Seah Jonathan, Lin Keegan, Tai David, Lim Soon T, Chan Alexandre
Department of Pharmacy, National University of Singapore, Singapore.
Onkologie. 2012;35(10):596-8. doi: 10.1159/000342690. Epub 2012 Sep 24.
L-Asparaginase (L-Asp) may induce hypertriglyceridemia; however, this has been mainly observed among pediatric patients. Treatment for L-Asp-induced hypertriglyceridemia is not standardized, ranging from fasting and diet restriction to the invasive plasmapheresis procedure.
We describe a 53-year-old male patient who presented with L-Asp-induced severe hypertriglyceridemia. He was receiving L-Asp as part of his chemotherapy regimen for natural killer T-cell lymphoma. After the 20th dose, his serum triglyceride level was 3,552 mg/dl, with a total cholesterol of 418 mg/dl. Despite the high triglyceride, the patient did not present with acute pancreatitis symptoms. Treatment comprising fasting, fenofibrate, and omega-3 fatty acids was initiated. Triglyceride levels dropped rapidly to 1,000 mg/dl within 2 days, and to 268 mg/dl after 10 days. The chemotherapy regimen was subsequently switched to exclude L-Asp.
L-Asp-induced severe hypertriglyceridemia may occur in adults and may be conservatively managed with fasting, fibrates, and omega-3 fatty acids. Plasmapheresis or continuous insulin infusion may be used for symptomatic patients with high triglyceride levels. Lipidlowering agents should be continued for patients previously treated for hyperlipidemia. Regular monitoring of lipid levels for patients receiving L-Asp is important, especially for those with a prior history of dyslipidemia. Re-challenge with L-Asp can be undertaken on an individual basis.
L-天冬酰胺酶（L-Asp）可能会诱发高甘油三酯血症；然而，这主要在儿科患者中观察到。L-Asp诱导的高甘油三酯血症的治疗并不规范，从禁食和饮食限制到侵入性的血浆置换术不等。
我们描述了一名53岁男性患者，他出现了L-Asp诱导的严重高甘油三酯血症。他正在接受L-Asp治疗，作为其自然杀伤T细胞淋巴瘤化疗方案的一部分。在第20次给药后，他的血清甘油三酯水平为3552mg/dl，总胆固醇为418mg/dl。尽管甘油三酯水平很高，但患者并未出现急性胰腺炎症状。开始了包括禁食、非诺贝特和ω-3脂肪酸在内的治疗。甘油三酯水平在2天内迅速降至1000mg/dl，10天后降至268mg/dl。随后更换了化疗方案以排除L-Asp。
L-Asp诱导的严重高甘油三酯血症可能发生在成人中，可通过禁食、贝特类药物和ω-3脂肪酸进行保守治疗。对于甘油三酯水平高的有症状患者，可使用血浆置换或持续胰岛素输注。对于先前接受过高脂血症治疗的患者，应继续使用降脂药物。对接受L-Asp治疗的患者定期监测血脂水平很重要，尤其是那些有血脂异常病史的患者。是否再次使用L-Asp可根据个体情况决定。
