中国高甘油三酯血症相关急性胰腺炎的降甘油三酯疗法:一项多中心前瞻性队列研究。

IF 7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL BMC Medicine Pub Date : 2024-11-15 DOI:10.1186/s12916-024-03755-8
Jing Zhou, Zuozheng Wang, Qinghong Liu, Longxiang Cao, Enrique de-Madaria, Gabriele Capurso, Christian Stoppe, Dong Wu, Wei Huang, Yingjie Chen, Siyao Liu, Donghuang Hong, Yun Sun, Zhenguo Zeng, Kaixiu Qin, Haibin Ni, Yi Sun, Yue Long, Feng Guo, Xiaofeng Liu, Xisheng Zheng, Guoxiu Zhang, Xiangcheng Zhang, Kai Zhou, Yizhe Chen, Qinghai Jiao, Xinsen Zou, Xiang Luo, Gang Li, Bo Ye, Chao Li, Lanting Wang, Shuai Li, John Windsor, Yuxiu Liu, Zhihui Tong, Weiqin Li, Lu Ke
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引用次数: 0

摘要

背景:对于高甘油三酯血症相关急性胰腺炎(HTG-AP)患者,没有推荐特定的降甘油三酯疗法,主要原因是缺乏高质量的证据。本研究旨在描述早期 HTG-AP 患者降甘油三酯疗法的实践差异,并评估甘油三酯下降更快是否与改善器官衰竭有关:这是一项多中心、前瞻性队列研究,招募自症状出现起 72 小时内入院的血浆甘油三酯升高(> 11.3 mmol/L)的 HTG-AP 患者。患者在研究第 3 天被二分为达到目标(血浆甘油三酯≤ 5.65 mmol/L)或未达到目标。主要结果是入组 14 天内无器官衰竭天数(OFFD)。对达到目标与无器官衰竭天数之间的关系进行了建模。此外,还计算了前三天血浆甘油三酯对治疗反应的斜率,并作为敏感性分析评估了其与无器官衰竭天数的关系:在 300 名入选患者中,211 人接受了独家药物治疗,89 人接受了各种血液净化疗法。230名患者在研究第3天获得了甘油三酯水平,其中122人(53.0%)的甘油三酯水平低于5.65毫摩尔/升。即使在调整了潜在的混杂因素后,这些患者与血浆甘油三酯仍> 5.65 mmol/L的患者之间的OFFD也没有差异[中位数(IQR):13 (10-14) vs. 14 (10-14),p = 0.46]。就下降斜率而言,下降斜率越陡,OFFD的变化越小[风险差异为- 0.088,95% CI为- 0.334至0.158,p = 0.48]:各中心的降甘油三酯疗法差异很大。甘油三酯下降更快与器官衰竭发生率和持续时间的改善无关。
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Triglyceride-lowering therapies in hypertriglyceridemia-associated acute pancreatitis in China: a multicentre prospective cohort study.

Background: No specific triglyceride-lowering therapy is recommended in patients with hypertriglyceridemia-associated acute pancreatitis (HTG-AP), primarily because of the lack of quality evidence. This study aimed to describe practice variations in triglyceride-lowering therapies for early HTG-AP patients and assess whether more rapid triglyceride decline is associated with improving organ failure.

Methods: This is a multicentre, prospective cohort study recruiting HTG-AP patients with elevated plasma triglyceride (> 11.3 mmol/L) admitted within 72 h from the onset of symptoms. Patients were dichotomised on study day 3 into either target reaching (plasma triglyceride ≤ 5.65 mmol/L) or not. The primary outcome was organ failure-free days (OFFD) to 14 days of enrolment. The association between target-reaching and OFFD was modelled. Additionally, the slope in plasma triglyceride over the first three days in response to treatment was calculated, and its association with OFFD was assessed as a sensitivity analysis.

Results: Among the 300 enrolled patients, 211 underwent exclusive medical treatment, and 89 underwent various blood purification therapies. Triglyceride levels were available in 230 patients on study day 3, among whom 122 (53.0%) had triglyceride levels of ≤ 5.65 mmol/l. The OFFD was not different between these patients and those in whom plasma triglyceride remained > 5.65 mmol/L [median (IQR): 13 (10-14) vs. 14 (10-14), p = 0.46], even after adjustment for potential confounders. For the decline slopes, there was no significant change in OFFD with a steeper decline slope [risk difference, - 0.088, 95% CI, - 0.334 to 0.158, p = 0.48].

Conclusions: Triglyceride-lowering therapies vary greatly across centres. More rapid triglyceride decline was not associated with improving incidence and duration of organ failure.

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来源期刊
BMC Medicine
BMC Medicine 医学-医学:内科
CiteScore
13.10
自引率
1.10%
发文量
435
审稿时长
4-8 weeks
期刊介绍: BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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