Okura Yoshifumi, Hayashi Kozo, Shingu Tetsuji, Kajiyama Goro, Nakashima Yoshiyuki, Saku Keijiro
Division of Cardiology, Department of Internal Medicine, Fukuoka Dental College Hospital, 2-15-1, Tamura, Sawara-ku, Fukuoka 814-0193, Japan.
World J Gastroenterol. 2004 Dec 15;10(24):3691-5. doi: 10.3748/wjg.v10.i24.3691.
We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type V hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels. The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis. Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist, exhibiting a relief of abdominal symptoms. As in the present cases with acute abdomen following the ingestion of fatty food, the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen, when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.
我们报告了两例诊断具有挑战性的急性胰腺炎病例，这些病例伴有高甘油三酯血症并伴有乳糜微粒血症，病因是脂蛋白脂肪酶缺乏以及存在V型高脂血症。两例患者在摄入脂肪类食物后均出现急腹症，炎症指标升高，但血清淀粉酶水平无显著升高。超声成像检查未发现急性胰腺炎的明显表现，最终计算机断层扫描证实了急性胰腺炎的诊断。两例患者对低脂饮食和给予胆囊收缩素受体拮抗剂均有反应，腹部症状得到缓解。在像本病例这样摄入脂肪类食物后出现急腹症的情况下，当高甘油三酯血症干扰胰腺酶活性评估且超声检查胰腺显影不佳时，血清高甘油三酯血症的鉴定和腹部计算机断层扫描可能有助于急性胰腺炎的诊断及制定治疗方案。
