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Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü

Yıl 2021, Cilt 2, Sayı 2, 65 - 67, 30.06.2021

Öz

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.

Kaynakça

  • 1. Fortson MR, Freedman SN, Webster 3rd PD. Clinical assessment of hyperlipidemic pancreatitis. The Ameri-can Journal of Gastroenterology 1995;90:2134-9.
  • 2. Tsuang W, Navaneethan U, Ruiz L, Palascak J B, Gelrud A. Hypertriglyceridemic pancreatitis: Presenta-tion and management. American Journal of Gastroen-terology 2009;104(4):984-91.
  • 3.Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Euro-pean Journal of Internal Medicine 2014;25(8):689-94.
  • 4. Christian JB, Bourgeois N, Snipes R, Lowe KA. Prevalence of severe (500 to 2,000 mg/dL) hypertri-glyceridemia in United States adults. Am J Cardiol 2011;107:891-7.
  • 5. Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: An update. J Clin Gastroenterol 2014;48:195-203.
  • 6. Uysal E, Acar YA, Gokmen E, Kutur A, Dogan H. Hypertriglyceridemia induced pancreatitis (chylomi-cronemia syndrome) treated with supportive care. Case Reports in Critical Care 2014;2014: 767831.
  • 7. Jain D, Zimmerschied J. Heparin and insulin for hypertriglyceridemia-induced pancreatitis: Case report. The Scientific World Journal 2009;9:1230-2.
  • 8. Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14:4558.
  • 9. Kimura W, Mossner J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats. Int J Pancreatol 1996;20:177-84.
  • 10. Knaus WA, Draper E A, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Critical Care Medicine 1985;13(10):818-29.
  • 11. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174(2):331-6.
  • 12. Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson crite-ria and APACHE II and III scoring systems in predict-ing acute pancreatitis outcome. Journal of Clinical Gastroenterology 2003;36(3):253-60.
  • 13. Alagözlü H, Cindoruk M, Karakan T, Unal S. Hepa-rin and insulin in the treatment of hypertriglyceridem-ia-induced severe acute pancreatitis. Dig Dis Sci 2006;51:931-3.
  • 14. Stefanutti C, Labbadia G, Morozzi C. Severe hyper-triglyceridemia-related acute pancreatitis. Therapeutic Apheresis and Dialysis 2013;17(2):130-7.
  • 15. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apheresis 2003;18:181-5.
  • 16. Erkan G, Kaya EK, Polat FB, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with plasmapheresis. Endoskopi 2012;20:95-6.
  • 17. Coskun A, Erkan N, Yakan S et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. Przegląd Gastroenterologiczny 2015;10(1):18-22.
  • 18. Berger FZ, Quera PR, Poniachik TJ, Oksenberg RD, Guerrero PJ. Heparin and/or insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Revista Medica de´Chile. 2001;129(12):1373-8.
  • 19. Jain P, Rai RR, Udawat H, Nijhawan S, Mathur A. Insulin and heparin in treatment of hypertriglyceridem-ia induced pancreatitis. World Journal of Gastroenter-ology 2007;13(18):2642-3.
  • 20. Nasstrom B, Stegmayr BG, Olivecrona G, Olivecro-na T. Lower plasma levels of lipoprotein lipase afer infusion of low molecular weight heparin than after administration of conventional heparin indicate more rapid catabolism of the enzyme. Journal of Laboratory and Clinical Medicine 2003;142(2):90-9.
  • 21. Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipopro-tein in familial hypercholesterolaemia. Lancet 1981;2:1005-7.
  • 22. Köksal F, Özkan B, Örsçelik Ö, et al. Ailevi hiperkolesterolemi hastalarında lipid aferezin lipid profili ve hs-CRP üzerine etkileri. Mersin Univ Saglık Bilim Derg 2018;11(1):24-31.
  • 23. Sezgin O, Özdoğan O, Yaraş S, Üçbilek E, Altıntaş E. Evaluation of hypertriglyceridemia-induced acute pancreatitis: A single tertiary care unit experience from Turkey. Turk J Gastroenterol 2019;30(3):271-7.

The role of lipid apheresis in hypertriglyceridemia-induced acute pancreatitis

Yıl 2021, Cilt 2, Sayı 2, 65 - 67, 30.06.2021

Öz

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.

Kaynakça

  • 1. Fortson MR, Freedman SN, Webster 3rd PD. Clinical assessment of hyperlipidemic pancreatitis. The Ameri-can Journal of Gastroenterology 1995;90:2134-9.
  • 2. Tsuang W, Navaneethan U, Ruiz L, Palascak J B, Gelrud A. Hypertriglyceridemic pancreatitis: Presenta-tion and management. American Journal of Gastroen-terology 2009;104(4):984-91.
  • 3.Valdivielso P, Ramirez-Bueno A, Ewald N. Current knowledge of hypertriglyceridemic pancreatitis. Euro-pean Journal of Internal Medicine 2014;25(8):689-94.
  • 4. Christian JB, Bourgeois N, Snipes R, Lowe KA. Prevalence of severe (500 to 2,000 mg/dL) hypertri-glyceridemia in United States adults. Am J Cardiol 2011;107:891-7.
  • 5. Scherer J, Singh VP, Pitchumoni CS, Yadav D. Issues in hypertriglyceridemic pancreatitis: An update. J Clin Gastroenterol 2014;48:195-203.
  • 6. Uysal E, Acar YA, Gokmen E, Kutur A, Dogan H. Hypertriglyceridemia induced pancreatitis (chylomi-cronemia syndrome) treated with supportive care. Case Reports in Critical Care 2014;2014: 767831.
  • 7. Jain D, Zimmerschied J. Heparin and insulin for hypertriglyceridemia-induced pancreatitis: Case report. The Scientific World Journal 2009;9:1230-2.
  • 8. Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14:4558.
  • 9. Kimura W, Mossner J. Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats. Int J Pancreatol 1996;20:177-84.
  • 10. Knaus WA, Draper E A, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Critical Care Medicine 1985;13(10):818-29.
  • 11. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JHC. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990;174(2):331-6.
  • 12. Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson crite-ria and APACHE II and III scoring systems in predict-ing acute pancreatitis outcome. Journal of Clinical Gastroenterology 2003;36(3):253-60.
  • 13. Alagözlü H, Cindoruk M, Karakan T, Unal S. Hepa-rin and insulin in the treatment of hypertriglyceridem-ia-induced severe acute pancreatitis. Dig Dis Sci 2006;51:931-3.
  • 14. Stefanutti C, Labbadia G, Morozzi C. Severe hyper-triglyceridemia-related acute pancreatitis. Therapeutic Apheresis and Dialysis 2013;17(2):130-7.
  • 15. Yeh JH, Chen JH, Chiu HC. Plasmapheresis for hyperlipidemic pancreatitis. J Clin Apheresis 2003;18:181-5.
  • 16. Erkan G, Kaya EK, Polat FB, et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with plasmapheresis. Endoskopi 2012;20:95-6.
  • 17. Coskun A, Erkan N, Yakan S et al. Treatment of hypertriglyceridemia-induced acute pancreatitis with insulin. Przegląd Gastroenterologiczny 2015;10(1):18-22.
  • 18. Berger FZ, Quera PR, Poniachik TJ, Oksenberg RD, Guerrero PJ. Heparin and/or insulin treatment of acute pancreatitis caused by hypertriglyceridemia. Revista Medica de´Chile. 2001;129(12):1373-8.
  • 19. Jain P, Rai RR, Udawat H, Nijhawan S, Mathur A. Insulin and heparin in treatment of hypertriglyceridem-ia induced pancreatitis. World Journal of Gastroenter-ology 2007;13(18):2642-3.
  • 20. Nasstrom B, Stegmayr BG, Olivecrona G, Olivecro-na T. Lower plasma levels of lipoprotein lipase afer infusion of low molecular weight heparin than after administration of conventional heparin indicate more rapid catabolism of the enzyme. Journal of Laboratory and Clinical Medicine 2003;142(2):90-9.
  • 21. Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipopro-tein in familial hypercholesterolaemia. Lancet 1981;2:1005-7.
  • 22. Köksal F, Özkan B, Örsçelik Ö, et al. Ailevi hiperkolesterolemi hastalarında lipid aferezin lipid profili ve hs-CRP üzerine etkileri. Mersin Univ Saglık Bilim Derg 2018;11(1):24-31.
  • 23. Sezgin O, Özdoğan O, Yaraş S, Üçbilek E, Altıntaş E. Evaluation of hypertriglyceridemia-induced acute pancreatitis: A single tertiary care unit experience from Turkey. Turk J Gastroenterol 2019;30(3):271-7.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Makaleler
Yazarlar

Derya TATLISULUOĞLU (Sorumlu Yazar)
İstanbul Çam Sakura Şehir Hastanesi, Yoğun BakımKliniği
0000-0002-4493-4353
Türkiye


Kadir BULUT Bu kişi benim
BAŞAKŞEHİT ÇAM SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0003-4114-5305
Türkiye


Alev ÖZTAŞ Bu kişi benim
BAŞAKŞEHİR ÇAM SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0002-8423-6824
Türkiye


Murat ÜNSEL Bu kişi benim
BAŞAKŞEHİR ÇAM SAKURA ŞEHİR HASTANESİ, YOĞUN BAKIM KLİNİĞİ
0000-0002-2786-6811
Türkiye


Güldem TURAN
Başakşehir Çam Sakura Şehir Hastanesi, Yoğun BakımKliniği
0000-0002-7281-1705
Türkiye

Yayımlanma Tarihi 30 Haziran 2021
Başvuru Tarihi 22 Şubat 2021
Kabul Tarihi 17 Mayıs 2021
Yayınlandığı Sayı Yıl 2021, Cilt 2, Sayı 2

Kaynak Göster

Bibtex @olgu sunumu { troiamedj884811, journal = {Troia Medical Journal}, issn = {2630-6107}, eissn = {2667-7172}, address = {ÇANAKKALE 18 MART ÜNiVERSiTESi TIP FAKÜLTESİ ÇANAKKALE/TÜRKiYE}, publisher = {Çanakkale Onsekiz Mart Üniversitesi}, year = {2021}, volume = {2}, pages = {65 - 67}, doi = {}, title = {Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü}, key = {cite}, author = {Tatlısuluoğlu, Derya and Bulut, Kadir and Öztaş, Alev and Ünsel, Murat and Turan, Güldem} }
APA Tatlısuluoğlu, D. , Bulut, K. , Öztaş, A. , Ünsel, M. & Turan, G. (2021). Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü . Troia Medical Journal , 2 (2) , 65-67 . Retrieved from https://dergipark.org.tr/tr/pub/troiamedj/issue/63300/884811
MLA Tatlısuluoğlu, D. , Bulut, K. , Öztaş, A. , Ünsel, M. , Turan, G. "Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü" . Troia Medical Journal 2 (2021 ): 65-67 <https://dergipark.org.tr/tr/pub/troiamedj/issue/63300/884811>
Chicago Tatlısuluoğlu, D. , Bulut, K. , Öztaş, A. , Ünsel, M. , Turan, G. "Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü". Troia Medical Journal 2 (2021 ): 65-67
RIS TY - JOUR T1 - Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü AU - Derya Tatlısuluoğlu , Kadir Bulut , Alev Öztaş , Murat Ünsel , Güldem Turan Y1 - 2021 PY - 2021 N1 - DO - T2 - Troia Medical Journal JF - Journal JO - JOR SP - 65 EP - 67 VL - 2 IS - 2 SN - 2630-6107-2667-7172 M3 - UR - Y2 - 2021 ER -
EndNote %0 Troia Tıp Dergisi Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü %A Derya Tatlısuluoğlu , Kadir Bulut , Alev Öztaş , Murat Ünsel , Güldem Turan %T Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü %D 2021 %J Troia Medical Journal %P 2630-6107-2667-7172 %V 2 %N 2 %R %U
ISNAD Tatlısuluoğlu, Derya , Bulut, Kadir , Öztaş, Alev , Ünsel, Murat , Turan, Güldem . "Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü". Troia Medical Journal 2 / 2 (Haziran 2021): 65-67 .
AMA Tatlısuluoğlu D. , Bulut K. , Öztaş A. , Ünsel M. , Turan G. Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü. Troia Med J. 2021; 2(2): 65-67.
Vancouver Tatlısuluoğlu D. , Bulut K. , Öztaş A. , Ünsel M. , Turan G. Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü. Troia Medical Journal. 2021; 2(2): 65-67.
IEEE D. Tatlısuluoğlu , K. Bulut , A. Öztaş , M. Ünsel ve G. Turan , "Hipertrigliseridemiye bağlı akut pankreatitte lipid aferezinin rolü", Troia Medical Journal, c. 2, sayı. 2, ss. 65-67, Haz. 2021