Fortson M R, Freedman S N, Webster P D
Department of Medicine, Medical College of Georgia, Augusta, USA.
Am J Gastroenterol. 1995 Dec;90(12):2134-9.
This study addresses three questions: 1) What are the clinical presentations of pancreatitis secondary to hyperlipidemia? 2) What is the role of alcohol, diabetes, or known causes of hypertriglyceridemia? and 3) Does the course of pancreatitis secondary to hypertriglyceridemia differ from that of other etiologies?
We reviewed patients between 1982 and 1994 with a diagnosis of pancreatitis (577.0) and hypertriglyceridemia (272.0). Four hospitals participated. Seventy patients had a clinical presentation consistent with pancreatitis, that is elevated amylase and lipase or evidence of pancreatitis by ultrasound or CT imaging and serum triglyceride levels greater than 500 mg/dl or lactescent serum. Clinical data were derived from hospital admissions.
Hypertriglyceridemia was the etiology in 1.3-3.8% of patients discharged with a diagnosis of pancreatitis. A history of diabetes mellitus was present in 72%, hypertriglyceridemia in 77%, alcohol use 23%, and gallstones in 7%. Lipemic serum was described on admission in 45%. Mean triglyceride levels were 4587 +/- 3616 ml/dl. Amylase was elevated two times normal in 54%, and lipase was elevated two times normal in 67%. CT scans were abnormal in 82%, with peripancreatic fluid in 34%, pseudocyst 37%, and necrosis in 15%. Abscess occurred in 13%, death in 6%.
Acute pancreatitis secondary to hyperlipidemia is characterized by three presentations. All patients present with abdominal pain, nausea, and vomiting of hours to days duration. The most common presentation is a poorly controlled diabetic with a history of hypertriglyceridemia. The second presentation is the alcoholic found to have hypertriglyceridemia or lactescent serum on admission. The third, about 15-20% of patients, is the nondiabetic, nonalcoholic, nonobese patient with drug- or diet-induced hypertriglyceridemia.
本研究探讨三个问题：1）高脂血症继发胰腺炎的临床表现是什么？2）酒精、糖尿病或已知的高甘油三酯血症病因起什么作用？3）高脂血症继发胰腺炎的病程与其他病因所致胰腺炎的病程是否不同？
我们回顾了1982年至1994年间诊断为胰腺炎（577.0）和高脂血症（272.0）的患者。四家医院参与了研究。70例患者的临床表现符合胰腺炎，即淀粉酶和脂肪酶升高，或超声或CT成像显示胰腺炎证据，且血清甘油三酯水平大于500mg/dl或血清呈乳状。临床数据来自医院入院记录。
高脂血症是1.3 - 3.8%诊断为胰腺炎出院患者的病因。72%的患者有糖尿病史，77%有高脂血症，23%有饮酒史，7%有胆结石。45%的患者入院时描述有脂血血清。平均甘油三酯水平为4587±3616mg/dl。54%的患者淀粉酶升高至正常的两倍，67%的患者脂肪酶升高至正常的两倍。82%的CT扫描异常，34%有胰周积液，37%有假性囊肿，15%有坏死。13%发生脓肿，6%死亡。
高脂血症继发急性胰腺炎有三种表现。所有患者均出现腹痛、恶心和呕吐，持续数小时至数天。最常见的表现是患有高脂血症且血糖控制不佳的糖尿病患者。第二种表现是入院时发现患有高脂血症或脂血血清的酗酒者。第三种表现，约15 - 20%的患者，是患有药物或饮食诱导的高脂血症的非糖尿病、非酗酒、非肥胖患者。
