合并全身炎症反应综合征的早期高甘油三酯血症性急性胰腺炎应用糖皮质激素的效果及预后

The Efficacy and Prognosis of Glucocorticoids in Early Hypertriglyceridemic Acute Pancreatitis Complicated with Systemic Inflammatory Response Syndrome

摘要: 目的：探究合并早期全身炎症反应综合征(Systemic Inflammatory Response Syndrome, SIRS)的高甘油三酯血症性急性胰腺炎(Hypertriglyceridemia-induced Acute Pancreatitis, HTG-AP)患者应用糖皮质激素(glucocorticoid, GC)的效果及预后。方法：纳入50例患者，随机分组为对照组(25例)与治疗组(25例)。对照组予禁食水、保持呼吸道通畅、纠正内环境紊乱、补液等常规治疗；治疗组在此基础上在入院后前3d加用地塞米松0.2 mg/(kg∙d)静滴。结果：治疗后第3天及第6天，两组SIRS评分均较治疗前下降(均P < 0.05)，且第3天时治疗组低于对照组(P < 0.05)。治疗后第６天，两组血清C反应蛋白(C-reactive protein, CRP)水平均较治疗前下降(均P < 0.05)。治疗组呼吸衰竭发生率、器官功能障碍(organ failure, OF)持续时间均低于或短于对照组(均P < 0.05)。两组在血清甘油三酯(triglyceride, TG)水平、肾衰竭与循环衰竭发生率、重症急性胰腺炎(severe acute pancreatitis, SAP)发生率、不良事件发生率、各系统感染率、住院时间及血清钙离子水平方面比较，差异均无统计学意义(P > 0.05)。结论：对于早期合并SIRS的HTG-AP患者，短期小剂量地塞米松治疗减轻全身炎症反应、缩短OF持续时间，降低血清CRP水平及呼吸衰竭发生率，且未增加感染、不良事件及升高TG水平的风险。

Abstract: Objective: To investigate the efficacy and prognosis of glucocorticoid (GC) therapy in patients with early-stage hypertriglyceridemia-induced acute pancreatitis (HTG-AP) complicated by systemic inflammatory response syndrome (SIRS). Methods: A total of 50 patients were enrolled and randomly assigned to a control group (n = 25) or a treatment group (n = 25). The control group received conventional therapy, including fasting, airway management, correction of internal environment disturbances, and fluid resuscitation. The treatment group received additional intravenous dexamethasone [0.2 mg/(kg∙d)] for the first 3 days after admission. Results: On the 3rd and 6th days of treatment, the SIRS scores in both groups decreased significantly compared to baseline (all P < 0.05), with the treatment group showing a lower score than the control group on day 3 (P < 0.05). By day 6, serum C-reactive protein (CRP) levels in both groups had decreased significantly from baseline (all P < 0.05). The incidence of respiratory failure and the duration of organ failure (OF) were significantly lower/shorter in the treatment group (all P < 0.05). There were no statistically significant differences between the two groups in serum triglyceride (TG) levels, incidence of renal or circulatory failure, incidence of severe acute pancreatitis (SAP), rate of adverse events, rate of systemic infections, length of hospital stay, or serum calcium levels (all P > 0.05). Conclusion: Short-term, low-dose dexamethasone therapy in early HTG-AP patients with SIRS can effectively mitigate systemic inflammation, shorten the duration of organ failure, reduce serum CRP levels and the incidence of respiratory failure, without increasing the risks of infection, adverse events, or elevated TG levels.