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Hipertrigliseridemiye Bağlı Akut Pankreatitte Klinik Seyir ve Tedavi Yaklaşımları: 10 Yıllık Tek Merkez Deneyimi

Yıl 2026, Cilt: 25 Sayı: 1 , 54 - 63 , 21.04.2026
https://doi.org/10.17941/agd.1817440
https://izlik.org/JA75NS34NU

Öz

Amaç:
Bu çalışmada, hipertrigliseridemiye bağlı akut pankreatit (HTG-AP) olgularında klinik özellikler, tedavi yaklaşımları ve izlem sonuçlarının değerlendirilmesi amaçlanmıştır.
Yöntem:
Ocak 2015–Mayıs 2025 tarihleri arasında izlenen 76 HTG-AP hastasının (serum trigliserid düzeyi ≥500 mg/dL) verileri retrospektif olarak incelendi. Hastalar, Revize Atlanta Sınıflamasına göre hafif (n=43) ve orta–ağır (n=33) gruplara ayrıldı. Demografik, klinik ve laboratuvar veriler ile uygulanan tedavi protokolleri değerlendirildi.
Bulgular:
Hastaların yaş ortalaması 41.8±10.0 yıl olup %72.4’ü erkekti. Orta–ağır grupta ön-ceki pankreatit öyküsü (%72.7 vs. %53.5, p=0.04) ve tekrar atak oranı (%45.5 vs. %11.6, p=0.002) anlamlı olarak daha yüksekti. CRP düzeyleri belirgin biçimde yük-sek, albümin ve kalsiyum düzeyleri ise düşüktü (p<0.05). Trigliserid düzeyleri hastalık şiddetiyle doğrudan ilişkili bulunmadı ancak yatış süresiyle pozitif korelasyon gösterdi (ρ=0.259, p=0.024). Trigliserid düzeyinin <500 mg/dL’ye düşme süresi or-ta–ağır grupta daha uzundu (4 vs. 3 gün, p=0.031).
Sonuç:
HTG-AP sıklıkla orta yaşlı erkeklerde görülmekte olup, yüksek CRP ve düşük albü-min düzeyleri hastalık şiddetiyle ilişkilidir. Trigliserid yüksekliği doğrudan şiddeti öngörmemekle birlikte, uzamış yatış süresiyle ilişkilidir. Önceki pankreatit öyküsü olan hastalarda hem daha ağır seyir hem de yeniden atak riski belirgin biçimde yüksektir. Bu bulgular, metabolik kontrolün klinik prognoz üzerindeki önemini vur-gulamaktadır.

Kaynakça

  • 1. Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689-94. doi: 10.1016/j.ejim.2014.08.008.
  • 2. Mosztbacher D, Hanák L, Farkas N, et al; Hungarian Pancreatic Study Group. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020;20(4):608-16. doi: 10.1016/j.pan.2020.03.018.
  • 3. Jin M, Bai X, Chen X, et al. A 16-year trend of etiology in acute pancreatitis: The increasing proportion of hypertriglyceridemia-associated acute pancreatitis and its adverse effect on prognosis. J Clin Lipidol. 2019;13(6):947-53.e1. doi: 10.1016/j.jacl.2019.09.005.
  • 4. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(9):2969-89. doi: 10.1210/jc.2011-3213.
  • 5. Sanchez RJ, Ge W, Wei W, Ponda MP, Rosenson RS. The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis. Lipids Health Dis. 2021;20(1):72. doi: 10.1186/s12944-021-01488-8.
  • 6. Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting Mild-to-Moderate Hypertriglyceridemia and Risk of Acute Pancreatitis. JAMA Intern Med. 2016;176(12):1834-42. doi: 10.1001/jamainternmed.2016.6875.
  • 7. Lu J, Wang Z, Mei W, et al; Chinese Hypertriglyceridemia-Associated Pancreatitis Study Group (CHPSG). A systematic review of the epidemiology and risk factors for severity and recurrence of hypertriglyceridemia-induced acute pancreatitis. BMC Gastroenterol. 2025;25(1):374. doi: 10.1186/s12876-025-03954-4.
  • 8. Quan Y, Yang XJ. Metabolic syndrome and acute pancreatitis: Current status and future prospects. World J Gastroenterol. 2024;30(45):4859-63. doi: 10.3748/wjg.v30.i45.4859.
  • 9. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
  • 10. Qiu M, Zhou X, Zippi M, et al. Comprehensive review on the pathogenesis of hypertriglyceridaemia-associated acute pancreatitis. Ann Med. 2023;55(2):2265939. doi: 10.1080/07853890.2023.2265939.
  • 11. Cai Y-L, Wang S-Q, Zhong H-J, He X-X. The effect of anemia on the severity and prognosis of patients with acute pancreatitis: A single-center retrospective study. Medicine (Baltimore). 2022;101(52):e32501. doi: 10.1097/MD.0000000000032501.
  • 12. Ruiz Rebollo ML, Muñoz Moreno MF, Piñerúa-Gonsálvez JF, Rizzo-Rodríguez MA. Anemia can predict organ failure in acute pancreatitis. Rev Esp Enferm Dig. 2024;116(4):229-30. doi: 10.17235/reed.2023.9700/2023.
  • 13. Remes-Troche JM, Duarte-Rojo A, Morales G, Robles-Díaz G. Hemoconcentration is a poor predictor of severity in acute pancreatitis. World J Gastroenterol. 2005;11(44):7018-23. doi: 10.3748/wjg.v11.i44.7018.
  • 14. Chen L, Huang Y, Yu H, et al. The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis. Lipids Health Dis. 2021;20(1):9. doi: 10.1186/s12944-021-01443-7.
  • 15. Ocskay K, Vinko Z, Németh D, et al. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci Rep. 2021;11(1):24158. doi: 10.1038/s41598-021-03449-8.
  • 16. Piñerúa-Gonsálvez JF, Ruiz Rebollo ML, Zambrano-Infantino RDC, Rizzo-Rodríguez MA, Fernández-Salazar L. Value of CRP/albumin ratio as a prognostic marker of acute pancreatitis: a retrospective study. Rev Esp Enferm Dig. 2023;115(12):707-12. doi: 10.17235/reed.2023.9345/2022.
  • 17. Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16(4):424-430. doi: 10.1016/S1499-3872(17)60007-9.
  • 18. Pian G, Li H, Piao Y. Clinical Significance of Inflammation Markers in Predicting the Severity of Acute Pancreatitis. Pancreas. 2021;50(2):201-5. doi: 10.1097/MPA.0000000000001749.
  • 19. Liu Y, Cheng JP, Zhao XL. The effect of serum triglyceride levels and different lipid-lowering methods on the prognosis of hypertriglyceridemic acute pancreatitis: a single-center 12-year retrospective study by propensity score matching. Scand J Gastroenterol. 2024;59(7):843-51. doi: 10.1080/00365521.2024.2342406.
  • 20. Zhang R, Deng L, Jin T, et al. Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity. HPB (Oxford). 2019;21(9):1240-9. doi: 10.1016/j.hpb.2019.01.015.
  • 21. Pascual I, Sanahuja A, García N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: Cohort analysis of 1457 patients. Pancreatology. 2019;19(5):623-9. doi: 10.1016/j.pan.2019.06.006.
  • 22. Garg R, Rustagi T. Management of Hypertriglyceridemia Induced Acute Pancreatitis. Biomed Res Int. 2018;2018:4721357. doi: 10.1155/2018/4721357.
  • 23. Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol. 2018;11(6):441-8. doi: 10.1007/s12328-018-0881-1.
  • 24. Yan L-H, Hu X-H, Chen R-X, et al. Plasmapheresis compared with conventional treatment for hypertriglyceridemia-induced acute pancreatitis: A systematic review and meta-analysis. J Clin Apher. 2023;38(1):4-15. doi: 10.1002/jca.22018.
  • 25. Berberich AJ, Ziada A, Zou GY, Hegele RA. Conservative management in hypertriglyceridemia-associated pancreatitis. J Intern Med. 2019;286(6):644-50. doi: 10.1111/joim.12925.
  • 26. Qiu F, Lü XS, Huang YK. Effect of low molecular weight heparin on pancreatic micro-circulation in severe acute pancreatitis in a rodent model. Chin Med J (Engl). 2007;120(24):2260-3.
  • 27. Podda M, Murzi V, Marongiu P, et al. Effectiveness and safety of low molecular weight heparin in the management of acute pancreatitis: a systematic review and meta-analysis. World J Emerg Surg. 2024;19(1):30. doi: 10.1186/s13017-024-00558-3.
  • 28. Köksal A, Tozlu M, Sezgin O, et al. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. Pancreatology. 2024;24(3):327-34. doi: 10.1016/j.pan.2023.10.005.
  • 29. Henzen C, Röck M, Schnieper C, Heer K. Heparin und Insulin in der Therapie der akuten Hypertriglyzeridämie-induzierten Pankreatitis [Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis]. Schweiz Med Wochenschr. 1999;129(35):1242-8. German.
  • 30. Näsström B, Olivecrona G, Olivecrona T, Stegmayr BG. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med. 2001;138(3):206-13. doi: 10.1067/mlc.2001.117666.
  • 31. Weintraub M, Rassin T, Eisenberg S, et al. Continuous intravenous heparin administration in humans causes a decrease in serum lipolytic activity and accumulation of chylomicrons in circulation. J Lipid Res. 1994;35(2):229-38.

Clinical Characteristics and Management of Hypertriglyceridemia-Associated Acute Pancreatitis: A Ten-Year Single Center Experience

Yıl 2026, Cilt: 25 Sayı: 1 , 54 - 63 , 21.04.2026
https://doi.org/10.17941/agd.1817440
https://izlik.org/JA75NS34NU

Öz

Background:
This study aimed to evaluate the clinical characteristics, treatment strategies, and outcomes of patients with hypertriglyceridemia-induced acute pancreatitis (HTG-AP).
Methods:
Medical data of 76 patients with HTG-AP (serum triglyceride ≥500 mg/dL) admitted between January 2015 and May 2025 were retrospectively analyzed. Patients were classified as mild (n=43) or moderately-severe/severe (n=33) according to the Revised Atlanta Classification. Demographic, clinical, and laboratory parameters, as well as treatment protocols, were evaluated.
Results:
The mean age was 41.8±10.0 years, and 72.4% were male. Patients in the moderately severe to severe group had significantly higher rates of previous pancreatitis (72.7% vs. 53.5%, p=0.04) and recurrence (45.5% vs. 11.6%, p=0.002). CRP levels were significantly higher, while albumin and calcium levels were lower (p<0.05). Triglyceride levels did not directly correlate with disease severity but showed a positive correlation with hospital stay (ρ=0.259, p=0.024). The time to achieve triglyceride <500 mg/dL was longer in the moderately-severe/severe group (4 vs. 3 days, p=0.031).
Conclusion:
HTG-AP predominantly affects middle-aged males. Elevated CRP and reduced albumin levels are associated with disease severity, while hypertriglyceridemia correlates with prolonged hospitalization rather than severity itself. Patients with prior pancreatitis have a higher risk of severe course and recurrence, highlighting the importance of maintaining metabolic control in improving clinical outcomes.

Kaynakça

  • 1. Valdivielso P, Ramírez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Eur J Intern Med. 2014;25(8):689-94. doi: 10.1016/j.ejim.2014.08.008.
  • 2. Mosztbacher D, Hanák L, Farkas N, et al; Hungarian Pancreatic Study Group. Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases. Pancreatology. 2020;20(4):608-16. doi: 10.1016/j.pan.2020.03.018.
  • 3. Jin M, Bai X, Chen X, et al. A 16-year trend of etiology in acute pancreatitis: The increasing proportion of hypertriglyceridemia-associated acute pancreatitis and its adverse effect on prognosis. J Clin Lipidol. 2019;13(6):947-53.e1. doi: 10.1016/j.jacl.2019.09.005.
  • 4. Berglund L, Brunzell JD, Goldberg AC, et al; Endocrine society. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(9):2969-89. doi: 10.1210/jc.2011-3213.
  • 5. Sanchez RJ, Ge W, Wei W, Ponda MP, Rosenson RS. The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis. Lipids Health Dis. 2021;20(1):72. doi: 10.1186/s12944-021-01488-8.
  • 6. Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting Mild-to-Moderate Hypertriglyceridemia and Risk of Acute Pancreatitis. JAMA Intern Med. 2016;176(12):1834-42. doi: 10.1001/jamainternmed.2016.6875.
  • 7. Lu J, Wang Z, Mei W, et al; Chinese Hypertriglyceridemia-Associated Pancreatitis Study Group (CHPSG). A systematic review of the epidemiology and risk factors for severity and recurrence of hypertriglyceridemia-induced acute pancreatitis. BMC Gastroenterol. 2025;25(1):374. doi: 10.1186/s12876-025-03954-4.
  • 8. Quan Y, Yang XJ. Metabolic syndrome and acute pancreatitis: Current status and future prospects. World J Gastroenterol. 2024;30(45):4859-63. doi: 10.3748/wjg.v30.i45.4859.
  • 9. Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
  • 10. Qiu M, Zhou X, Zippi M, et al. Comprehensive review on the pathogenesis of hypertriglyceridaemia-associated acute pancreatitis. Ann Med. 2023;55(2):2265939. doi: 10.1080/07853890.2023.2265939.
  • 11. Cai Y-L, Wang S-Q, Zhong H-J, He X-X. The effect of anemia on the severity and prognosis of patients with acute pancreatitis: A single-center retrospective study. Medicine (Baltimore). 2022;101(52):e32501. doi: 10.1097/MD.0000000000032501.
  • 12. Ruiz Rebollo ML, Muñoz Moreno MF, Piñerúa-Gonsálvez JF, Rizzo-Rodríguez MA. Anemia can predict organ failure in acute pancreatitis. Rev Esp Enferm Dig. 2024;116(4):229-30. doi: 10.17235/reed.2023.9700/2023.
  • 13. Remes-Troche JM, Duarte-Rojo A, Morales G, Robles-Díaz G. Hemoconcentration is a poor predictor of severity in acute pancreatitis. World J Gastroenterol. 2005;11(44):7018-23. doi: 10.3748/wjg.v11.i44.7018.
  • 14. Chen L, Huang Y, Yu H, et al. The association of parameters of body composition and laboratory markers with the severity of hypertriglyceridemia-induced pancreatitis. Lipids Health Dis. 2021;20(1):9. doi: 10.1186/s12944-021-01443-7.
  • 15. Ocskay K, Vinko Z, Németh D, et al. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci Rep. 2021;11(1):24158. doi: 10.1038/s41598-021-03449-8.
  • 16. Piñerúa-Gonsálvez JF, Ruiz Rebollo ML, Zambrano-Infantino RDC, Rizzo-Rodríguez MA, Fernández-Salazar L. Value of CRP/albumin ratio as a prognostic marker of acute pancreatitis: a retrospective study. Rev Esp Enferm Dig. 2023;115(12):707-12. doi: 10.17235/reed.2023.9345/2022.
  • 17. Kaplan M, Ates I, Akpinar MY, et al. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16(4):424-430. doi: 10.1016/S1499-3872(17)60007-9.
  • 18. Pian G, Li H, Piao Y. Clinical Significance of Inflammation Markers in Predicting the Severity of Acute Pancreatitis. Pancreas. 2021;50(2):201-5. doi: 10.1097/MPA.0000000000001749.
  • 19. Liu Y, Cheng JP, Zhao XL. The effect of serum triglyceride levels and different lipid-lowering methods on the prognosis of hypertriglyceridemic acute pancreatitis: a single-center 12-year retrospective study by propensity score matching. Scand J Gastroenterol. 2024;59(7):843-51. doi: 10.1080/00365521.2024.2342406.
  • 20. Zhang R, Deng L, Jin T, et al. Hypertriglyceridaemia-associated acute pancreatitis: diagnosis and impact on severity. HPB (Oxford). 2019;21(9):1240-9. doi: 10.1016/j.hpb.2019.01.015.
  • 21. Pascual I, Sanahuja A, García N, et al. Association of elevated serum triglyceride levels with a more severe course of acute pancreatitis: Cohort analysis of 1457 patients. Pancreatology. 2019;19(5):623-9. doi: 10.1016/j.pan.2019.06.006.
  • 22. Garg R, Rustagi T. Management of Hypertriglyceridemia Induced Acute Pancreatitis. Biomed Res Int. 2018;2018:4721357. doi: 10.1155/2018/4721357.
  • 23. Rawla P, Sunkara T, Thandra KC, Gaduputi V. Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies. Clin J Gastroenterol. 2018;11(6):441-8. doi: 10.1007/s12328-018-0881-1.
  • 24. Yan L-H, Hu X-H, Chen R-X, et al. Plasmapheresis compared with conventional treatment for hypertriglyceridemia-induced acute pancreatitis: A systematic review and meta-analysis. J Clin Apher. 2023;38(1):4-15. doi: 10.1002/jca.22018.
  • 25. Berberich AJ, Ziada A, Zou GY, Hegele RA. Conservative management in hypertriglyceridemia-associated pancreatitis. J Intern Med. 2019;286(6):644-50. doi: 10.1111/joim.12925.
  • 26. Qiu F, Lü XS, Huang YK. Effect of low molecular weight heparin on pancreatic micro-circulation in severe acute pancreatitis in a rodent model. Chin Med J (Engl). 2007;120(24):2260-3.
  • 27. Podda M, Murzi V, Marongiu P, et al. Effectiveness and safety of low molecular weight heparin in the management of acute pancreatitis: a systematic review and meta-analysis. World J Emerg Surg. 2024;19(1):30. doi: 10.1186/s13017-024-00558-3.
  • 28. Köksal A, Tozlu M, Sezgin O, et al. Acute pancreatitis in Turkey: Results of a nationwide multicenter study. Pancreatology. 2024;24(3):327-34. doi: 10.1016/j.pan.2023.10.005.
  • 29. Henzen C, Röck M, Schnieper C, Heer K. Heparin und Insulin in der Therapie der akuten Hypertriglyzeridämie-induzierten Pankreatitis [Heparin and insulin in the treatment of acute hypertriglyceridemia-induced pancreatitis]. Schweiz Med Wochenschr. 1999;129(35):1242-8. German.
  • 30. Näsström B, Olivecrona G, Olivecrona T, Stegmayr BG. Lipoprotein lipase during continuous heparin infusion: tissue stores become partially depleted. J Lab Clin Med. 2001;138(3):206-13. doi: 10.1067/mlc.2001.117666.
  • 31. Weintraub M, Rassin T, Eisenberg S, et al. Continuous intravenous heparin administration in humans causes a decrease in serum lipolytic activity and accumulation of chylomicrons in circulation. J Lipid Res. 1994;35(2):229-38.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Gastroenteroloji ve Hepatoloji
Bölüm Araştırma Makalesi
Yazarlar

Yunus Günegül 0000-0003-2182-8598

İlyas Ethem Şenocak 0000-0003-1493-873X

Talha Ercan 0000-0003-2786-432X

Yunus Emre Demiral 0009-0000-3082-026X

Ahmet Tarık Eminler

Gönderilme Tarihi 5 Kasım 2025
Kabul Tarihi 13 Nisan 2026
Yayımlanma Tarihi 21 Nisan 2026
DOI https://doi.org/10.17941/agd.1817440
IZ https://izlik.org/JA75NS34NU
Yayımlandığı Sayı Yıl 2026 Cilt: 25 Sayı: 1

Kaynak Göster

APA Günegül, Y., Şenocak, İ. E., Ercan, T., Demiral, Y. E., & Eminler, A. T. (2026). Hipertrigliseridemiye Bağlı Akut Pankreatitte Klinik Seyir ve Tedavi Yaklaşımları: 10 Yıllık Tek Merkez Deneyimi. Akademik Gastroenteroloji Dergisi, 25(1), 54-63. https://doi.org/10.17941/agd.1817440