Tan Pan, Lu Shasha, Chen Qingxia, Ma Huijian, Kong Wei, Huang Xiawei, Yu Chaohui, Jin Meng
Department of Gastroenterology, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Department of Emergency, Zhejiang University School of Medicine First Affiliated Hospital, No. 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China.
Lipids Health Dis. 2025 Mar 21;24(1):108. doi: 10.1186/s12944-025-02511-y.
Effective management of hypertriglyceridemia is crucial in the treatment of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). The prognosis of HTG-AP may vary with different serum triglyceride levels, suggesting the need for stratified treatment approaches. In this study, we investigated hypertriglyceridemia management in HTG-AP patients and the optimal strategy.
Patients with HTG-AP from October 2020 to October 2022 were included in the study. Propensity score matching was used to balance the bias and confounding variables. A mixed-effects model was used to analyse the decreasing tendency of triglycerides.
A total of 171 patients who were diagnosed with HTG-AP were enrolled in this cohort. Patients with very severe serum triglycerides (> 22.6mmol/L) had a higher proportion of severe acute pancreatitis (p < 0.05) than patients with severe hypertriglyceridemia (11.3-22.6 mmol/L). For the very severe hypertriglyceridemia group, no significant differences in prognosis were noted between the insulin and heparin group and the plasma exchange group. The cost of the insulin and heparin group was significantly lower than that of the plasma exchange group (p < 0.01). In patients with severe hypertriglyceridemia, no significant differences in prognosis were noted between the nothing-by-mouth (NPO) group and the insulin and heparin group. Compared with the insulin and heparin group, the NPO group had lower hospital costs (p < 0.05).
HTG-AP patients with very severe hypertriglyceridemia may be treated safely and effectively with insulin and heparin, potentially offering a more cost-effective treatment approach. Similarly, patients with severe hypertriglyceridemia might benefit from treatment involving NPO, which may be associated with lower costs. Further studies are needed to validate these findings in diverse populations and through long-term follow-up.
高甘油三酯血症的有效管理在高甘油三酯血症性急性胰腺炎（HTG-AP）的治疗中至关重要。HTG-AP的预后可能因血清甘油三酯水平不同而有所差异，这表明需要采用分层治疗方法。在本研究中，我们调查了HTG-AP患者的高甘油三酯血症管理情况及最佳策略。
纳入2020年10月至2022年10月期间的HTG-AP患者。采用倾向得分匹配法平衡偏差和混杂变量。使用混合效应模型分析甘油三酯的下降趋势。
本队列共纳入171例诊断为HTG-AP的患者。血清甘油三酯水平极重度（>22.6mmol/L）的患者中，重症急性胰腺炎的比例高于重度高甘油三酯血症（11.3-22.6mmol/L）的患者（p<0.05）。对于极重度高甘油三酯血症组，胰岛素联合肝素组和血浆置换组在预后方面无显著差异。胰岛素联合肝素组的费用显著低于血浆置换组（p<0.01）。在重度高甘油三酯血症患者中，禁食组和胰岛素联合肝素组在预后方面无显著差异。与胰岛素联合肝素组相比，禁食组的住院费用更低（p<0.05）。
HTG-AP且伴有极重度高甘油三酯血症的患者使用胰岛素和肝素治疗可能安全有效，这可能提供一种更具成本效益的治疗方法。同样，重度高甘油三酯血症患者可能从禁食治疗中获益，这可能与较低的费用相关。需要进一步研究以在不同人群中并通过长期随访验证这些发现。
