Valaiyapathi Badhma, Sunil Bhuvana, Ashraf Ambika P
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Department of Pediatrics, Harlem Hospital Center, New York, NY.
Pediatr Rev. 2017 Sep;38(9):424-434. doi: 10.1542/pir.2016-0138.
Hypertriglyceridemia is increasingly identified in children and adolescents, owing to improved screening and higher prevalence of childhood obesity. Hypertriglyceridemia can result from either increased triglyceride (TG) production or reduced TG clearance. The etiologic origin can be primary (genetic) or secondary, but it is often multifactorial. Management is challenging because of the interplay of genetic and secondary causes and lack of evidence-based guidelines. Lifestyle changes and dietary interventions are most important, especially in hypertriglyceridemia associated with obesity. Dietary restriction of fat remains the mainstay of management in primary hypertriglyceridemia. When fasting TG concentration is increased above 500 mg/dL (5.65 mmol/L), fibrates may be used to prevent pancreatitis. Omega-3 fatty acids are often used as an adjunctive therapy. When the fasting TG concentration is less than 500 mg/dL (5.65 mmol/L) and if the non-high-density lipoprotein cholesterol level is above 145 mg/dL (3.76 mmol/L), statin treatment can be considered.
由于筛查手段的改进以及儿童肥胖患病率的上升，高甘油三酯血症在儿童和青少年中越来越常见。高甘油三酯血症可能是由于甘油三酯（TG）生成增加或TG清除减少所致。其病因可能是原发性（遗传性）的，也可能是继发性的，但通常是多因素的。由于遗传因素和继发性病因相互作用，且缺乏循证指南，治疗颇具挑战性。生活方式改变和饮食干预最为重要，尤其是对于与肥胖相关的高甘油三酯血症。限制脂肪摄入仍是原发性高甘油三酯血症治疗的主要手段。当空腹TG浓度升高至500mg/dL（5.65mmol/L）以上时，可使用贝特类药物预防胰腺炎。ω-3脂肪酸常作为辅助治疗药物。当空腹TG浓度低于500mg/dL（5.65mmol/L），且非高密度脂蛋白胆固醇水平高于145mg/dL（3.76mmol/L）时，可考虑使用他汀类药物治疗。
