combined with low molecular weight heparin calcium and double hemofiltration[J]. Journal of Changchun University of Chinese Medicine, 2023, 39(9): 989-992.] DOI: 10.13463/j.cnki.cczyy.2023.09.010.

17.欧阳洁琼. 低分子肝素对高脂血症性胰腺炎患者血脂及凝血功能指标的影响研究[J]. 北方药学, 2023, 20(8): 15-16, 22. [Ouyang JQ. Study on the influence of low molecular weight heparin on blood lipids and coagulation function indicators in patients with hyperlipidemic pancreatitis[J]. Journal of North Pharmacy, 2023, 20(8): 15-16, 22.] DOI: 10.3969/j.issn.1672-8351.2023.08.005.

18.张龙, 尤宁. 低相对分子质量肝素辅助治疗高脂血症性重症急性胰腺炎的效果及对凝血状态的影响[J]. 血栓与止血学, 2022, 28(3): 614-615. [Zhang L, You N. The effect and influence on the coagulation state of low relative molecular weight heparin adjuvant therapy in patients with hyperlipidemic severe acute pancreatitis[J]. Thrombosis and Hemostasis, 2022, 28(3): 614-615.] DOI: 10.3969/j.issn.1009-6213.2022.03.114.

19.顾鑫怡, 杨建锋. 低分子肝素在重症急性胰腺炎治疗中抗炎作用的研究进展[J]. 国际消化病杂志, 2023, 43(4): 221-223, 227. [Gu XY, Yang JF. Progress in the anti-inflammatory effects of low molecular weight heparin in the treatment of severe acute pancreatitis[J]. International Journal of Digestive, 2023, 43(4): 221-223, 227.] DOI: 10.3969/j.issn.1673-534X.2023.04.003.