Navarro Salvador, Cubiella Joaquín, Feu Fausto, Zambón Daniel, Fernández-Cruz Laureano, Ros Emilio
Servicio de Gastroenterología, Institut de Malalties Digestives, Hospital Clínic de Barcelona, Barcelona, Spain.
Med Clin (Barc). 2004 Oct 30;123(15):567-70. doi: 10.1016/s0025-7753(04)74599-6.
Although hypertriglyceridemia is an accepted cause of acute pancreatitis, its clinical course is not well defined. What is more, lipemic serum may interfere with an accurate pancreatic enzyme measurement and may hinder the diagnosis of acute pancreatitis. The objective was to analyze the clinical performance of hypertriglyceridemic acute pancreatitis and the diagnosis value of the serum measurement of pancreatic enzymes.
31 demographic, clinical, analytical and radiological data of 19 hypertriglyceridemic acute pancreatitis were retrospectively analyzed and their results were compared with data of 19 lithiasic acute pancreatitis without hypertriglyceridemia. Diagnosis of acute pancreatitis was based on clinical, radiological and/or laparotomical findings. Serum levels of triglycerides higher than 1,000 mg/dl were considered the cause of acute pancreatitis when other causes were excluded. Acute pancreatitis was considered lithiasic when gallstones were identified by ultrasonography, serum levels of triglycerides were lower than 200 mg/dl and there was no history of alcohol consumption.
Compared with lithiasic acute pancreatitis, hypertriglyceridemic acute pancreatitis showed more personal and family hypertriglyceridemia (9 vs 0), more previous episodes of pancreatitis (13 vs 2), pancreatitis was more severe (13 vs 5) and had more complications (29 vs 5). There was no mortality in either group. The serum levels of amylase and lipase supported the diagnosis in 26% and 58% of patients with hypertriglyceridemic acute pancreatitis compared with 58% and 79% of patients with lithiasic acute pancreatitis, respectively. Hospital stay was longer in hypertriglyceridemic than in lithiasic acute pancreatitis (24 [45] vs 7.6 [3.1] days; p = NS). Demographic and analytical factors which could permit to predict the severity of acute pancreatitis could not be identified.
Hypertriglyceridemic acute pancreatitis is relapsing and its clinical course is more severe than lithiasic acute pancreatitis. The measurement of amylase and lipase levels is less useful in the diagnosis of hypertriglyceridemic than in lithiasic acute pancreatitis.
尽管高甘油三酯血症是急性胰腺炎公认的病因，但其临床病程尚不明确。此外，脂血血清可能会干扰胰腺酶的准确测定，并可能妨碍急性胰腺炎的诊断。目的是分析高甘油三酯血症性急性胰腺炎的临床表现及血清胰腺酶测定的诊断价值。
回顾性分析19例高甘油三酯血症性急性胰腺炎患者的31项人口统计学、临床、分析及影像学资料，并将其结果与19例无高甘油三酯血症的胆石症性急性胰腺炎患者的数据进行比较。急性胰腺炎的诊断基于临床、影像学和/或剖腹探查结果。当排除其他病因时，血清甘油三酯水平高于1000mg/dl被视为急性胰腺炎的病因。当通过超声检查发现胆结石、血清甘油三酯水平低于200mg/dl且无饮酒史时，急性胰腺炎被认为是胆石症性的。
与胆石症性急性胰腺炎相比，高甘油三酯血症性急性胰腺炎患者的个人及家族性高甘油三酯血症更多（9例对0例），既往胰腺炎发作史更多（13例对2例），胰腺炎更严重（13例对5例），并发症更多（29例对5例）。两组均无死亡病例。高甘油三酯血症性急性胰腺炎患者中，淀粉酶和脂肪酶血清水平分别在26%和58%的患者中支持诊断，而胆石症性急性胰腺炎患者中这一比例分别为58%和79%。高甘油三酯血症性急性胰腺炎患者的住院时间比胆石症性急性胰腺炎患者更长（24[45]天对7.6[3.1]天；p=无显著性差异）。无法确定可预测急性胰腺炎严重程度的人口统计学和分析因素。
高甘油三酯血症性急性胰腺炎易复发，其临床病程比胆石症性急性胰腺炎更严重。淀粉酶和脂肪酶水平测定在高甘油三酯血症性急性胰腺炎诊断中的作用不如在胆石症性急性胰腺炎中有用。
