聚乙二醇化天冬酰胺酶引起的高甘油三酯血症的胰岛素和肝素持续静脉输注治疗：一例报告。
Treatment of Pegylated Asparaginase-Induced Hypertriglyceridemia with Continuous Intravenous Infusion of Insulin and Heparin: A Case Report.
机构信息
Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany,
Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
出版信息
Chemotherapy. 2019;64(4):210-214. doi: 10.1159/000505773. Epub 2020 Feb 11.
BACKGROUND
Pegylated asparaginase may induce prolonged hypertriglyceridemia. To date, there is no standard management of this complication. Here, we present a case report of pegylated asparaginase-induced hypertriglyceridemia and hepatotoxicity successfully treated with continuous intravenous infusion of insulin and heparin.
CASE PRESENTATION
A 51-year-old male patient with lymphoid blast crisis of chronic myelogenous leukemia was treated with pegylated asparaginase. The patient developed severe hypertriglyceridemia. Supportive therapy with low-fat diet, fibric acids, and omega-3 fatty acids was not successful, and later, the patient developed high-grade hepatotoxicity. Like hypertriglyceridemia-induced pancreatitis, continuous intravenous infusion of insulin and heparin was initiated. The level of triglyceride and cholesterol decreased rapidly within 4 days.
CONCLUSION
In case of severe pegylated asparaginase-induced hypertriglyceridemia, continuous intravenous infusion of insulin and heparin can reduce rapidly and safely the triglyceride level. Controlled trials are needed to address this important issue.
背景
聚乙二醇化天冬酰胺酶可能会引起长时间的高甘油三酯血症。迄今为止，对于这种并发症尚无标准的治疗方法。在此，我们报告一例聚乙二醇化天冬酰胺酶诱导的高甘油三酯血症和肝毒性，成功地通过持续静脉输注胰岛素和肝素进行了治疗。
病例介绍
一名 51 岁男性慢性髓性白血病淋巴细胞母细胞危象患者接受了聚乙二醇化天冬酰胺酶治疗。该患者出现严重的高甘油三酯血症。低脂饮食、纤维酸和欧米伽-3 脂肪酸等支持性治疗无效，随后患者出现了高级别的肝毒性。与高甘油三酯血症诱导的胰腺炎类似，开始持续静脉输注胰岛素和肝素。甘油三酯和胆固醇水平在 4 天内迅速降低。
结论
对于严重的聚乙二醇化天冬酰胺酶诱导的高甘油三酯血症，持续静脉输注胰岛素和肝素可以快速、安全地降低甘油三酯水平。需要进行对照试验来解决这个重要问题。
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