a Internal Medicine Residency Program , Mercy Medical Center , Des Moines , IA , USA.
Postgrad Med. 2018 Jun;130(5):494-500. doi: 10.1080/00325481.2018.1470439. Epub 2018 May 4.
There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics predictive of lipid-lowering therapy selection in a large community hospital for treatment of hypertriglyceridemia; evaluate for a concentration-dependent relationship between hypertriglyceridemia severity and risk of acute pancreatitis; assess for differences in clinical outcomes between patients treated with IV insulin versus apheresis.
Single center, retrospective cohort study including patients with hypertriglyceridemia between January 2007 and December 2016. Main measures included frequency of pancreatitis, choice of lipid-lowering therapy, and clinical comparisons of diet, oral lipid-lowering agents, IV insulin, and apheresis.
Initial serum triglyceride level and disease acuity was higher among patients in insulin and apheresis groups. Neither triglyceride level, Charlson comorbidity index, age, BISAP score, nor initial CRP predicted use of IV insulin versus apheresis. Prevalence of pancreatitis increased with higher triglyceride level, reaching 48% with triglycerides >2000 md/dL (p < 0.001). There was a significant decrease in serum triglycerides at each time interval (p < 0.05) in patients treated with IV insulin and apheresis, but no difference in clearance rate between the two. Length of stay did not differ between IV insulin and apheresis.
The presence of pancreatitis, hyperglycemia, and hypertriglyceridemia severity influenced selection of therapies like IV insulin and apheresis. We found no superiority of either IV insulin or apheresis in the treatment of severe hypertriglyceridemia among patients hospitalized for pancreatitis.
有证据表明，高甘油三酯血症的严重程度增加会增加急性胰腺炎的风险。关于治疗方法的优越性存在争议，以前的研究特别呼吁直接比较静脉胰岛素和血浆分离术。确定在大型社区医院中治疗高甘油三酯血症时降低血脂治疗选择的患者特征；评估高甘油三酯血症严重程度与急性胰腺炎风险之间的浓度依赖性关系；评估接受静脉胰岛素与血浆分离术治疗的患者之间临床结果的差异。
单中心回顾性队列研究，纳入 2007 年 1 月至 2016 年 12 月期间患有高甘油三酯血症的患者。主要措施包括胰腺炎的发生频率、降脂治疗的选择，以及饮食、口服降脂药、静脉胰岛素和血浆分离术的临床比较。
胰岛素组和血浆分离组患者的初始血清甘油三酯水平和疾病严重程度更高。甘油三酯水平、Charlson 合并症指数、年龄、BISAP 评分和初始 CRP 均不能预测静脉胰岛素与血浆分离术的使用。随着甘油三酯水平的升高，胰腺炎的患病率增加，甘油三酯水平＞2000 md/dL 时达到 48%（p＜0.001）。接受静脉胰岛素和血浆分离术治疗的患者，每个时间间隔的血清甘油三酯水平均显著降低（p＜0.05），但两种方法的清除率无差异。静脉胰岛素与血浆分离术的住院时间无差异。
胰腺炎、高血糖和高甘油三酯血症的严重程度影响了静脉胰岛素和血浆分离术等治疗方法的选择。我们发现，在因胰腺炎住院的患者中，静脉胰岛素和血浆分离术在治疗严重高甘油三酯血症方面没有优势。
