Berger Amnon A, Sherburne Robert, Urits Ivan, Patel Haresh, Eskander Jonathan
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Critical Care Medicine, Maryview Medical Center, Portsmouth, USA.
Cureus. 2020 Nov 18;12(11):e11551. doi: 10.7759/cureus.11551.
Acute pancreatitis is the most common gastrointestinal pathology that warrants hospital admission, with an estimated incidence of 13-45/100,000 annually in the US. The overall mortality is low but is significantly increased in 15-25% of patients that develop severe disease, likely secondary to an increase in inflammation and an exaggerated response, sometimes referred to as a cytokine storm. Management is largely supportive, and no specific cure exists to hasten recovery. Icosapent Ethyl (IPE, Vascepa®) is an omega-3 fatty acid derivative that is indicated for the treatment of hypertriglyceridemia and has been shown to improve mortality from cardiovascular causes, likely through an anti-inflammatory mechanism. We report here a case of very severe, abrupt acute alcoholic pancreatitis in a 31-year-old male, requiring intensive care unit admission, ventilation, and support with multiple vasoactive medications. Shortly after the initiation of IPE, the patient started to improve and ultimately made a complete recovery. His initially greatly elevated inflammatory markers downtrended quickly under IPE treatment and he followed with a remarkable clinical recovery. Several previous studies, such as the Patients With Persistent High Triglyceride Levels (≥ 200 mg/dL and < 500 mg/dL) Despite Statin Therapy (ANCHOR; NCT01047501) and the Multi-Center, PlAcebo-Controlled, Randomized, Double-BlINd, 12-week study with an open-label Extension (MARINE; NCT01047683), provided evidence of the anti-inflammatory activity of IPE. In our case, we provide the first evidence to support its use as a direct anti-inflammatory in severe disease. With the absence of direct therapy and the significant mortality from severe acute pancreatitis, IPE can be a breakthrough therapy. Its treatment is not limited to pancreatitis only, and it may also be beneficial in other cases of severe inflammation. Though anecdotal, this case provides evidence to support further study of IPE in states of exaggerated inflammation.
急性胰腺炎是最常见的需要住院治疗的胃肠道疾病，在美国，其年发病率估计为每10万人中有13 - 45例。总体死亡率较低，但在15% - 25%发展为重症的患者中显著增加，这可能继发于炎症加剧和过度反应，有时被称为细胞因子风暴。治疗主要是支持性的，不存在加速康复的特效疗法。二十碳五烯酸乙酯（IPE，Vascepa®）是一种ω-3脂肪酸衍生物，被用于治疗高甘油三酯血症，并且已显示可能通过抗炎机制改善心血管疾病导致的死亡率。我们在此报告一例31岁男性的非常严重、突发的急性酒精性胰腺炎病例，该患者需要入住重症监护病房、机械通气，并使用多种血管活性药物进行支持治疗。在开始使用IPE后不久，患者病情开始好转并最终完全康复。他最初大幅升高的炎症标志物在IPE治疗下迅速下降，随后临床症状显著恢复。此前的多项研究，如尽管接受他汀类药物治疗但甘油三酯水平持续居高（≥200 mg/dL且<500 mg/dL）的患者（ANCHOR；NCT01047501）以及多中心、安慰剂对照、随机、双盲、为期12周并开放标签扩展的研究（MARINE；NCT01047683），都提供了IPE具有抗炎活性的证据。在我们的病例中，我们提供了首个证据支持其在重症疾病中作为直接抗炎药物使用。由于缺乏针对重症急性胰腺炎的直接治疗方法且死亡率较高，IPE可能是一种突破性疗法。其治疗不限于胰腺炎，在其他严重炎症病例中可能也有益处。尽管这只是个例，但该病例为支持进一步研究IPE在炎症过度状态下的应用提供了证据。
