Geng Zhengguang, Su De, Zhang Bao, Gao Fei, Yao Hua, Yang Chaojin, Fu Bao, Fu Xiaoyun
Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Severe Acute Pancreatitis Diagnosis and Treatment Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Medicine (Baltimore). 2025 Jun 27;104(26):e43009. doi: 10.1097/MD.0000000000043009.
The important etiological treatment for hyperlipidemic severe acute pancreatitis is to reduce blood lipid. Statins or fibrates are often selected in clinical practice. Most reports indicate that statins or statin combination therapy can cause serious complications such as rhabdomyolysis syndrome (RM) and even poor prognosis. However, in fact, RM may also occur when fibrates alone are used to reduce blood lipid.
A 25-year-old man was admitted to our hospital for a 2-day history of abdominal pain, nausea, and vomiting. This patient presented with typical clinical manifestations of acute pancreatitis such as abdominal pain, abdominal distension, nausea, vomiting, and difficulty in defecation after a greasy diet. Auxiliary examinations such as blood (urine) amylase, lipase, blood lipid, abdominal computed tomography, and color Doppler ultrasound confirmed hyperlipidemic severe acute pancreatitis. However, after admission, during the treatment for reducing blood lipid, the blood creatine kinase index of the patient continued to increase, reaching more than 200 times the upper limit of normal at the highest. Accompanied by typical clinical manifestations, rhabdomyolysis was considered. After discussions among experts in the department, differentiations were mainly made from drugs after admission, recent history of toxicant exposure, history of trauma, past history of similar rhabdomyolysis, and other etiologies causing elevated myocardial enzyme spectrum. Finally, it was considered related to bezafibrate.
RM.
Bezafibrate tablets for lowering blood lipids were immediately discontinued. On the second day after discontinuation, there was a small decrease in creatine kinase. Then, appropriate fluid infusion, alkalinization of urine, addition of plasma exchange, and bedside continuous renal replacement therapy were administered.
The level of muscle enzymes decreased progressively and finally returned to normal before discharge.
In clinical practice, it is necessary to dynamically monitor the changes of liver and kidney functions and myocardial enzyme spectrum when using bezafibrate tablets to treat hyperlipidemic pancreatitis.
高脂血症性重症急性胰腺炎的重要病因治疗是降低血脂。临床实践中常选用他汀类药物或贝特类药物。大多数报告表明，他汀类药物或他汀类联合治疗可导致严重并发症，如横纹肌溶解综合征（RM），甚至预后不良。然而，事实上，单独使用贝特类药物降低血脂时也可能发生RM。
一名25岁男性因腹痛、恶心和呕吐2天入院。该患者在进食油腻食物后出现腹痛、腹胀、恶心、呕吐及排便困难等急性胰腺炎的典型临床表现。血（尿）淀粉酶、脂肪酶、血脂、腹部计算机断层扫描和彩色多普勒超声等辅助检查确诊为高脂血症性重症急性胰腺炎。然而，入院后在降血脂治疗过程中，患者血肌酸激酶指标持续升高，最高达正常上限的200多倍。伴有典型临床表现，考虑为横纹肌溶解。经科室专家讨论，主要从入院后用药、近期毒物接触史、外伤史、既往类似横纹肌溶解病史及其他导致心肌酶谱升高的病因进行鉴别。最终考虑与苯扎贝特有关。
RM。
立即停用苯扎贝特片降血脂。停药后第二天，肌酸激酶略有下降。随后给予适当补液、尿液碱化、加用血浆置换及床边连续性肾脏替代治疗。
肌肉酶水平逐渐下降，出院前最终恢复正常。
临床实践中，使用苯扎贝特片治疗高脂血症性胰腺炎时，有必要动态监测肝肾功能及心肌酶谱的变化。
