Athyros Vassilios G, Giouleme Olga I, Nikolaidis Nikolaos L, Vasiliadis Themistoklis V, Bouloukos Vassilios I, Kontopoulos Athanasios G, Eugenidis Nikolaos P
Lipid Out-Patient, 2nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece.
J Clin Gastroenterol. 2002 Apr;34(4):472-5. doi: 10.1097/00004836-200204000-00020.
An acute and potentially life-threatening complication of hypertriglyceridemia (HTG) is acute pancreatitis (AP). Hypertriglyceridemia, usually severe, may be primary in origin or secondary to alcohol abuse, diabetes mellitus, pregnancy, and use of drugs.
The efficacy of treatment to prevent relapses in 17 patients with AP attributed to HTG was investigated in the current prospective study. The mean follow-up period of patients was 42 months. Hypertriglyceridemia-induced AP comprised 6.9% of all patients with AP (n = 246) hospitalized in our clinic during the study (6 years).
Causative conditions of HTG-induced AP were familial HTG in eight patients, HTG caused by uncontrolled diabetes mellitus in five, HTG aggravated by drugs in two (one by tamoxifen and one by fluvastatin), familial hyperchylomicronemia (HCM) in one, and lipemia of pregnancy in one. During the acute phase of pancreatitis, patients underwent standard treatment. Thereafter, HTG was efficiently controlled with high dosages of fibrates or a fibrate plus acipimox, except for the patient with HCM, who was on a specific diet (the only source of fat was a special oil consisting of medium chain triglyceride) and taking a high dosage of acipimox. One of the patients died during the acute phase of pancreatitis with acute respiratory distress syndrome. During follow-up, maintenance treatment was successful and only one patient relapsed, because he discontinued diet and drug treatment.
Appropriate diet and drug treatment, including dose titration, of severe HTG is very effective in preventing relapses of HTG-induced AP.
高甘油三酯血症（HTG）的一种急性且可能危及生命的并发症是急性胰腺炎（AP）。高甘油三酯血症通常较为严重，其病因可能是原发性的，也可能继发于酒精滥用、糖尿病、妊娠及药物使用。
在当前这项前瞻性研究中，对17例因HTG导致的AP患者预防复发的治疗效果进行了调查。患者的平均随访期为42个月。在研究期间（6年），我院收治的所有AP患者（n = 246）中，HTG诱导的AP占6.9%。
HTG诱导AP的病因包括：8例为家族性HTG，5例为未控制的糖尿病导致的HTG，2例为药物加重的HTG（1例由他莫昔芬引起，1例由氟伐他汀引起），1例为家族性高乳糜微粒血症（HCM），1例为妊娠性脂血症。在胰腺炎急性期，患者接受了标准治疗。此后，除HCM患者采用特定饮食（唯一的脂肪来源是一种由中链甘油三酯组成的特殊油）并服用高剂量阿西莫司外，其他患者通过高剂量贝特类药物或贝特类药物加阿西莫司有效地控制了HTG。1例患者在胰腺炎急性期死于急性呼吸窘迫综合征。在随访期间，维持治疗取得成功，仅1例患者复发，原因是他停止了饮食和药物治疗。
对严重HTG进行适当的饮食和药物治疗，包括剂量滴定，对于预防HTG诱导的AP复发非常有效。
