From the Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, East Tennessee State University, Johnson City, TN.
Pancreas. 2020 Mar;49(3):429-434. doi: 10.1097/MPA.0000000000001505.
Hypertriglyceridemia-induced pancreatitis is an important cause of acute pancreatitis (AP) in children, which lacks established guidelines. The aim of this study was to review management approaches at a single pediatric center.
This retrospective study included all inpatients younger than 21 years with AP and triglycerides (TG) of 1000 mg/dL or greater. A linear mixed effect model was used to calculate drop in TGs. The patient's diet, intravenous fluid (IVF) rate, insulin, and plasmapheresis were included in the model.
Seventeen admissions were identified among 8 patients, average age 15 years (range, 6-19 years). Fifty percent had recurrent AP and 29% of admissions had complications including 1 death. The population was primarily female (75%), white (75%), and overweight, and 63% had diabetes. The median stay was 5.4 days. There were 14 approaches used with variations in IVF rates, insulin, plasmapheresis, and nill per os (NPO) versus feeds. Variables that reduced TG's were NPO, higher IVF rates, plasmapheresis, and insulin (P < 0.05). Importantly, NPO reduced TGs faster than those who started early nutrition.
Hypertriglyceridemia is an important cause of pancreatitis in children. This study shares a management algorithm from a single institution. Larger studies are needed for more evidence-based guidelines.
由高甘油三酯血症引起的胰腺炎是儿童急性胰腺炎（AP）的一个重要病因，但目前对此缺乏既定的指南。本研究旨在回顾单一儿科中心的治疗方法。
本回顾性研究纳入了所有甘油三酯（TG）水平≥1000mg/dL 的、年龄小于 21 岁的 AP 住院患儿。采用线性混合效应模型来计算 TG 下降值。模型中包含了患者的饮食、静脉输液（IVF）速度、胰岛素和血浆置换等因素。
在 8 例患儿中发现了 17 例次住院，平均年龄 15 岁（范围：6-19 岁）。50%的患儿有复发性 AP，29%的住院患儿出现了并发症，包括 1 例死亡。患儿主要为女性（75%）、白人（75%）和超重，63%患有糖尿病。中位住院时间为 5.4 天。共采用了 14 种治疗方法，IVF 速度、胰岛素、血浆置换和禁食与进食的应用存在差异。降低 TG 的因素有禁食、更高的 IVF 速度、血浆置换和胰岛素（P<0.05）。重要的是，与早期开始营养相比，禁食能更快地降低 TG。
高甘油三酯血症是儿童胰腺炎的一个重要病因。本研究分享了来自单一机构的治疗方案。需要更大规模的研究来制定更具循证医学证据的指南。
