Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series.
Treatment of Hypertriglyceridemia-Induced Acute Pancreatitis With Insulin, Heparin, and Gemfibrozil: A Case Series.
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DOI：
10.1177/0018578717725168
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发表时间：
2017-11-01
影响因子：
0.7
通讯作者：
Finlay, Laura
中科院分区：
文献类型：
--
作者：
Hammond, Drayton A;Finlay, Laura
高甘油三酯血症是急性胰腺炎的全球第三大常见原因。解决根本的病因对于优化管理是必不可少的。对于高甘油三酯血症尤其如此，因为这种病因可能会导致比其他原因更严重的急性胰腺炎和更严重的症状。针对高甘油三酯血症所致的急性胰腺炎(HTGP)，已经提出了许多药物治疗方案，然而，具体治疗方案的安全性和有效性仍不明确。在我所，6名平均Ranson标准评分为5，甘油三酯浓度为3501 mg/dL的患者接受持续胰岛素、肝素和口服吉非罗齐治疗HTGP。最大胰岛素输注速率为0.8~20.9U/h。有一半的患者接受了非罗非罗齐胆固醇药物治疗。5例患者的HTGP消失(中位数为第3天)。唯一的不良药物事件是单一患者的低血糖。肝素、胰岛素和吉非罗齐联合治疗在快速降低HTGP患者血清甘油三酯浓度方面是安全有效的。这一组合值得进一步研究。
Hypertriglyceridemia is the third most common worldwide cause of acute pancreatitis. Resolving the underlying etiology is imperative for optimal management. This is especially true with regard to hypertriglyceridemia, as this etiology may cause more severe acute pancreatitis and worse symptoms than other causes of the disease. Many pharmacological treatment options for hypertriglyceridemia-induced acute pancreatitis (HTGP) have been proposed; however, the safety and efficacy for specific treatment regimens remain nebulous. At our institution, 6 patients, whose average Ranson criteria score were 5 and presenting triglyceride concentrations were 3501 mg/dL, were managed with a continuous infusion of insulin, subcutaneous heparin, and oral gemfibrozil for HTGP. Maximum insulin infusion rates ranged from 0.8 to 20.9 U/h. Half of the patients received nongemfibrozil cholesterol medication. Five patients experienced a resolution of HTGP (median day 3). The only adverse drug event was hypoglycemia in a single patient. Combination therapy with heparin, insulin, and gemfibrozil is safe and efficacious in quickly lowering serum triglyceride concentrations in HTGP. This combination warrants further study.