Redick Jack C, Kesslering Christy
Internal Medicine, The Ohio State University College of Medicine, Columbus, USA.
Metabolic Health, KessRX, Elmhurst, USA.
Cureus. 2024 Jul 9;16(7):e64144. doi: 10.7759/cureus.64144. eCollection 2024 Jul.
This is the first case report of a very low-carbohydrate, high-fat ketogenic diet for the treatment of chylothorax. A 61-year-old female with recurrent chylothorax following thoracic surgery was refractory to a very low-fat diet managed by a hospital dietitian. She required repeated palliative thoracentesis to the point where she was scheduled for a thoracic duct embolization. Prior to the embolization, she was placed on a very low-carbohydrate (<20 total grams daily), high-fat, ketogenic diet. Metabolic markers and imaging were obtained regularly. The patient had improvements in her serum triglycerides, triglyceride/HDL ratio, and triglyceride-glucose index, as well as clinical and radiographic improvements in her chylothorax as assessed by a chest X-ray and CT scan. Within three months of starting her ketogenic diet, imaging revealed complete resolution of the chylous pleural effusion. This case suggests that metabolic optimization to decrease insulin resistance, improve chylomicron metabolism, decrease lymphatic permeability, and lower serum triglycerides, as occurs with a ketogenic diet, should be considered for conservative treatment of chylothorax and warrants further study.
这是首例关于采用极低碳水化合物、高脂肪生酮饮食治疗乳糜胸的病例报告。一名61岁女性在胸外科手术后反复出现乳糜胸，对医院营养师管理的极低脂肪饮食治疗无效。她需要反复进行姑息性胸腔穿刺抽液，直至安排进行胸导管栓塞术。在栓塞术前，她开始采用极低碳水化合物（每日总量<20克）、高脂肪的生酮饮食。定期获取代谢指标和影像学资料。患者的血清甘油三酯、甘油三酯/高密度脂蛋白比值以及甘油三酯-葡萄糖指数均有改善，通过胸部X光和CT扫描评估，其乳糜胸的临床和影像学表现也有所改善。在开始生酮饮食的三个月内，影像学显示乳糜性胸腔积液完全消退。该病例表明，对于乳糜胸的保守治疗，应考虑通过代谢优化来降低胰岛素抵抗、改善乳糜微粒代谢、降低淋巴通透性并降低血清甘油三酯，生酮饮食即能实现这些效果，这值得进一步研究。
