Evaluation of hypertriglyceridemia-induced acute pancreatitis

Yıl 2017, Cilt: 16 Sayı: 3, 110 - 114, 20.11.2017

Altay Kandemir Adil Coşkun

https://doi.org/10.17941/agd.351674

Öz

Background and Aims: Hypertriglyceridemia is the third most common cause of acute pancreatitis. This study investigated the characteristics and outcomes (recurrence and mortality) of patients presenting with hypertriglyceridemia-induced acute pancreatitis. Materials and Methods: A total of 24 patients (average age: 38.8±6.5 years, 79% males) treated at our institution for severe hypertriglyceridemia-induced acute pancreatitis between January 2010 and August 2017 were included in this study. Complete fasting lipid profiles, amylase and lipase levels, and patient demographics were recorded for the evaluation of severe hypertriglyceridemia-induced acute pancreatitis. Results: A total of 615 patients were admitted with acute pancreatitis in our institution within the study period. Severe hypertriglyceridemia-induced acute pancreatitis was present in 24 patients (3.9%). All patients showed significant improvement in their triglyceride levels with medical treatment [therapeutic plasmapheresis with standard treatment (20 patients) or only standard treatment (4 patients)]. Of these patients 41.6% had type 2 diabetes mellitus, 16.6% had impaired glucose tolerance, 25% displayed excessive alcohol use, and 8.3% were pregnant. All these conditions are known to be associated with hypertriglyceridemia. Hospital mortality was 4.1%, and recurrent pancreatitis was detected in 29% of the patients. Conclusions: A high rate of recurrent pancreatitis was observed, which may be related to irregular drug use, lack of diet compliance, poor blood glucose regulation, and pregnancy. The low mortality rate of 4.1% in this cohort may partly be due to aggressive serum triglyceride lowering through a multidisciplinary team. Patients with severe hypertriglyceridemia-induced acute pancreatitis should be treated quickly. If therapeutic plasma exchange is available, triglyceride levels should be lowered to <500 mg/dl.

Anahtar Kelimeler

Acute pancreatitis, hypertriglyceridemia, amylase

Hipertrigliseridemi ilişkili akut pankreatit hastalarının değerlendirilmesi

Öz

Giriş ve Amaç: Hipertrigliseridemi, akut pankreatitin en yaygın üçüncü sebebidir. Bu çalışmanın amacı, hipertrigliseridemi ilişkili akut pankreatit tanısı konulan hastaların karakteristiklerini, tekrar ortaya çıkma sıklığı ve mortalitesini araştırmaktır. Gereç ve Yöntem: Ocak 2010 - Ağustos 2017 tarihleri arasında şiddetli hipertrigliseridemi ilişkili akut pankreatit tanısı ile kurumumuzda 24 hasta (yaş ortalaması:38,8±6,5 yıl, %79 erkek) tedavi edildi. Şiddetli hipertrigliseridemi ilişkili akut pankreatiti değerlendirmek için açlık lipid profili, amilaz, lipaz değerleri ve hasta demografik verileri kaydedildi. Bulgular: Çalışma periyodu sırasında kurumumuza akut pankreatit tanısı ile 615 hasta kabul edildi. Şiddetli hipertrigliseridemi ilişkili akut pankreatiti olan hasta sayısı 24 (%3,9) idi. Tüm hastalarda, medikal tedavi sonrası [standart tedavi ile terapötik plazma aferezi (20 hasta) veya sadece standart tedavi (4 hasta)] trigliserid düzeylerinde anlamlı iyileşme oldu. Bizim hastaların hipertrigliseridemi ile ilişkili olarak bilinen durumlardan, %41,6’sında diyabetes mellitus, %16,6’sında bozulmuş glukoz toleransı, %25’inde aşırı alkol alımı, %8,3’ünde hamilelik vardı. Hastane mortalitesi %4,1, rekürren pankreatit ise %29 idi. Sonuç: Rekürren pankreatit oranı yüksek saptandı. Bu, düzensiz fibrat kullanımı, diyet uyumumun zayıf olması, kötü kan şekeri regülasyonu, hamilelik ile ilişkili olabilir. Mortalite oranı %4,1 idi. Bu kısmen bizim multidisipliner takım çalışması sayesinde, serum trigliserid düzeyinin agresif düzeltilmesinden dolayı olabilir. Şiddetli hipertrigliseridemi ilişkili akut pankreatit hızlıca tedavi edilmelidir. Eğer terapötik plazma afarezine ulaşılabiliyor ise trigilserid düzeyi < 500 mg/dl olana kadar yapılmalıdır.

Anahtar Kelimeler

Akut pankreatit, hipertrigliseridemi

Kaynakça

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