血浆置换联合糖皮质激素治疗系统性红斑狼疮相关急性胰腺炎回顾分析被引量：6

A retrospective analysis of plasma exchange com bined with glucocorticosteroids in the treatment of systemic lupus erythematosus associated with acute pancreatitis

原文传递

导出

摘要目的：分析系SLE相关急性胰腺炎（AP）（SLEAP）的临床特点，初步探讨血浆置换联合糖皮质激素（GC）治疗SLEAP的机制和可行性。方法回顾性分析我院近8年来收治SLEAP共24例患者。根据治疗方式将患者分为2组，其中血浆置换联合GC共9例患者归为A组，单纯使用GC治疗共15例患者归为B组。采用Wilcoxon秩和检验和单因素方差分析进行统计学分析。结果基线期A组SLEDAI评分16±5和B组患者18±4，差异无统计学意义（t=1.31，P=0.320）。 A组患者治疗2周内GC日均用量31.0（20.50，30.08） mg/d明显小于B组[47.85（45.58，59.23） mg/d，Z=35.50，P=0.002]。基线期A、B 2组IL-6水平差异无统计学意义[13.14（11.12，16.57） mg/L与14.63（11.37，16.37） mg/L，Z=12.00，P=0.300]，治疗后A组患者IL-6水平9.16（7.93，10.75） mg/L有下降趋势，明显低于B组[13.62（9.29，17.63） mg/L，Z=28.50，P=0.039]。A组患者治疗2周后血脂[TC=（5.0±0.5） mmol/L，TG=（1.5±0.4） mmol/L]明显低于基线期[TC=（6.1±0.5） mmol/L，TG=（2.1±0.6） mmol/L]水平（F=4.46，P=0.010；F=6.09，P=0.002）；而B组治疗前后差异无统计学意义（F=1.57，P〉0.05）。结论血浆置换联合GC治疗能较快改善病情且能减少GC用量，是安全有效且值得继续探讨的治疗手段之一。其机制在于能有效降低血脂水平，对清除体内炎症因子IL-6可能也有一定作用。 Objective To investigate the clinical features and mechanism and feasibility of plasma exchange （PE） in treating systemic lupus erythematosus （SLE） complicated with acute pancreatitis （AP）. Methods A retrospective analysis of SLE associated with AP was done based on the HIS in Tongji Hospital. Totally 24 SLEAP patients were admitted to Tongji hospital from March 2006 to May 2014. Patientsˊ serum amylase, lipase and interleukin （IL）-6 concentration were measured before and after plasma exchange. According to different therapy strategy, patients were divided into two groups. Fifteen patients treated with plasma exchange combination with glucocorticosteroid （GC） were classified as Group A, the other 9 patients who were treated with GC only were classified as group B. At baseline and after treatment, the serum lipid concentration, average daily glucocorticosteroid dosage between group A and B were compared with ANOVA and serum IL-6 concentration between roup A and B were compared with Wilcoxon rank test. Results SLEDAI＆amp;nbsp;score in group A patients at baseline （16 ±5） was no statistically different from that in group B （18 ±4）（t=1.31, P=0.320）. Average daily GC dosage in group A 31.0 （20.50, 30.08）mg/d was significantly less than that in group B 47.85 （45.58, 59.23） mg/d （Z=35.50, P= 0.002）. Serum IL-6 levels in group A and B at baseline was not significantly different 13.14 （11.12,16.57） mg/L vs 14.63 （11.37, 16.37） mg/L （Z=12.20, P=0.300）, after 2 weeks treatment, IL-6 level, which was 9.16 （7.93, 10.75） mg/L, decreased significantly in group A while it didnˊt show tendency of decrease in group B, which was 13.62（9.29, 17.63） mg/L （Z=28.50, P=0.039）. Serum lipid concentration after 2 weeks therapy in Group A [TC=（5.02 ±0.53） mmol/L, TG=（1.46 ±0.44） mmol/L] decreased significantly compared to baseline [TC=（6.11±0.50） mmol/L, TG=（2.14±0.65） mmol/L] （F=4.46, P=0.010; F=6.09, P=0.002）, while similar tendency wasnˊt observed in group B （F=1.57, P〉0.05）. Conclusion PE combined with GC could lower serum IL-6 levels, reduce the amount of GC and lower serum lipid to improve prognosis. Therefore it might be a safe and effective way and is worthy of continuing to explore its feasibility.

作者余毅恺李菊黄晓伟冯业晨董凌莉胡绍先雷小妹

机构地区华中科技大学同济医学院附属同济医院风湿免疫科华中科技大学同济医学院附属同济医院胆胰外科华中科技大学同济医学院附属同济医院消化内科长航总医院消化内科

出处《中华风湿病学杂志》 CAS CSCD 北大核心 2015年第6期410-413,共4页 Chinese Journal of Rheumatology

关键词红斑狼疮系统性胰腺炎急性坏死性血浆置换糖皮质激素类白细胞介素-6 Lupus erythematosus,systemic Pancreatitis,acute necrotizing Plasma exchange Glucocorticoids

分类号 R593.241 [医药卫生—内科学] R576 [医药卫生—消化系统]

引文网络
相关文献

参考文献10

1Banks PA, Freeman ML. Practice guidelines in acute pancre- atitis[J]. Am J Gastroenterol, 2006, 101 (10) : 2379-2400.
2Singh R, Saunders B, Seopelitis E. Pancreatitis leading to thro- mbotic thrombocytopenic purpura in systemic lupus erythemato- sus: a case report and review of literature[J]. Lupus, 2003, 12 (2): 136-139.
3Ikura Y, Matsuo T, Ogami M, et al. Cytomegalovirus associated pancreatitis in a patient with systemic lupus erythematosus[J]. J Rheumatol, 2000, 27( 11 ) : 2715-2717.
4Sadr-Azodi O, Mattsson F, Bexlius TS, et al. Association of oral glueoeortieoid use with an increased risk of acute panereatitis: a population-based nested case-control study[J]. JAMA Intern Med, 2013, 173(6): 444-449.
5Breuer GS, Baer A, Dahan D, Nesher G. Lupus-associated pan- creatitis[J]. Autoimmun Rev, 2006, 5(5): 314-318.
6Makol A, Petri M. Panereatitis in systemic lupus erythematosus: frequency and associated faetors-a review of the Hopkins lupus cohort[J]. J Rheumatol, 2010, 37(2): 341-345.
7Gregoric P, Sijacki A, Stankovic S, et al. SIRS score on admission and initial concentration of IL-6 as severe acute pan- creatitis outcome predictors[J]. Hepatogastroenterology, 2010, 57 (98): 349-353.
8Nakae H, Asanuma Y, Tajimi K. Cytokine removal by plasma exchange with continuous hemodiafihration in critically ill pa- tients[J]. Ther Apher, 2002, 6(6): 419-424.
9Sadeghi M, Daniel V, Wang H, et al. Plasmapheresis adjusts inflammatory responses in potential kidney transplant recipients [J]. Transplantation, 2013, 95(8): 1021-1029.
10Arai A, Nogami A, Imadome K, et al. Sequential monitoring of serum IL-6, TNF-alpha, and IFN-gamma levels in a CAEBV patient treated by plasma exchange and immunoehemotherapy[J]. Int J Hematol, 2012, 96(5): 669-673.