高脂血症性急性胰腺炎反复发作的病因及防治策略

奇丽娜; 陈平

doi:10.12449/JCH241030

高脂血症性急性胰腺炎反复发作的病因及防治策略

DOI: 10.12449/JCH241030

奇丽娜,
陈平^, ,

内蒙古医科大学附属医院消化内科，呼和浩特 010000

基金项目:

内蒙古自治区科技计划项目 (2021GG0234)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：奇丽娜负责资料分析，撰写论文及修改；陈平负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
陈平， nmgcp@sina.com （ORCID： 0000-0003-2504-3659）

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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-06
- 录用日期: 2024-03-04
- 出版日期: 2024-10-25

Recurrent hyperlipidemic acute pancreatitis： Etiology and prevention and treatment strategies

Lina QI,
Ping CHEN^{,
,}

Department of Gastroenterology，The Affiliated Hospital of Inner Mongolia Medical University，Huhehot 010000，China

Research funding:

The Science and Technology Project of Inner Mongolia (2021GG0234)

More Information

Corresponding author: CHEN Ping， nmgcp@sina.com （ORCID： 0000-0003-2504-3659）

摘要

摘要: 高脂血症性急性胰腺炎（HLAP）发病率逐年上升，具有年轻化、病情重、易复发和预后差等特点。复发性HLAP已成为临床亟须解决的难题。本文重点总结了HLAP复发的危险因素以及相应的防治策略。HLAP反复发作的危险因素主要有血脂异常、糖代谢异常、肥胖、吸烟和饮酒等。除了急性期的早期治疗，HLAP还需要长期管理，包括有效地控制血糖和血脂，调节饮食，戒烟限酒。对于不明原因反复发作的HLAP患者，基因检测及基因治疗另辟蹊径，将为此类患者提供新的诊疗策略。
- 胰腺炎 /
- 高脂血症 /
- 复发 /
- 危险因素
Abstract: The incidence rate of hyperlipidemic acute pancreatitis （HLAP） is gradually increasing， with the features of young age， severe conditions， frequent recurrence， and poor prognosis， and recurrent HLAP has become a difficult issue that needs to be solved urgently in clinical practice. This article summarizes the risk factors for HLAP recurrence and corresponding prevention and treatment strategies. The risk factors for HLAP recurrence include dyslipidemia， abnormal glucose metabolism， obesity， smoking， and drinking. In addition to the early treatment in the acute stage， HLAP requires long-term management， including effective control of blood glucose and lipids， diet regulation， and cigarette and alcohol withdrawal. As for patients with unexplained recurrent HLAP， genetic testing and gene therapy may provide novel diagnosis and treatment strategies.
- Pancreatitis /
- Hyperlipidemias /
- Recurrence /
- Risk Factors

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参考文献(50)

[1]	ZHANG RW, DENG LH, JIN T, et al. Hypertriglyceridaemia-associated acute pancreatitis: Diagnosis and impact on severity[J]. HPB, 2019, 21( 9): 1240- 1249. DOI: 10.1016/j.hpb.2019.01.015.
[2]	Expert group of emergency expert consensus on diagnosis and treatment of hypertriglyceridemic acute pancreatitis. Emergency expert consensus on diagnosis and treatment of hypertriglyceridemia acute pancreatitis[J]. Chin J Emerg Med, 2021, 30( 8): 937- 947. DOI: 10.3760/cma.j.issn.1671-0282.2021.08.005. 高甘油三酯血症性急性胰腺炎诊治急诊共识专家组. 高甘油三酯血症性急性胰腺炎诊治急诊专家共识[J]. 中华急诊医学杂志, 2021, 30( 8): 937- 947. DOI: 10.3760/cma.j.issn.1671-0282.2021.08.005.
[3]	MENG L, WANG XM, LI H, et al. Etiology of hyperlipidemic acute pancreatitis[J]. World Latest Med Inf, 2019, 19( 92): 98- 99. DOI: 10.19613/j.cnki.1671-3141.2019.92.048. 孟亮, 王晓明, 李辉, 等. 高脂血症性急性胰腺炎的病因学进展[J]. 世界最新医学信息文摘, 2019, 19( 92): 98- 99. DOI: 10.19613/j.cnki.1671-3141.2019.92.048.
[4]	CHEN MM, YANG NL, GE WL, et al. Investigation of dietary habits and analysis of influencing factors in patients with hyperlipidemia acute pancreatitis[J]. Clin J Med Offic, 2023, 51( 9): 978- 981. DOI: 10.16680/j.1671-3826.2023.09.25. 陈明媚, 杨宁琍, 葛万里, 等. 高脂血症性急性胰腺炎患者饮食习惯现状调查及影响因素分析[J]. 临床军医杂志, 2023, 51( 9): 978- 981. DOI: 10.16680/j.1671-3826.2023.09.25.
[5]	YANG AL, MCNABB-BALTAR J. Hypertriglyceridemia and acute pancreatitis[J]. Pancreatology, 2020, 20( 5): 795- 800. DOI: 10.1016/j.pan.2020.06.005.
[6]	ZENG GN, LU SY, HUANG L. Analysis of risk factors for recurrence of hyperlipidemic acute pancreatitis[J]. J Med Theory Pract, 2021, 34( 20): 3510- 3512, 3525. DOI: 10.19381/j.issn.1001-7585.2021.20.006. 曾冠男, 卢世云, 黄龙. 高脂血症性急性胰腺炎患者复发的相关危险因素分析[J]. 医学理论与实践, 2021, 34( 20): 3510- 3512, 3525. DOI: 10.19381/j.issn.1001-7585.2021.20.006.
[7]	GUAN LY, DING L, WAN JH, et al. Serum triglyceride levels are associated with recurrence in patients with acute hypertriglyceridemic pancreatitis[J]. Front Med, 2023, 10: 1079637. DOI: 10.3389/fmed.2023.1079637.
[8]	YAN P, ZHAO HX, CHEN X. Suboptimal management of hypertriglyceridemia in the outpatient setting is associated with the recurrent pancreatitis: A retrospective cohort study[J]. Medicine, 2020, 99( 43): e22887. DOI: 10.1097/MD.0000000000022887.
[9]	ZHONG JK. Clinical characteristics of recurrent acute pancreatitis and its relationship with hyperlipidemia[J]. J Clin Pathol Res, 2022, 42( 8): 1836- 1840. DOI: 10.3978/j.issn.2095-6959.2022.08.008. 仲继宽. 复发性急性胰腺炎的临床特点及与高脂血症的关系[J]. 临床与病理杂志, 2022, 42( 8): 1836- 1840. DOI: 10.3978/j.issn.2095-6959.2022.08.008.
[10]	AN WH, YANG J, HE XC, et al. Clinical features of hyperlipidemic acute pancreatitis and their association with lipid metabolism[J]. J Clin Hepatol, 2020, 36( 4): 860- 864. DOI: 10.3969/j.issn.1001-5256.2020.04.030. 安文慧, 杨婧, 何旭昶, 等. 高脂血症性急性胰腺炎的临床特征及其与脂代谢的关系[J]. 临床肝胆病杂志, 2020, 36( 4): 860- 864. DOI: 10.3969/j.issn.1001-5256.2020.04.030.
[11]	WU BU, BATECH M, DONG EY, et al. Influence of ambulatory triglyceride levels on risk of recurrence in patients with hypertriglyceridemic pancreatitis[J]. Dig Dis Sci, 2019, 64( 3): 890- 897. DOI: 10.1007/s10620-018-5226-x.
[12]	HE Q, LV D, CUI PL, et al. Analysis on the characteristics of clinical features of recurrent hyperlipidemic acute pancreatitis[J]. J Clin Exp Med, 2019, 18( 6): 617- 619. DOI: 10.3969/j.issn.1671-4695.2019.06.017. 何强, 吕栋, 崔培林, 等. 复发性高脂血症性急性胰腺炎临床特点分析[J]. 临床和实验医学杂志, 2019, 18( 6): 617- 619. DOI: 10.3969/j.issn.1671-4695.2019.06.017.
[13]	HOU CQ, YU R, PENG YP, et al. RNA sequence analysis reveals pathways and candidate genes associated with pancreatic acinar cells injury in a mouse pancreatitis model[J]. Tissue Cell, 2022, 79: 101940. DOI: 10.1016/j.tice.2022.101940.
[14]	FU Y, LIU X, CUI BC, et al. Clinical characteristics and risk factors of hypertriglyceridemic pancreatitis in type 2 diabetes mellitus patients[J]. Chin J Crit Care Med, 2022, 42( 2): 149- 153. DOI: 10.3969/j.issn.1002-1949.2022.02.011. 付燕, 刘雪, 崔北辰, 等. 2型糖尿病合并高甘油三酯血症性急性胰腺炎患者临床特点及危险因素分析[J]. 中国急救医学, 2022, 42( 2): 149- 153. DOI: 10.3969/j.issn.1002-1949.2022.02.011.
[15]	TU XM, LIU QX, CHEN L, et al. Number of recurrences is significantly associated with the post-acute pancreatitis diabetes mellitus in a population with hypertriglyceridemic acute pancreatitis[J]. Lipids Health Dis, 2023, 22( 1): 82. DOI: 10.1186/s12944-023-01840-0.
[16]	DING L, GUAN LY, LI XY, et al. Recurrence for patients with first episode of hypertriglyceridemia-induced acute pancreatitis: A prospective cohort study[J]. J Clin Lipidol, 2023, 17( 1): 94- 102. DOI: 10.1016/j.jacl.2022.11.006.
[17]	GADDE KM, MARTIN CK, BERTHOUD HR, et al. Obesity: Pathophysiology and management[J]. J Am Coll Cardiol, 2018, 71( 1): 69- 84. DOI: 10.1016/j.jacc.2017.11.011.
[18]	HANSEN SEJ, MADSEN CM, VARBO A, et al. Body mass index, triglycerides, and risk of acute pancreatitis: A population-based study of 118 000 individuals[J]. J Clin Endocrinol Metab, 2020, 105( 1): dgz059. DOI: 10.1210/clinem/dgz059.
[19]	YAN B, FU HR, SHU YX. Study on recurrence risk factors of hyperlipidemic acute pancreatitis[J]. Chin J Gastroenterol Hepatol, 2023, 32( 9): 1029- 1033. DOI: 10.3969/j.issn.1006-5709.2023.09.014. 颜博, 付泓锐, 舒义雄. 高脂血症性急性胰腺炎复发危险因素的研究[J]. 胃肠病学和肝病学杂志, 2023, 32( 9): 1029- 1033. DOI: 10.3969/j.issn.1006-5709.2023.09.014.
[20]	LI XQ, LIU H, XIAO CT, et al. Influence of metabolic syndrome on patients with recurrence of hypertriglyceridemic acute pancreatitis[J]. J Clin Hepatol, 2020, 36( 11): 2515- 2520. DOI: 10.3969/j.issn.1001-5256.2020.11.023. 李贤秋, 刘慧, 肖春桃, 等. 代谢综合征对高脂血症急性胰腺炎患者复发的影响[J]. 临床肝胆病杂志, 2020, 36( 11): 2515- 2520. DOI: 10.3969/j.issn.1001-5256.2020.11.023.
[21]	XIANG JX, HU LS, LIU P, et al. Impact of cigarette smoking on recurrence of hyperlipidemic acute pancreatitis[J]. World J Gastroenterol, 2017, 23( 47): 8387- 8394. DOI: 10.3748/wjg.v23.i47.8387.
[22]	BARRETO SG. How does cigarette smoking cause acute pancreatitis?[J] Pancreatology, 2016, 16( 2): 157- 63. DOI: 10.1016/j.pan.2015.09.002.
[23]	SUN YY, JIN J, ZHU AY, et al. Risk factors for recurrent pancreatitis after first episode of acute pancreatitis[J]. Int J Gen Med, 2022, 15: 1319- 1328. DOI: 10.2147/IJGM.S344863.
[24]	NWAOBI S, KHAN A, OJEMOLON PE, et al. A case of hypertriglyceridemia-induced acute pancreatitis in the setting of alcohol abuse[J]. Cureus, 2023, 15( 4): e38028. DOI: 10.7759/cureus.38028.
[25]	ZAFRIR B, SALIBA W, JUBRAN A, et al. Severe hypertriglyceridemia-related pancreatitis: Characteristics and predictors of recurrence[J]. Pancreas, 2019, 48( 2): 182- 186. DOI: 10.1097/MPA.0000000000001235.
[26]	OZCELIK S, BAŞ S, OZCELIK M, et al. Efficacy of insulin, heparin and fenofibrate combination treatment in severe hypertriglyceridemia: Double center experience[J]. Acta Endocrinol, 2019, 15( 4): 460- 465. DOI: 10.4183/aeb.2019.460.
[27]	NEWMAN CB, BLAHA MJ, BOORD JB, et al. Lipid management in patients with endocrine disorders: An endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2020, 105( 12): dgaa674. DOI: 10.1210/clinem/dgaa674.
[28]	SU W, GUO F. Triglyceride-controlling during acute phase of hypertriglyceridemia induced pancreatitis[J]. Chin J Dig Surg, 2023, 22( 1): 89- 93. DOI: 10.3760/cma.j.cn115610-20221220-00755. 苏伟, 郭丰. 高甘油三酯血症性胰腺炎急性期的血脂控制[J]. 中华消化外科杂志, 2023, 22( 1): 89- 93. DOI: 10.3760/cma.j.cn115610-20221220-00755.
[29]	DHINDSA S, SHARMA A, AL-KHAZAALI A, et al. Intravenous insulin versus conservative management in hypertriglyceridemia-associated acute pancreatitis[J]. J Endocr Soc, 2020, 4( 1): bvz019. DOI: 10.1210/jendso/bvz019.
[30]	DICHTWALD S, MEYER A, ZOHAR E, et al. Hypertriglyceridemia Induced Pancreatitis: Plasmapheresis or conservative management?[J]. J Intensive Care Med, 2022, 37( 9): 1174- 1178. DOI: 10.1177/08850666211054365.
[31]	ZHANG R, CHENG XW, XU CF. Therapeutic effect of Dachengqi decoction and low molecular weight heparin calcium combined with double hemofiltration in the treatment of hyperlipidemic severe acute pancreatitis[J]. J Changchun Univ Chin Med, 2023, 39( 9): 989- 992. DOI: 10.13463/j.cnki.cczyy.2023.09.010. 张荣, 程贤文, 徐长飞. 大承气汤联合低分子肝素钙配合双重血液滤过治疗高脂血症性重症急性胰腺炎[J]. 长春中医药大学学报, 2023, 39( 9): 989- 992. DOI: 10.13463/j.cnki.cczyy.2023.09.010.
[32]	HU Y, XIONG WJ, LI CY, et al. Continuous blood purification for severe acute pancreatitis: A systematic review and meta-analysis[J]. Medicine, 2019, 98( 12): e14873. DOI: 10.1097/MD.0000000000014873.
[33]	CHEN Z, HUANG XL, ZHANG MW, et al. Rapid reduction in triglyceride levels by therapeutic plasma exchange in patients with hypertriglyceridemic pancreatitis[J]. J Clin Apher, 2022, 37( 1): 82- 90. DOI: 10.1002/jca.21954.
[34]	HUANG ZY, MA X, JIA XT, et al. Prevention of severe acute pancreatitis with cyclooxygenase-2 inhibitors: A randomized controlled clinical trial[J]. Am J Gastroenterol, 2020, 115( 3): 473- 480. DOI: 10.14309/ajg.0000000000000529.
[35]	EKOR M, OWUSU AGYEI PE, OBESE E, et al. Celecoxib exhibits therapeutic potential in experimental model of hyperlipidaemia[J]. PLoS One, 2021, 16( 8): e0247735. DOI: 10.1371/journal.pone.0247735.
[36]	ELKHALIFA AME, NAZAR M, SI ALI, et al. Novel therapeutic agents for management of diabetes mellitus: A hope for drug designing against diabetes mellitus[J]. Life, 2024, 14( 1): 99. DOI: 10.3390/life14010099.
[37]	BERBERICH AJ, HEGELE RA. Genetic testing in dyslipidaemia: An approach based on clinical experience[J]. Best Pract Res Clin Endocrinol Metab, 2023, 37( 3): 101720. DOI: 10.1016/j.beem.2022.101720.
[38]	PAQUETTE M, BERNARD S, HEGELE RA, et al. Chylomicronemia: Differences between familial chylomicronemia syndrome and multifactorial chylomicronemia[J]. Atherosclerosis, 2019, 283: 137- 142. DOI: 10.1016/j.atherosclerosis.2018.12.019.
[39]	AGUILAR-SALINAS CA, GÓMEZ-DÍAZ RA, CORRAL P. New therapies for primary hyperlipidemia[J]. J Clin Endocrinol Metab, 2022, 107( 5): 1216- 1224. DOI: 10.1210/clinem/dgab876.
[40]	RAMMS B, GORDTS PLSM. Apolipoprotein C-III in triglyceride-rich lipoprotein metabolism[J]. Curr Opin Lipidol, 2018, 29( 3): 171- 179. DOI: 10.1097/MOL.0000000000000502.
[41]	GOUNI-BERTHOLD I, ALEXANDER VJ, YANG QQ, et al. Efficacy and safety of volanesorsen in patients with multifactorial chylomicronaemia(COMPASS): A multicentre, double-blind, randomised, placebo-controlled, phase 3 trial[J]. Lancet Diabetes Endocrinol, 2021, 9( 5): 264- 275. DOI: 10.1016/S2213-8587(21)00046-2.
[42]	JONES A, PEERS K, WIERZBICKI AS, et al. Long-term effects of volanesorsen on triglycerides and pancreatitis in patients with familial chylomicronaemia syndrome(FCS) in the UK Early Access to Medicines Scheme(EAMS)[J]. Atherosclerosis, 2023, 375: 67- 74. DOI: 10.1016/j.atherosclerosis.2023.05.008.
[43]	GINSBERG HN, GOLDBERG IJ. Broadening the scope of dyslipidemia therapy by targeting APOC3(apolipoprotein C3) and ANGPTL3(angiopoietin-like protein 3)[J]. Arterioscler Thromb Vasc Biol, 2023, 43( 3): 388- 398. DOI: 10.1161/ATVBAHA.122.317966.
[44]	WATTS GF, SCHWABE C, SCOTT R, et al. RNAi inhibition of angiopoietin-like protein 3(ANGPTL3) with ARO-ANG3 mimics the lipid and lipoprotein profile of familial combined hypolipidemia[J]. Eur Heart J, 2020, 41( Supplement_2): ehaa946.3331. DOI: 10.1093/ehjci/ehaa946.3331.
[45]	FALKO JM. Familial chylomicronemia syndrome: A clinical guide for endocrinologists[J]. Endocr Pract, 2018, 24( 8): 756- 763. DOI: 10.4158/EP-2018-0157.
[46]	GLIGORIJEVIC N, STEFANOVIC-RACIC M, KERSHAW EE. Medical management of hypertriglyceridemia in pancreatitis[J]. Curr Opin Gastroenterol, 2023, 39( 5): 421- 427. DOI: 10.1097/MOG.0000000000000956.
[47]	JUHÁSZ MF, VERECZKEI Z, OCSKAY K, et al. The Effect of dietary fat content on the recurrence of pancreatitis(EFFORT): Protocol of a multicenter randomized controlled trial[J]. Pancreatology, 2022, 22( 1): 51- 57. DOI: 10.1016/j.pan.2021.10.002.
[48]	AHMED ALI U, ISSA Y, HAGENAARS JC, et al. Risk of recurrent pancreatitis and progression to chronic pancreatitis after a first episode of acute pancreatitis[J]. Clin Gastroenterol Hepatol, 2016, 14( 5): 738- 746. DOI: 10.1016/j.cgh.2015.12.040.
[49]	HAN S, PATEL B, MIN M, et al. Quality of life comparison between smokers and non-smokers with chronic pancreatitis[J]. Pancreatology, 2018, 18( 3): 269- 274. DOI: 10.1016/j.pan.2018.02.012.
[50]	OCSKAY K, JUHÁSZ MF, FARKAS N, et al. Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking(REAPPEAR): Protocol of a randomised controlled trial and a cohort study[J]. BMJ Open, 2022, 12( 1): e050821. DOI: 10.1136/bmjopen-2021-050821.