Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü

Abstract

Safra taşı ve alkol kullanımı akut pankreatitin (AP) en yaygın iki nedenidir. Hipertrigliseridemi (HTG) ise nadir görülen ancak iyi bilinen akut pankreatit nedenlerindendir. Kliniği diğer akut pankreatitlerden farklı değildir. HTG’ye sekonder pankreatit olgularında bir veya daha fazla ikincil faktörün (kontrolsüz diyabet, alkolizm vb.) varlığı söz konusudur. Tedavisi diğer pankreatitlerin tedavisine benzemektedir. HTG'li diyabetik hastalarda insülin infüzyonu, trigliserit düzeylerini hızla düşürebilir. Aferez kullanımı ise hala deneysel olup HTG pankreatitinin yönetimindeki rolünü açıklığa kavuşturmak için daha iyi tasarlanmış çalışmalara ihtiyaç vardır. Olgu: 39 yaşında erkek hasta karın ağrısı, bulantı, kusma şikâyeti ile acil serviste görüldü. Hastanın özgeçmişinde diabetes mellitus ve hiperli-pidemi mevcuttu. Fizik muayenede, batında distansiyon, epigastrik bölgede hassasiyet ve Murphy bulgusu pozitifti. Abdomen bilgisayarlı tomografisi AP ile uyumlu, trigliserit (TG) düzeyi 9884 mg/dL idi. Hasta, HTG-AP olarak kabul edildi; hidrasyon, insülin infüzyonu ve plazmaferez tedavisi uygulandı. Ancak TG seviyesinde etkili bir düşme olmaması nedeni ile 3 gün lipid aferezi uygulandı. Hastanın TG seviyesinde 673 mg/dL'ye kadar düşme sağlandı. Sonuç: HTG-AP’de TG düzeylerini efektif olarak normal seviyelere çekmek AP progresyonunu önlemede çok önemli olup lipid aferez yöntemi alternatif ve etkin bir yöntemdir.

Keywords

• Pankreatit
• hipertrigliseridemi
• lipid aferezi

The role of lipid apheresis in hypertriglyceridemia-induced acute pancreatitis

Abstract

Gallstones and alcohol abuse are the two most common causes of acute pancreatitis (AP). Hypertriglyceridemia (HTG) is an uncommon but well-established etiology of acute pancreatitis. The clinical presentation of HTG-induced pancreatitis is similar to other causes. Pancreatitis secondary to HTG is typically seen in the presence of one or more secondary factors (uncontrolled diabetes, alcoholism, etc.) within a patient. Clinical management of HTG pancreatitis follows the same treatment guide-lines when compared to the other causes of pancreatitis. Insulin infusion in diabetic patients with HTG can rapidly reduce triglyceride levels. The use of apheresis is still experimental and better-designed studies are needed to clarify its role in the management of HTG pancreatitis. Case: the 39-year-old male patient was examined in the emergency service. He had abdominal pain, nausea, and vomiting, and his medical history included diabetes mellitus and hyperlipidemia. Physical examination findings: He had abdominal distension, epigastric discomfort, and Murphy’s sign was positive. Abdomen computed tomography considered AP and triglyceride (TG) level was 9884mg/dL who was evaluated HTG-AP. We applied hydration, insulin infusion, and plasmapheresis treatment to the patient but we could not achieve an effective reduction in TG level. Therefore, we applied lipid apheresis for 3 days and achieved a decrease in the patient’s TG level to 673 mg/dL. Conclusion: In HTG-AP, effectively lowering the TG levels to within the normal range is crucial in preventing AP progression. Therefore, the lipid apheresis method in HTG-AP is an effective method that can serve as an alternative to procedural treatment.

Keywords

• Pancreatitis
• hypertriglyceridemia
• lipid apheresis

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