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妊娠期高脂血症性急性胰腺炎(HLAP)是一种罕见但极为严重的疾病,它对母婴双方的健康构成了双重威胁。由于妊娠期间脂质代谢的改变和胰岛素抵抗的增加,女性更容易出现高脂血症,这可能进一步诱发急性胰腺炎。本综述系统回顾了妊娠期HLAP的血液净化治疗模式,包括血浆置换、血液滤过、血液灌流及其组合疗法。文章探讨了治疗的适应证、治疗启动的最佳时机、抗凝策略选择以及是否需要考虑终止妊娠等关键问题。早期实施血液净化治疗对于控制炎症反应和改善器官功能具有至关重要的作用。然而,关于不同治疗模式的最佳应用和疗效差异,尤其是在妊娠期患者中的应用,尚需进一步研究。本文旨在为妊娠期HLAP患者的治疗方案提供循证依据,并为未来的研究方向提出建议。
Abstract：Hyperlipidemic acute pancreatitis(HLAP) during pregnancy is a rare but extremely serious condition that poses a dual threat to the health of both mother and baby. Due to changes in lipid metabolism and increased insulin resistance during pregnancy, women are more prone to hyperlipidemia, which can further induce acute pancreatitis. This review systematically examines the blood purification treatment modalities for HLAP during pregnancy, including plasma exchange, hemofiltration, hemoperfusion, and combination therapies. The article discusses key issues such as indications for treatment, the optimal timing for initiating therapy, the choice of anticoagulation strategies, and whether to consider termination of pregnancy. Early implementation of blood purification therapy is crucial for controlling inflammatory responses and improving organ function. However, further research is needed on the optimal application and efficacy differences of different treatment modalities, especially in pregnant patients. This article aims to provide an evidence-based foundation for the treatment of HLAP during pregnancy and to suggest directions for future research.
[1]Zhou D,Sun G Q,Hu J,et al.Clinical characteristics and pregnancy outcome analysis of 20 cases of acute pancreatitis during pregnancy[J].Int Gynaecol Obstet,2024,166(1):435-441.
[2]Tang W,Chen Y,Huang S,et al.Acute pancreatitis in pregnancy:propensity score matching analysis and dynamic nomogram for risk assessment[J].Dig Dis Sci,2024,69(6):2235-2246.
[3]Haiyan Z,Na P,Jialin H,et al.Acute pancreatitis in pregnancy:ten-year noninterventional,retrospective cohort experience[J].Gastroenterol Res Pract,2022,2022:3663079.
[4]Sheng C,Wang Y,Xu Z X,et al.The effect of admission serum triglyceride level on the prediction of severity of acute pancreatitis in pregnancy[J].Risk Manag Healthc Policy,2021,14:3209-3222.
[5]Zhang T,Wang G X,Cao Z,et al.Acute pancreatitis in pregnancy:10-year,multi-center,retrospective study in Beijing[J].BMC Pregnancy Childbirth,2022,22(1):414.
[6]Gubensek J.The role of apheresis and insulin therapy in hypertriglyceridemic acute pancreatitis-a concise review[J].BMC Gastroenterol,2023,23(1):341.
[7]Yadav C,Zhang B.Effect of early continuous venovenous haemofiltration in severe acute pancreatitis for the prevention of local pancreatic complications[J].Gastroenterol Res Pract,2022,2022:7575231.
[8]黄朝晖,彭侃夫,李宁,等重症急性胰腺炎血液净化模式和时机的选择[J].中国中西医结合急救杂志,2013,20(6):332-336.
[9]Duarte C,Farnden L,Hughes R C E,et al.Pregnancy-induced severe hypertriglyceridemia effectively treated with therapeutic plasmapheresis[J].Transfus Apher Sci,2023,62(3):103659.
[10]Coronado Arroyo C,Concepción Zavaleta M J,García Villasante J,et al.Familial chylomicronemia syndrome-induced acute necrotizing pancreatitis during pregnancy[J].Rev Bras Ginecol Obstet,2021,43(3):220-224.
[11]Zheng K,Hu W H,Wang J R,et al.Plasmapheresis for the treatment of hypertriglyceridemia-induced severe acute pancreatitis in pregnancy:it could be good choice[J].Int Colorectal Dis,2015,30(10):1443-1444.
[12]Pecin I,Leskovar D,?abic M,et al.Prophylactic therapeutic plasma exchange in pregnant woman with Familial Chylomicronemia Syndrome-A case report[J].Transfus Apher Sci,2022,61(3):103346.
[13]Kim S,Hakeem R,Abdullah A,et al.Therapeutic plasma exchange for the management of severe gestational hypertriglyceridaemic pancreatitis due to lipoprotein lipase mutation[J].Endocrinol Diabetes Metab Case Rep,2020,2020:19-0165.
[14]Nguyen T,Nath P V,Mai V Q,et al.Treatment of severe hypertriglyceridemia during pregnancy with high doses of omega-3 fatty acid and plasmapheresis[J].AACE Clin Case Rep,2021,7(3):211-215.
[15]张官文,董晨明,陈宇,等双重滤过血浆置换治疗高脂血症性急性胰腺炎临床疗效的Meta分析[J].中国中西医结合急救杂志,2023,30(1):60-65.
[16]Cheng X,Zhan Y,Wang Z,et al.single-center experience of non-bioartificial DFAPP support systems among Chinese patients with hyperlipidemic moderate/severe acute pancreatitis[J].Sci Rep,2024,14(1):1128.
[17]Lu H,Chen Y L,Wu Y S,et al.The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis:propensity score matching analysis[J].JClin Apher,2020,35(5):388-397.
[18]Wang J,Xia Y,Cao Y,et al.Evaluating the efficacy and timing of blood purification modalities in early-stage hyperlipidemic acute pancreatitis treatment[J].Lipids Health Dis,2023,22(1):208.
[19]Jouve T,Marlu R,Naciri Bennani H,et al.Fibrinogen reconstitution after therapeutic apheresis:comparison of double-filtration plasmapheresis,plasma exchange,and immunoadsorption[J].Clin Apher,2021,36(4):574-583.
[20]Pu W,Tang W,Shen L,et al.Comparison of different intensive triglyceride-lowering therapies in patients with hyperlipidemic acute pancreatitis[J].Pancreatology,2023,23(8):919-925.
[21]Mao Q.Intensive management of severe acute pancreatitis[J].Ann Transl Med,2019,7(22):687.
[22]高元妹,黄东健,廖广园,等局部枸橼酸抗凝血液灌流在妊娠合并高脂血症性胰腺炎中的应用[J].中华产科急救电子杂志,2018,7(1):48-51.
[23]更藏尖措,周莉,李文歌,等血浆置换联合连续性肾脏替代治疗妊娠期高脂血症性急性胰腺炎的临床观察[J].国际移植与血液净化杂志,2012,10(4):25-28.
[24]李梦蝶,许明,史新格,等早期血液灌流联合连续性静脉-静脉血液滤过治疗高脂血症性重症急性胰腺炎的临床效果观察[J].中国中西医结合急救杂志,2021,28(6):662-667.
[25]Gürsoy A,Kulaksizoglu M,Sahin M,et al.Severe hypertriglyceridemia-induced pancreatitis during pregnancy[J].Natl Med Assoc,2006,98(4):655-657.
[26]张婷婷,刘瑞霞,阴赪宏高脂血症性妊娠期急性胰腺炎的临床进展[J].中国医刊,2022,57(1):42-45.
[27]Lin Y,He S,Gong J,et al.Continuous veno-venous hemofiltration for severe acute pancreatitis[J].Cochrane Database Syst Rev,2019,10(10):CD012959.
[28]严永峰,蒋鑫,钟瑞,等急性胰腺炎初期全身炎症反应综合征持续时间与感染性胰腺坏死的关系[J].临床肝胆病杂志,2021,37(3):654-659.
[29]蔡学英,陈嘉伊,曾龙欢,等妊娠期高甘油三酯性急性胰腺炎临床特征分析:10年单中心回顾性分析[J].中华危重症医学杂志(电子版),2021,14(5):393-399.
[30]Choi J,Kim H,Jun J,et al.Recurrent pancreatitis in a pregnant woman with severe hypertriglyceridemia successfully managed by multiple plasmapheresis[J].Atheroscler Thromb,2022,29(7):1108-1116.
[31]He H,Zhang Z,Cai W H,et al.Defined,low threshold for Caesarean section and multidisciplinary team management improves fetal outcome from acute pancreatitis in pregnancy[J].Pancreatology,2023,23(5):473-480.
[32]Tan H,Ong J Y K,Devendra K.Hyperglyceridaemia-induced acute pancreatitis in pregnancy:Experience from tertiary hospital in Singapore[J].Med Malaysia,2021,76(4):591-593.
[33]Garg R,Rustagi T.Management of hypertriglyceridemia induced acute pancreatitis[J].Biomed Res Int,2018,2018:4721357.
[34]Mao Q,Tang Y Q,Zhang S D.Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis[J].World Gastroenterol,2003,9(11):2622-2626.
[35]Gubensek J,Buturovic-Ponikvar J,Romozi K,et al.Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange:an observational cohort study[J].PLo SOne,2014,9(7):e102748.
[36]Zhang Q,Lin J Y,Wu L J,et al.Blood purification for hypertriglyceridemia-induced acute pancreatitis:meta-analysis[J].Pancreas,2022,51(5):531-539.
[37]Huang P,Toh D E,Sue Y M,et al.Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia:Three case reports[J].Medicine (Baltimore),2018,97(44):e12987.
[38]Hang Y,Chen Y,Lu X,et al.Acute hyperlipidemic pancreatitis in pregnant woman[J].World J Emerg Med,2013,4(4):311-313.
[39]Zheng B,Zheng Y P,Zheng Z H.Therapeutic plasma exchange decreases serum triglyceride level rapidly and reduces early recurrence rate but no advantages in improving outcomes for patients with hyperlipidemic acute pancreatitis:retrospective propensity score matching analysis based on twenty year's experience[J].BMC Endocr Disord,2024,24(1):32.
基本信息:
中图分类号:R714.255
引用信息:
[1]巩雪敏,甘泉.妊娠期高脂血症性急性胰腺炎血液净化治疗的研究进展[J].巴楚医学,2025,8(03):124-128.
基金信息:
武汉市卫生健康委员会中青年医学骨干人才培养工程(武卫通[2020]55号)
2025-09-28
2025-09-28