Tan Hong Lin Evelyn, McDonald Georgina, Payne Alexander, Yu William, Ismadi Zahrul, Tran Huy, Gani Jon, Wynne Katie
Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.
School of Medicine & Public Health, University of Newcastle, New Lambton Heights, NSW 2305, Australia.
J Clin Med. 2020 Dec 6;9(12):3954. doi: 10.3390/jcm9123954.
Hypertriglyceridemia-associated acute pancreatitis (HTGAP) has been linked with increased severity and morbidity. In this study, triglyceride levels were measured in all patients admitted with acute pancreatitis (AP) to establish the incidence of HTGAP in an Australian center.
A prospective cohort with AP was collated over an 18-month period in a single tertiary referral hospital. HTGAP was defined as AP with triglycerides ≥ 11.2 mmol/L (1000 mg/dL). Incidence, clinical co-morbidities, severity and management strategies were recorded.
Of the 292 episodes of AP, 248 (85%) had triglycerides measured and were included. HTGAP was diagnosed in 10 of 248 (4%) AP cases. Type 2 diabetes, obesity, alcohol misuse and gallstones were common cofactors. The HTGAP group demonstrated severe hypertriglyceridemia compared to the non-HTGAP group (median 51 mmol/L vs. 1.3 mmol/L). Intensive care unit (ICU) admissions were significantly increased (odds ratio (OR) 16; 95% CI 4-62) in the HTGAP group (5/10 vs. 14/238 admissions, < 0.001) and constituted 26% (5/19) of total ICU admissions for AP. Four patients received intravenous insulin with fasting and had a rapid reduction in triglyceride levels by 65-77% within 24 h; one patient had mild hypoglycemia secondary to therapy.
HTGAP occurred in 4% of AP cases and was associated with higher risk of ICU admission. Intravenous insulin and fasting appear safe and efficacious for acutely lowering triglyceride levels in HTGAP.
高甘油三酯血症相关性急性胰腺炎（HTGAP）与病情严重程度增加及发病率升高有关。在本研究中，对所有因急性胰腺炎（AP）入院的患者进行甘油三酯水平测定，以确定澳大利亚一家中心HTGAP的发病率。
在一家三级转诊医院，对18个月期间的AP患者进行前瞻性队列研究。HTGAP定义为甘油三酯≥11.2 mmol/L（1000 mg/dL）的AP。记录发病率、临床合并症、严重程度及治疗策略。
292例AP发作中，248例（85%）测定了甘油三酯并纳入研究。248例AP病例中有10例（4%）诊断为HTGAP。2型糖尿病、肥胖、酒精滥用和胆结石是常见的共同因素。与非HTGAP组相比，HTGAP组表现出严重的高甘油三酯血症（中位数51 mmol/L对1.3 mmol/L）。HTGAP组重症监护病房（ICU）入院率显著增加（优势比（OR）16；95%置信区间4 - 62）（5/10例入院对14/238例入院，<0.001），占AP患者ICU总入院人数的26%（5/19）。4例患者接受禁食静脉胰岛素治疗，24小时内甘油三酯水平迅速降低65 - 77%；1例患者治疗后出现轻度低血糖。
4%的AP病例发生HTGAP，且与ICU入院风险较高相关。静脉胰岛素和禁食对于急性降低HTGAP患者的甘油三酯水平似乎安全有效。
