高三酰甘油血症性急性胰腺炎治疗进展

赵成思; 姚维杰; 王佐正

doi:10.3969/j.issn.1001-5256.2020.12.047

高三酰甘油血症性急性胰腺炎治疗进展

DOI: 10.3969/j.issn.1001-5256.2020.12.047

宁夏医科大学总医院肝胆外科

基金项目:

宁夏自治区重点研发计划重点项目（2020BEG02002）；

详细信息

中图分类号: R576
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- 被引次数: 0
出版历程
- 收稿日期: 2020-05-17
- 出版日期: 2020-12-20

Advances in the treatment of hypertriglyceridemic pancreatitis

Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University

Research funding:

摘要

摘要:
高三酰甘油血症性胰腺炎（HTGP）发病率逐渐升高,由于其发病机制较复杂且尚不明确,导致治疗困难。目前还没有明确的治疗指南指导HTGP的治疗,按照HTGP发生和发展的过程从急性发作期治疗、特殊人群治疗、长期预防复发等三个主要方面围绕近些年中、外相关文献进行阐述。
- 胰腺炎 /
- 高脂血症 /
- 治疗学
Abstract:
The incidence rate of hypertriglyceridemic pancreatitis( HTGP) is gradually increasing,and its complex pathogenesis has not been fully elucidated,which causes the difficulty in treatment. At present,there are no recommended guidelines for the treatment of HTGP.According to the process of the development and progression of HTGP,this article reviews related articles in China and foreign countries from the aspects of treatment during acute exacerbation,treatment for the special population,and long-term prevention of recurrence.
- pancreatitis /
- hyperlipidemias /
- therapeutics

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参考文献(46)

[1] VALDIVIELSO P,RAMREZ-BUENO A,EWALD N. Current knowledge of hypertriglyceridemic pancreatitis[J]. Eur J Intern Med,2014,25(8):689-694.

[2] DU YQ,CHEN QK,LI HY,et al. Chinese guidelines for the management of acute pancreatitis(Shenyang,2019)[J]. J Clin Hepatol,2019,35(12):2706-2711.(in Chinese)杜奕奇，陈其奎，李宏宇，等．中国急性胰腺炎诊治指南(2019年，沈阳)[J]．临床肝胆病杂志，2019,35(12):2706-2711.

[3] SONG YX,ZHU HY,DU YQ. Advances in research of pathogenesis and treatment of hyperlipidemic acute pancreatitis[J]. World Chin J Dig,2019,27(2):112-116.(in Chinese)宋英晓，朱惠云，杜奕奇．高脂血症性急性胰腺炎发病机制及治疗的研究进展[J]．世界华人消化杂志，2019,27(2):112-116.

[4] LI D,LIU FK,WANG GX. Analysis of clinical characteristics between hyperlipidemic acute pancreatitis and biliary acute pancreatitis[J]. J Clin Exp Med,2019,18(19):2066-2071.(in Chinese)李丹，刘凤奎，王国兴．高脂血症性急性胰腺炎和胆源性急性胰腺炎的临床特点分析[J]．临床和实验医学杂志，2019,18(19):2066-2071.

[5] LLORET LINARES C,PELLETIER AL,CZERNICHOW S,et al.Acute pancreatitis in a cohort of 129 patients referred for severe hypertriglyceridemia[J]. Pancreas,2008,37(1):13.

[6] MA JC. Progress in the treatment of hyperlipidemia acute pancreatitis(HLAP)[J]. Fudan Univ J Med Sci,2019,46(4):540-543.(in Chinese)马江辰．高脂血症性急性胰腺炎(HLAP)的治疗进展[J]．复旦学报(医学版)，2019,46(4):540-543.

[7] RAWLA P,SUNKARA T,THANDRA KC,et al. Hypertriglyceridemia-induced pancreatitis:updated review of current treatment and preventive strategies[J]. Clin J Gastroenterol,2018,11(6):441-448.

[8] ZARNESCU NO,BARBU ST,ZARNESCU VASILIU EC,et al.Management of acute pancreatitis in the early stage[J].Maedica(Buchar),2015,10(3):257-263.

[9] CRUCIANI RA,JAIN S. Pancreatic pain:A mini review[J].Pancreatology,2008,8(3):230-235.

[10] WITTAU M,MAYER B,SCHEELE J,et al. Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis[J]. Scand J Gastroenterol,2011,46(3):261-270.

[11] AL-OMRAN M,ALBALAWI ZH,TASHKANDI MF,et al. Enteral versus parenteral nutrition for acute pancreatitis[J]. Cochrane Database Syst Rev,2010(1):CD002837.

[12] MAO EQ,TANG YQ,ZHANG SD. Discussion of normative therapeutic strategy for hyperlipidemic severe acute pancreatitis[J]. Chin J Pract Surg,2003,23(9):33-36.(in Chinese)毛恩强，汤耀卿，张圣道．高脂血症性重症急性胰腺炎规范化治疗方案的探讨[J]．中国实用外科杂志，2003,23(9):33-36.

[13] LU Z,LI M,GUO F,et al. Timely reduction of triglyceride levels is associated with decreased persistent organ failure in hypertriglyceridemic pancreatitis[J]. Pancreas,2020,49(1):105-110.

[14] INAYAT F,ZAFAR F,RIAZ I,et al. Hypertriglyceridemic pancreatitis:Is insulin monotherapy a feasible therapeutic option?[J]. Cureus,2018,10(10):e3461.

[15] COSKUN A,ERKAN N,YAKAN S,et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin[J].Prz Gastroenterol,2015,10(1):18-22.

[16] ZHAO Y,LI T. Meta analysis of clinical efficacy of low molecular weight heparin in the treatment of hyperlipidemic pancreatitis from 2014 to 2018[J]. Med Innov Chin,2019,16(29):160-164.(in Chinese)赵彦，李婷．2014-2018年低分子肝素对高脂血症胰腺炎的临床疗效Meta分析[J]．中国医学创新，2019,16(29):160-164.

[17] KHAN R,JEHANGIR W,REGETI K,et al. Hypertriglyceridemia-induced pancreatitis:Choice of treatment[J]. Gastroenterology Res,2015,8(3-4):234-236.

[18] NSSTRM B,OLIVECRONA G,OLIVECRONA T,et al. Lipoprotein lipase during continuous heparin infusion:Tissue stores become partially depleted[J]. J Lab Clin Med,2001,138(3):206-213.

[19] ANDERSON F,MBATHA SZ,THOMSON SR. The early management of pancreatitis associated with hypertriglyceridaemia[J]. S Afr J Surg,2011,49(2):82-84.

[20] CHEN SQ. Influence of low molecular weight heparin and insulin lipid-lowering therapy for prognosis of patients with hyperlipidemia and severe acute pancreatitis[J]. Jilin Med J,2019,40(10):2213-2215.(in Chinese)陈升强．低分子肝素和胰岛素降脂治疗对高脂血症急性重症胰腺炎患者预后的影响[J]．吉林医学，2019,40(10):2213-2215.

[21] KUCHAY MS,FAROOQUI KJ,BANO T,et al. Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis:Case series and literature review[J]. Arch Endocrinol Metab,2017,61(2):198-201.

[22] GAVVA C,SARODE R,AGRAWAL D,et al. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis:A rapid and practical approach[J]. Transfus Apher Sci,2016,54(1):99-102.

[23] MIYAMOTO K,HORIBE M,SANUI M,et al. Plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis[J]. Intensive Care Med,2017,43(6):949-951.

[24] BERBERICH AJ,ZIADA A,ZOU GY,et al. Conservative management in hypertriglyceridemia-associated pancreatitis[J].J Intern Med,2019,286(6):644-650.

[25] BIBERCI KESKIN E,KOHAN K,KKERI·H,et al. The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis[J]. Eur J Gastroenterol Hepatol,2019,31(6):674-677.

[26] ZHU Y,YUAN J,ZHANG P,et al. Adjunctive continuous high-volume hemofiltration in patients with acute severe pancreatitis:A prospective nonrandomized study[J]. Pancreas,2011,40(1):109-113.

[27] HE WH,YU M,ZHU Y,et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against lowmolecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis:A prospective randomized controlled trial[J]. J Clin Gastroenterol,2016,50(9):772-778.

[28] SUN S,HE L,BAI M,et al. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis:A controlled pilot study[J]. Ann Saudi Med,2015,35(5):352-358.

[29] WANG HL,YU KJ. Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis[J]. World J Gastroenterol,2015,21(20):6304-6309.

[30] ZOU J,ZHANG Y,WANG P. Effects of continuous renal replacement therapy combined with plasma exchange on inflammation and organ function in patients with severe hyperlipidemic acute pancreatitis[J]. Anhui Med and Pharm J,2020,24(1):95-98.(in Chinese)邹军，张毅，王平．连续性肾脏替代治疗联合血浆置换对高脂血症性重症急性胰腺炎病人炎性因子水平和多器官功能的影响[J]．安徽医药，2020,24(1):95-98.

[31] LI G,ZHANG SQ,LIAN R,et al. Clinical value of alprostadil in the treatment of severe acute pancreatitis caused by hyperlipemia[J]. Chin J Pancreatol,2017,17(5):298-301.(in Chinese)李刚，张素巧，练睿，等．前列地尔治疗高脂血症性重症急性胰腺炎的临床价值[J]．中华胰腺病杂志，2017,17(5):298-301.

[32] YE D,KE L,ZHANG C,et al. Effect of octreotide combined with alprostadil in the treatment of hyperlipidemic acute pancreatitis and the effect on gastrointestinal function recovery12and negative conversion rate of blood amylase[J]. Hebei Med J,2019,25(12):1975-1978.(in Chinese)叶丹，柯丽，张川，等．奥曲肽联合前列地尔治疗高脂血症性急性胰腺炎疗效及对患者胃肠功能恢复血淀粉酶阴转率的影响[J]．河北医学，2019,25(12):1975-1978.

[33] CHE SB. Efficacy of the Qingyi Tongfu decoction retention enema on severe acute pancreatitis[J]. Clin J Chin Med,2019,11(10):92-93.(in Chinese)车松倍．清胰通腑汤保留灌肠对重症急性胰腺炎的临床治疗效果观察[J]．中医临床研究，2019,11(10):92-93.

[34] FENG PP,XU YF,TONG BY,et al. Effects of Chaishao Chengqi Decoctionon Amylase,blood lipid and inflammatory cytokines in patients with hyperlipidemic acute pancreatitis at different periods[J]. Chin J Tradit Med Sci and Tech,2020,27(1):15-18.(in Chinese)冯萍萍，徐燕芳，童宝燕，等．柴芍承气汤对不同时期高脂血症性急性胰腺炎患者淀粉酶、血脂及炎性因子的影响[J]．中国中医药科技，2020,27(1):15-18.

[35] HUANG Y,WANG Y. Clinical analysis of diabetes mellitus complicated with hyperlipidemic acute pancreatitis[J]. Chin J Gastroenterol,2018,23(7):423-425.(in Chinese)黄瑶，王营．糖尿病合并高脂血症性急性胰腺炎的临床分析[J]．胃肠病学，2018,23(7):423-425.

[36] LIU LN,XUE Z,LIN CW,et al. Case ananlysis of diabetic ketoacidosis complicated with hyperlipidemic acute pancreatitis[J]. J Chin Physician,2016,44(8):31-33.(in Chinese)刘丽娜，薛峥，林财威，等．糖尿病酮症酸中毒合并高脂血症性急性胰腺炎病例分析[J]．中国临床医生，2016,44(8):31-33.

[37] GAO NN. Diagnosis and treatment of hypertriglyceridemic pancreatitis in pregnancy[J]. J Clin Hepatol,2016,32(9):1763-1765.(in Chinese)高娜娜．妊娠期高甘油三酯血症性胰腺炎的诊治分析[J]．临床肝胆病杂志，2016,32(9):1763-1765.

[38] SHEN XF,ZHANG G,HU J,et al. Diagnosis and treatment of severe acute pancreatitis induced by hyperlipidemia during pregnancy[J]. Chin J Curr Adv Gen Surg,2018,21(6):480-481.(in Chinese)沈先锋，张淦，胡军，等．妊娠高脂血症性重症急性胰腺炎的诊治分析[J]．中国现代普通外科进展，2018,21(6):480-481.

[39] BASAR R,UZUM AK,CANBAZ B,et al. Therapeutic apheresis for severe hypertriglyceridemia in pregnancy[J]. Arch Gynecol Obstet,2013,287(5):839-843.

[40] RAWLA P,SUNKARA T,THANDRA KC,et al. Hypertriglyceridemia-induced pancreatitis:Updated review of current treatment and preventive strategies[J]. Clin J Gastroenterol,2018,11(6):441-448.

[41] ITO MK. Long-chain omega-3 fatty acids,fibrates and niacin as therapeutic options in the treatment of hypertriglyceridemia:A review of the literature[J]. Atherosclerosis,2015,242(2):647-656.

[42] GARG R,RUSTAGI T. Management of hypertriglyceridemia induced acute pancreatitis[J]. Biomed Res Int,2018,2018:4721357.

[43] SAHEBKAR A,SIMENTAL-MENDA LE,WATTS GF,et al.Comparison of the effects of fibrates versus statins on plasma lipoprotein(a)concentrations:A systematic review and meta-analysis of head-to-head randomized controlled trials[J]. BMC Med,2017,15(1):22.

[44] FLORENTIN M,KOSTAPANOS MS,ANAGNOSTIS P,et al.Recent developments in pharmacotherapy for hypertriglyceridemia:What’s the current state of the art?[J]. Expert Opin Pharmacother,2020,21(1):107-120.

[45] CHYZHYK V,BROWN AS. Familial chylomicronemia syndrome:A rare but devastating autosomal recessive disorder characterized by refractory hypertriglyceridemia and recurrent pancreatitis[J].Trends Cardiovasc Med,2020,30(2):80-85.

[46] 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.

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