Continuous Veno-venous Hemofiltration for Patients with Hyperlipidemic Pancreatitis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 HUANGHui-bin ¹ , ZHENGWen-he ² , LIYing ¹ ,  LINJian-dong ¹

1. Department of Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China;
2. Department of Critical Care Medicine, People's Hospital of Fujian Traditional Medical University, Fuzhou 350000, China;

Corresponding?author：

LINJian-dong, Email: linjd1680067@sina.com

Keywords：

Continuous veno-venous hemofiltration; Hyperlipidemic pancreatitis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140101

Video：

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Objective To systematically review the effect and safety of continuous veno-venous hemofiltration (CVVH) on patients with hyperlipidemic pancreatitis. Methods Databases including the Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI and WanFang Data were electronically searched for randomized controlled trials (RCTs) about CVVH on patients with hyperlipidemic pancreatitis till Feb. 12, 2014. According to the inclusion and exclusion criteria, literature was screened, data were extracted, and the methodological quality of included studies was also assessed. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 7 trials met eligibility criteria, involving 360 cases, including 183 cases of CVVH group and 177 cases of control group. The results of meta-analysis showed that compared with only routine medical treatment, CVVH significantly reduced the levels of lipid (WMD=-4.63, 95%CI-5.98 to-3.27, P < 0.000 01), levels of IL-6 (WMD=-29.59, 95%CI-34.30 to-24.89, P < 0.000 01), overall mortality (RR=0.39, 95%CI 0.18 to 0.84, P=0.02), and APACHE II score (WMD=-3.34, 95%CI-5.12 to-1.56, P=0.000 2) after treatment. Conclusion CVVH is more effective for hyperlipidemic pancreatitis than only routine medical treatment. Due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are required to verify the above conclusion.

Citation： HUANGHui-bin, ZHENGWen-he, LIYing, LINJian-dong. Continuous Veno-venous Hemofiltration for Patients with Hyperlipidemic Pancreatitis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 611-617. doi: 10.7507/1672-2531.20140101 Copy

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2.	Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis:presentation and management. Curr Opin Lipidol, 2009, 20(6):497-504.
3.	Durval A, Zamidei L, Bettocchi D, et al. Hyperlipidemic acute pancreatitis:a possible role of antiretroviral therapy with entecavir. Minerva Anestesiol, 2011, 77(10):1018-1021.
4.	于浩, 鄒忠東, 王烈.高脂血癥性胰腺炎的診治進展.醫學綜述, 2010, 16(16):2449-2451.
5.	中華醫學會消化病學分會胰腺疾病學組.中國急性胰腺炎診治指南草案.中華內科雜志, 2004, 43(3):236-238.
6.	Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci, 2006, 34(3):253-257.
7.	Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemiarelated acute pancreatitis. Ther Apher Dial, 2013, 17(2):130-137.
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9.	Chen JH, Yeh JH, Lai HW, et al. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol, 2004, 10(15):2272-2274.
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12.	錢明江, 高飛, 陳淼, 等.血液灌流聯合CVVH治療高脂血癥性重癥急性胰腺炎的臨床觀察.中國醫藥科學, 2013, 3(18):16-18.
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15.	何文華, 劉王, 朱勇.高甘油三脂血癥性胰腺炎的緊急降脂治療:比較早期高容量血液濾過與低分子肝素聯合胰島素的單中心, 前瞻性, 隨機對照研究初步結果. 2012中國消化病學大會:190.
16.	鐘世洪, 辛志軍.低分子肝素聯合床旁持續血液濾過應用于高脂血癥性胰腺炎的效果分析.健康必讀, 2012, (4):26.
17.	戴曉榮, 成宏偉, 陳永康, 等.早期血液凈化對重癥急性胰腺炎伴重度高脂血癥的療效分析.中外醫療, 2012, 31(35):87-89.
18.	季大璽, 龔德華, 徐斌, 等.連續性血液凈化在重癥監護病房中的應用.中華醫學雜志, 2002, 82(18):1292-1294.
19.	毛恩強, 湯耀卿, 韓天權, 等.短時血濾對重癥急性胰腺炎治療的影響.中華外科雜志, 1999, 37(3):141-143.
20.	Mao EQ, Tang YQ, et al. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis. World J Gastroenterolo, 2003, 9(11):2622.
21.	中華醫學會消化病分會胰腺病學組.中國急性胰腺炎診治指南(草案).中華消化雜志, 2004, 24:190-192.
22.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
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24.	Wang XP, Zheng Y. Advancement in research on the heperlipidemia with etiopathogenesis of pancreatitis. Inte J Dig Dis, 2006, 26(4): 219-220.
25.	Strate T, Mann O, Kleinhans H, et al. Systemic intravenous infusion of bovine hemoglobin significantly reduces microcirculatory dysfunction in experimentally induced pancreatitis in the rat. Ann Surg, 2003, 238(5):765-771.
26.	楊朝暉, 楊搖軍, 汪勇俊.連續性血液濾過對重癥急性胰腺炎誘發組織器官損害的保護作用.中國危重病急救醫學, 2004, 16(4): 232.
27.	李振江, 陳威, 徐月清, 等.重癥急性胰腺炎患者HV-CVVH清除細胞因子的作用.第四軍醫大學學報, 2004, 25(9):846-848.
28.	楊春娥.連續靜脈-靜脈血液濾過治療中并發癥的預防.中國實用護理雜志, 2004, 20(2):12-14.

1. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol, 2003, 36:54-62.
2. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis:presentation and management. Curr Opin Lipidol, 2009, 20(6):497-504.
3. Durval A, Zamidei L, Bettocchi D, et al. Hyperlipidemic acute pancreatitis:a possible role of antiretroviral therapy with entecavir. Minerva Anestesiol, 2011, 77(10):1018-1021.
4. 于浩, 鄒忠東, 王烈.高脂血癥性胰腺炎的診治進展.醫學綜述, 2010, 16(16):2449-2451.
5. 中華醫學會消化病學分會胰腺疾病學組.中國急性胰腺炎診治指南草案.中華內科雜志, 2004, 43(3):236-238.
6. Kadikoylu G, Yavasoglu I, Bolaman Z. Plasma exchange in severe hypertriglyceridemia a clinical study. Transfus Apher Sci, 2006, 34(3):253-257.
7. Stefanutti C, Labbadia G, Morozzi C. Severe hypertriglyceridemiarelated acute pancreatitis. Ther Apher Dial, 2013, 17(2):130-137.
8. Bajpai M, Tyagi P, Maharshi S. Therapeutic plasma exchange in hyperlipidemic pancreatitis. Transfusion, 2012, 52(5):929.
9. Chen JH, Yeh JH, Lai HW, et al. Therapeutic plasma exchange in patients with hyperlipidemic pancreatitis. World J Gastroenterol, 2004, 10(15):2272-2274.
10. Zhang G, Feng J, Xu QP, et al. Double filtration plasmapheresis in treatment of hyperlipidemic acute pancreatitis. Journal of Zhejiang University. Medical sciences, 2008, 37(1):93-96.
11. 邵偉, 趙二鵬, 傅強, 等.血液凈化對重癥急性胰腺炎伴重度高脂血癥的作用.中國中西醫結合外科雜志, 2009, (5):509-511.
12. 錢明江, 高飛, 陳淼, 等.血液灌流聯合CVVH治療高脂血癥性重癥急性胰腺炎的臨床觀察.中國醫藥科學, 2013, 3(18):16-18.
13. 周秀華.血液灌流聯合連續腎臟替代治療高脂血癥性重癥胰腺炎的研究.山西醫藥雜志, 2012, 41(12):1282-1283.
14. 黃鵬, 王春友, 吳河水, 等.持續血液濾過治療高脂血癥性急性胰腺炎24例.世界華人消化雜志, 2012, 20(11):964-968.
15. 何文華, 劉王, 朱勇.高甘油三脂血癥性胰腺炎的緊急降脂治療:比較早期高容量血液濾過與低分子肝素聯合胰島素的單中心, 前瞻性, 隨機對照研究初步結果. 2012中國消化病學大會:190.
16. 鐘世洪, 辛志軍.低分子肝素聯合床旁持續血液濾過應用于高脂血癥性胰腺炎的效果分析.健康必讀, 2012, (4):26.
17. 戴曉榮, 成宏偉, 陳永康, 等.早期血液凈化對重癥急性胰腺炎伴重度高脂血癥的療效分析.中外醫療, 2012, 31(35):87-89.
18. 季大璽, 龔德華, 徐斌, 等.連續性血液凈化在重癥監護病房中的應用.中華醫學雜志, 2002, 82(18):1292-1294.
19. 毛恩強, 湯耀卿, 韓天權, 等.短時血濾對重癥急性胰腺炎治療的影響.中華外科雜志, 1999, 37(3):141-143.
20. Mao EQ, Tang YQ, et al. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis. World J Gastroenterolo, 2003, 9(11):2622.
21. 中華醫學會消化病分會胰腺病學組.中國急性胰腺炎診治指南(草案).中華消化雜志, 2004, 24:190-192.
22. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
23. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414):557-560.
24. Wang XP, Zheng Y. Advancement in research on the heperlipidemia with etiopathogenesis of pancreatitis. Inte J Dig Dis, 2006, 26(4): 219-220.
25. Strate T, Mann O, Kleinhans H, et al. Systemic intravenous infusion of bovine hemoglobin significantly reduces microcirculatory dysfunction in experimentally induced pancreatitis in the rat. Ann Surg, 2003, 238(5):765-771.
26. 楊朝暉, 楊搖軍, 汪勇俊.連續性血液濾過對重癥急性胰腺炎誘發組織器官損害的保護作用.中國危重病急救醫學, 2004, 16(4): 232.
27. 李振江, 陳威, 徐月清, 等.重癥急性胰腺炎患者HV-CVVH清除細胞因子的作用.第四軍醫大學學報, 2004, 25(9):846-848.
28. 楊春娥.連續靜脈-靜脈血液濾過治療中并發癥的預防.中國實用護理雜志, 2004, 20(2):12-14.

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Continuous Veno-venous Hemofiltration for Patients with Hyperlipidemic Pancreatitis: A Systematic Review

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