University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Digestion. 2021;102(5):809-813. doi: 10.1159/000512682. Epub 2021 Jan 21.
Hypertriglyceridemia (HTG) is considered within the top 5 etiologies in acute pancreatitis (AP), but the association of serum triglyceride (TG) levels with the clinical course of AP remains controversial.
This study aims to examine the effect of TG levels on severity of AP.
Patients were enrolled prospectively through APPRENTICE. High TG levels were defined based on the Endocrine Society Clinical Practice Guidelines. HTG was categorized as mild (serum TG levels 150-199 mg/dL), moderate (200-999 mg/dL), severe (1,000-1,999 mg/dL), and very severe (≥2,000 mg/dL). Severity of AP was based on the revised Atlanta classification criteria.
Early TG levels were measured in 764 subjects and found elevated in 342 (120 with mild; 176, moderate; and 46, severe/very severe HTG). Patients with increased TG levels were younger (age ≥60, 16.7 vs. 30.3%), more likely to be male (66.1 vs. 51.2%), with more frequent alcohol use (62.8 vs. 50.7%), and diabetes mellitus (30.2 vs. 12.3%; all p ≤ 0.005). Severe AP (24.9 vs. 10.0%), ICU admission (32.5 vs. 19.7%), and mortality (5.3 vs. 1.7%; all p ≤ 0.005) were more frequently seen in patients with elevated TG levels. Based on multivariable analysis, elevated TG levels were independently associated with severe AP (p < 0.05).
This large multicenter study confirms that elevated TG levels are associated with severe disease regardless of AP etiology.
高甘油三酯血症（HTG）被认为是急性胰腺炎（AP）的前 5 种病因之一，但血清甘油三酯（TG）水平与 AP 临床病程的关系仍存在争议。
本研究旨在探讨 TG 水平对 AP 严重程度的影响。
通过 APPRENTICE 前瞻性纳入患者。根据内分泌学会临床实践指南定义高 TG 水平。HTG 分为轻度（血清 TG 水平 150-199mg/dL）、中度（200-999mg/dL）、重度（1000-1999mg/dL）和非常重度（≥2000mg/dL）。AP 的严重程度基于修订后的亚特兰大分类标准。
共纳入 764 例患者，早期测量 TG 水平，其中 342 例（120 例轻度；176 例中度；46 例重度/非常重度 HTG）升高。TG 水平升高的患者更年轻（年龄≥60 岁，16.7%比 30.3%），更可能为男性（66.1%比 51.2%），更频繁饮酒（62.8%比 50.7%），以及患有糖尿病（30.2%比 12.3%；所有 p≤0.005）。TG 水平升高的患者更易发生重症 AP（24.9%比 10.0%）、入住 ICU（32.5%比 19.7%）和死亡（5.3%比 1.7%；所有 p≤0.005）。基于多变量分析，升高的 TG 水平与重症 AP 独立相关（p<0.05）。
这项多中心研究证实，无论 AP 的病因如何，升高的 TG 水平与疾病的严重程度相关。
