Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis.
OBJECTIVE
To investigate a formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis (HL-SAP).


METHODS
Thirty-two consecutive patients with severe acute pancreatitis were included in the clinical trial. All of them met the following five criteria for admission to the study, namely the Atlanta classification and stratification system for the clinical diagnosis of SAP, APACHEII score more than 8, time interval for therapeutic intervention less than 72 hours after onset of the disease, serum triglyceride (TG) level 6.8 mmol/l or over, and exclusion of other etiologies. They were divided into severe acute pancreatitis group (SAP, 22 patients) and fulminant severe acute pancreatitis group (FSAP, 10 patients). Besides the conventional therapeutic measures, Penta-association therapy was also applied in the two groups, which consisted of blood purification (adsorption of triglyceride and hemofiltration), antihyperlipidemic agents (fluvastatin or lipanthyl), low molecular weight heparin (fragmin), insulin, topical application of Pixiao (a traditional Chinese medicine) over the whole abdomen. Serum triglyceride, pro-inflammatory cytokines and anti-inflammatory cytokines were determined before blood purification (PF), at the end of blood purification (AFE) and on the 7th day after onset of the disease (AF7) respectively. Simultaneously, severity of the diseases was assessed by the APACHE II system. PROGNOSIS was evaluated by non-operation cure rate, absorption rate of pseudocyst, time interval pseudocyst absorption, hospital stay and survival rate.


RESULTS
Serum triglyceride level (mmol/L), TNFalpha (U/ml) concentration and APACHE II score were significantly decreased (P<0.05) at AFE and AF7, as compared with PF. However, serum IL-10 concentration (pg/ml) was increased significantly (P<0.001) at AFE, and decreased significantly (P<0.05) at AF7 when compared with PF.


METHODS
The First surgical intervention time was 55.8+/-42.6 days in SAP group (5 patients) and 12.2+/-6.6 days in FSAP group (7 patients), there was a significant difference between the two groups (P=0.02). The number of operations in the two groups was 1.33+/-0.5 vs 3.5+/-1.2 (P=0.0037), respectively.


CONCLUSIONS
Non-operation cure rate, absorption rate of pseudocyst, hospital stay and survival rate in SAP group and FSAP group were 100% (22/22) vs 11.1% (1/9), 77.3% (17/22) vs 11.1% (1/9), 54.2+/-35.9 vs 99.1+/-49.5 days (P=0.008) and 100%(22/22) vs 66.7% (6/9) (P=0.0044). The time for absorption of pseudocyst was 135.1+/-137.5 days in SAP group.


CONCLUSIONS
Penta-association therapy is an effective guideline in the treatment of hyperlipidemic severe acute pancreatitis at its early stage (within 72 hours).
Mao
En-Qiang
EQ
Department of Surgery, Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025, China. maoeq@yeah.net
Tang
Yao-Qing
YQ
Zhang
Sheng-Dao
SD
D018806:APACHE; D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016207:Cytokines / Q000097:blood; D004359:Drug Therapy, Combination; D006440:Hemofiltration; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008516:Medicine, Chinese Traditional; D010195:Pancreatitis / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood
D000925:Anticoagulants; D016207:Cytokines; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D014280:Triglycerides; D006493:Heparin