Comparison of plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis

Objective To compare the efficacy of two rapid lipid lowering methods as plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis. Methods The clinical data of 98 patients with hyperlipidemic acute pancreatitis in Peking Union Medical College Hospital from January 2014 to December 2016 were retrospectively analyzed. All patients were divided into plasma exchange group (n=42) and insulin group (n=56) according to rapid lipid lowering method. Results There were no significant differences in the onset-to-treatment time, the proportion of patients with diabetes, the proportion of patients with pregnancy, the initial triglyceride level, Acute Physiology, Age and Chronic Health Evaluation Ⅱ score and modified CT severity index score score and conditioning-test stimulus interval(CTSI) score between the plasma exchange group and the insulin group (P>0.05). In addition, there were also no significant differences in the incidences of acute respiratory distress syndrome, acute kidney injury, shock and pancreatic abscess, and the proportion of moderate pancreatitis and severe pancreatitis, oral / jejunum nutrition tolerating start time, hospitalization time and mortality between the two groups (P>0.05). The plasma exchange group had significantly less time to achieve the target triglyceride level and to reach normal free fatty acids level than the insulin group [(13.09 ±12.50)h vs. (46.92±20.92)h, t=3.291, P=0.001; (15.75±14.13)h vs.(73.21±38.49)h, t=3.291, P=0.001]. The pancreatic pseudocyst incidence was significantly lower (7.14% vs.23.21%, t=2.120, P=0.034), and the hospitalization cost was significantly higher[(81 794.92±33 719.69)yuan vs. (56 042.43±30 565.34)yuan, t=2.034, P=0.042] in the plasma exchange group than in the insulin group. Conclusions Both plasma exchange and insulin can rapidly lower blood lipids. Plasma exchange has certain advantages over insulin in lipid-lowering, for it is faster, and has lower incidence of pancreatic pseudocyst, thus can be applied in patients whose financial conditions permit. Key words: Acute fat pancreatitis; Plasma exchange; Insulin