高甘油三酯血症性胰腺炎诊疗进展
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摘要
<正>急性胰腺炎(acute pancreatitis,AP)发病呈全球上升趋势~([1])。在美国,其发病率在过去十年增长了20%,每年大约有275000人因为急性胰腺炎住院治疗,并由此带来了约25亿美元的医疗支出~([2])。尽管大多数AP病情呈自限性,但少数重症胰腺炎患者病死率仍高达30%~([3])。AP的病因较多,流行病学的数据表明高甘油三酯血症性胰腺炎(hypertriglyceridemia pancreatitis,HTGP)成为继胆源性
Hypertriglyceridemia pancreatitis(HTGP)is a disease that seriously threatens human health and life.The primary cause is high triglycerides,and the factors that can be classified are primary and secondary.On the basis of hypertriglyceridemia,a variety of pathological mechanisms are involved in the pathogenesis of HTGP.In clinical diagnosis,there are various interference factors in blood lipid measurement,symptom analysis,and pancreatic enzyme measurement.HTGP treatment involves Intensive lipid-lowering treatment.
Hypertriglyceridemia pancreatitis(HTGP)is a disease that seriously threatens human health and life.The primary cause is high triglycerides,and the factors that can be classified are primary and secondary.On the basis of hypertriglyceridemia,a variety of pathological mechanisms are involved in the pathogenesis of HTGP.In clinical diagnosis,there are various interference factors in blood lipid measurement,symptom analysis,and pancreatic enzyme measurement.HTGP treatment involves Intensive lipid-lowering treatment.
引文
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[2] Forsmark CE,Vege SS,Wilcox CM.Acute Pancreatitis[J].New England J Med,2016,375(20):1972-1981.
[3] Whitcomb DC.Clinical practice.Acute pancreatitis[J].New England J Med,2006,354(20):2142-2150.
[4]张娜,张海燕,郭晓红,等.中国近十年急性胰腺炎病因变化特点的Meta分析[J].中华消化病与影像杂志,2016,6(2):271-275.
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[7] Berglund L,Brunzell JD,Goldberg AC,et al.Evaluation and treatment of hypertriglyceridemia:an Endocrine Society clinical practice guideline[J].J Clin Endocrinol Metab,2012,97(9):2969-2989.
[8] Scherer J,Singh VP,Pitchumoni CS,et al.Issues in hyperlipidemic pancreatitis an update[J].J Clin Endocrinol Metab,2014,48(3):195-203.
[9] Fredrickson DS,Levy RI,Lees RS.Fat transport in lipoproteins—an integrated approach to medianisms and disorders[J].New England J Med,1967,276(5):273-281.
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[14]Nair S,Yadav D,Pitchumoni CS.Association of diabetic ketoacidosis and acute pancreatitis:observations in 100consecutive episodes of DKA[J].Am J Endocrinol,2000,95(10):2795-2800.
[15]Van de Wiel A.The effect of alcohol on postprandial and fasting triglycerides[J].Int J Vascular Med,2012,2012:862504.
[16] Brinton EA.Oral estrogen replacement therapy in postmenopausal women selectively raises concentrations and production rates of lipoprotein A-1and lowers hepatic lipase activity without lowering the fractional catabolic rate[J].Arterioscl Thromb Vascular Biol,1996,16:431-440.
[17]O'Sullivan AJ,Ho KK.A comparison of the effects of oral and transdermal estrogen replacement on insulin sensitivity in postmenopausal women[J].J Clinic Endocrinol Metab,1995,80(6):1783-1788.
[18]Hammadeh ME,Munz W,Meisinger M,et al.Effects of ovarian stimulation on serum concentrations of lipids and ketone bodies in patients undergoing IVF/ICSI treatment[J].Zentralbl Gynakol,2004,126(2):67
[19]Hong S,Qiwen B,Ying J,et al.Body mass index and the risk and prognosis of acute pancreatitis:a meta-analysis[J].Eur J Gastroenterol Hepatol,2011,23(12):1136-1143.
[20]Chen SM,Xiong GS,Wu SM.Is obesity an indicator of complications and mortality in acute pancreatitis?An updated meta-analysis[J].J Dig Dis,2012,13(5):244-251.
[21]Lee YH,Pratley RE.The evolving role of inflammation in obesity and the metabolic syndrome[J].Current diabetes report,2005,5(1):70-75.
[22]Fain JN,Madan AK,Hiler ML,et al.Comparison of the release of adipokines by adipose tissue,adipose tissue matrix,and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans[J].Endocrinology,2004,145(5):2273-2282.
[23]Lyon CJ,Law RE,Hsueh WA.Minireview:adiposity,inflammation and atherogenesis[J].Endocrinology,2003,144(6):2195-2200.
[24]Fantuzzi G.Adipose tissue,adipokines and inflammation[J].J Clin Immunol,2005,115(5):911-919,quiz920.
[25]Tilg H,Moschen AR.Adipocytokines:mediators linking adipose tissue,inflammation and immunity[J].Immunology,2006,6(10):772-783.
[26]Sharma A,Muddana V,Lamb J,et al.Low serum adiponectin levels are associated with systemic organ failure in acute pancreatitis[J].Pancreas,2009,38(8):907-912.
[27]Kimura W,Mossner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
[28]Georgi AM,Krasimira SH,Yovcho PY,et al.Pathophysiological mechanisms of acute pancreatitis define inflammatory markers of clinical prognosis[J].Pancreas,2015,44(5):713-717.
[29]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.
[30] Dominguez-Mu1oz JE,Malfertheiner P,Ditschuneit HH,et al.Hyperlipidemia in acute pancreatitis.Relationship with etiology,onset and severity of the disease[J].Int J Pancreatol,1991,10(3-4):261-267.
[31]Wang Y,Attar BM,Hinami K,et al.Concurrent Diabetic Ketoacidosis in Hypertriglyceridemia-Induced Pancreatitis How Does It Affect the Clinical Course and Severity Scores?[J].Pancreas,2017,46(10):1336-1440.
[32]Li HP,Huang YJ,Chen X.Acute pancreatitis in pregnancy:a 6-year single center clinical experience[J].Chin Med J,2011,124(17):2771-2775.
[33]Zhang DL,Huang Y,Yan L,et al.Thirty-eight cases of acute pancreatitis in pregnancy:a 6-year single center retrospective analysis[J].J Huazhong Univ Sci Technolog Med Sci,2013,33(3):361-367.
[34]Keim V,Teich N,Fiedler F,et al.A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain[J].Pancreas,1998,16(1):45-49.
[35]Cartier T,Sogni P,Perruche F,et al.Normal lipase serum level in acute pancreatitis:a case report[J].Emerg Med J,2006,23(9):701-702.
[36]Yokoe M,Takada T,Mayumi T,et al.Japanese guidelines for the management of acute pancreatitis:Japanese Guidelines 2015[J].J Hepatobiliary Pancreat Sci,2015,22(6):405-432.
[37] Lesser PB,Warshaw AL.Diagnosis of pancreatitis masked by hyperlipemia[J].Ann Int Med,1975,82(2):795-798.
[38]Pan L,Feng W,Jia W,et al.Elevated serum miR-7,miR-9,miR-122,and miR-141are noninvasive biomarkers of acute pancreatitis[J].J Dis Mark,2017,2017:7293459.
[39]Gardner TB,Vege SS,Pearson RK,et al.Fluid resuscitation in acute pancreatitis[J].Clin Gastroenterol Hepatol,2008,6(10):1070-1076.
[40]Besselink M,van Santvoort H,Freeman M,et al.IAP/APA evidence-based guidelines for the management of acute pancreatitis[J].Pancreatology,2013,13(4Suppl2):e1-e15.
[41]Kadikoylu G,Yukselen V,Yavasoglu I,et al.Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia[J].Transfus Apher Sci,2010,43(3):285-289.
[42]Goldberg AS,Hegele RA.Severe hypertriglyceridemia in pregnancy[J].J Clinic Endocrinol Metab,2012;97:2589-2596.
[43]Staels B,Dallongeville J,Auwerx J,et al.Mechanism of action of brates on lipid and lipoprotein metabolism[J].Circulation,1998,98(19):2088-2093.
[44] Whitten AE,Lorenz RP,Smith JM.Hyperlipidemiaassociated pancreatitis in pregnancy managed with fenofibrate[J].Obstet Gynecol,2011,117(2):517-519.
[45]Alagozlu H,Cindoruk M,Karakan T,et al.Heparin and insulin in the treatment of hypertriglyceridemiainduced severe acute pancreatitis[J].Dig Dis Sci,2006,51(5):931-933.
[46]Monga A,Arora A,Makkar RP,et al.Hypertriglyceridemia-induced acute pancreatitis—treatment with heparin and insulin[J].Indian J Gastroenterol,2003,22(3):102-103.
[47]Henderson SR,Maitland R,Mustafa OG,et al.Severe hypertriglyceridaemia in Type 2 diabetes mellitus:beneficial effect of continuous insulin infusion[J].QJM,2013,106(4):355-359.
[48]Gubensek J,Buturovic-Ponikvar J,Marn-Pernat A,et al.Treat-ment of hyperlipidemic acute pancreatitis with plasma exchange:a single-center experience[J].Ther Apher Dial,2009,13(4):314-317.
[49]Yeh JH,Chen JH,Chiu HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J Clin Apher,2003,18(4):181-185.
[50]Schwartz J,Winters JL,Padmanabhan A,et al.Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis:the sixth special issue[J].J Clin Apher,2013,28(3):145-284.
[51]Tang M,Hu G,Zhao Y,et al.A serum metabolomic investigation on lipoprotein lipase-deficient mice with hyperlipidemic pancreatitis using gas chromatography/mass spectrometry[J].Biomed Rep,2013,1(3):469-473.
[52]Liu RX,Hong J,Xu XQ,et al.Gut microbiome and serum metabolome alterations in obesity and after weight-loss intervention[J].Nat Med,2017,23(7):859-868.
[53]Lutgendorff F,Nijmeijer RM,Sandstrom PA,et al.Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J].PLoS One,2009,4(2):e4512.
[2] Forsmark CE,Vege SS,Wilcox CM.Acute Pancreatitis[J].New England J Med,2016,375(20):1972-1981.
[3] Whitcomb DC.Clinical practice.Acute pancreatitis[J].New England J Med,2006,354(20):2142-2150.
[4]张娜,张海燕,郭晓红,等.中国近十年急性胰腺炎病因变化特点的Meta分析[J].中华消化病与影像杂志,2016,6(2):271-275.
[5] Chang CC,Hsieh YY,Tsai HD,et al.Acute pancreatitis in pregnancy[J].Zhonghua Yi Xue Za Zhi,1998,61:85-92.
[6] Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1416.
[7] Berglund L,Brunzell JD,Goldberg AC,et al.Evaluation and treatment of hypertriglyceridemia:an Endocrine Society clinical practice guideline[J].J Clin Endocrinol Metab,2012,97(9):2969-2989.
[8] Scherer J,Singh VP,Pitchumoni CS,et al.Issues in hyperlipidemic pancreatitis an update[J].J Clin Endocrinol Metab,2014,48(3):195-203.
[9] Fredrickson DS,Levy RI,Lees RS.Fat transport in lipoproteins—an integrated approach to medianisms and disorders[J].New England J Med,1967,276(5):273-281.
[10] Yadav D,Pitchumoni CS.Issues in hyperlipidemic pancreatitis[J].J Clin Endocrinol Metab,2003,36(1):54-62.
[11]Shenoy SD,Cody D,Rickett AB,et al.Acute pancreatitis and its association with diabetes mellitus in children[J].J Pediatr Endocrinol Metab,2004,17(12):1667-1670.
[12]Havel RJ.Approach to the patient with hyperlipidemia[J].Med Clin North Am,1982,66(2):319-333.
[13]Rivellese AA,De Natale C,Di Marino L,et al.Exogenous and endogenous postprandial lipid abnormalities in type 2diabetic patients with optimal blood glucose control and optimal fasting triglyceride levels[J].J Clinic Endocrinol Metab,2004,89(5):2153-2159.
[14]Nair S,Yadav D,Pitchumoni CS.Association of diabetic ketoacidosis and acute pancreatitis:observations in 100consecutive episodes of DKA[J].Am J Endocrinol,2000,95(10):2795-2800.
[15]Van de Wiel A.The effect of alcohol on postprandial and fasting triglycerides[J].Int J Vascular Med,2012,2012:862504.
[16] Brinton EA.Oral estrogen replacement therapy in postmenopausal women selectively raises concentrations and production rates of lipoprotein A-1and lowers hepatic lipase activity without lowering the fractional catabolic rate[J].Arterioscl Thromb Vascular Biol,1996,16:431-440.
[17]O'Sullivan AJ,Ho KK.A comparison of the effects of oral and transdermal estrogen replacement on insulin sensitivity in postmenopausal women[J].J Clinic Endocrinol Metab,1995,80(6):1783-1788.
[18]Hammadeh ME,Munz W,Meisinger M,et al.Effects of ovarian stimulation on serum concentrations of lipids and ketone bodies in patients undergoing IVF/ICSI treatment[J].Zentralbl Gynakol,2004,126(2):67
[19]Hong S,Qiwen B,Ying J,et al.Body mass index and the risk and prognosis of acute pancreatitis:a meta-analysis[J].Eur J Gastroenterol Hepatol,2011,23(12):1136-1143.
[20]Chen SM,Xiong GS,Wu SM.Is obesity an indicator of complications and mortality in acute pancreatitis?An updated meta-analysis[J].J Dig Dis,2012,13(5):244-251.
[21]Lee YH,Pratley RE.The evolving role of inflammation in obesity and the metabolic syndrome[J].Current diabetes report,2005,5(1):70-75.
[22]Fain JN,Madan AK,Hiler ML,et al.Comparison of the release of adipokines by adipose tissue,adipose tissue matrix,and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans[J].Endocrinology,2004,145(5):2273-2282.
[23]Lyon CJ,Law RE,Hsueh WA.Minireview:adiposity,inflammation and atherogenesis[J].Endocrinology,2003,144(6):2195-2200.
[24]Fantuzzi G.Adipose tissue,adipokines and inflammation[J].J Clin Immunol,2005,115(5):911-919,quiz920.
[25]Tilg H,Moschen AR.Adipocytokines:mediators linking adipose tissue,inflammation and immunity[J].Immunology,2006,6(10):772-783.
[26]Sharma A,Muddana V,Lamb J,et al.Low serum adiponectin levels are associated with systemic organ failure in acute pancreatitis[J].Pancreas,2009,38(8):907-912.
[27]Kimura W,Mossner J.Role of hypertriglyceridemia in the pathogenesis of experimental acute pancreatitis in rats[J].Int J Pancreatol,1996,20(3):177-184.
[28]Georgi AM,Krasimira SH,Yovcho PY,et al.Pathophysiological mechanisms of acute pancreatitis define inflammatory markers of clinical prognosis[J].Pancreas,2015,44(5):713-717.
[29]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis--2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.
[30] Dominguez-Mu1oz JE,Malfertheiner P,Ditschuneit HH,et al.Hyperlipidemia in acute pancreatitis.Relationship with etiology,onset and severity of the disease[J].Int J Pancreatol,1991,10(3-4):261-267.
[31]Wang Y,Attar BM,Hinami K,et al.Concurrent Diabetic Ketoacidosis in Hypertriglyceridemia-Induced Pancreatitis How Does It Affect the Clinical Course and Severity Scores?[J].Pancreas,2017,46(10):1336-1440.
[32]Li HP,Huang YJ,Chen X.Acute pancreatitis in pregnancy:a 6-year single center clinical experience[J].Chin Med J,2011,124(17):2771-2775.
[33]Zhang DL,Huang Y,Yan L,et al.Thirty-eight cases of acute pancreatitis in pregnancy:a 6-year single center retrospective analysis[J].J Huazhong Univ Sci Technolog Med Sci,2013,33(3):361-367.
[34]Keim V,Teich N,Fiedler F,et al.A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain[J].Pancreas,1998,16(1):45-49.
[35]Cartier T,Sogni P,Perruche F,et al.Normal lipase serum level in acute pancreatitis:a case report[J].Emerg Med J,2006,23(9):701-702.
[36]Yokoe M,Takada T,Mayumi T,et al.Japanese guidelines for the management of acute pancreatitis:Japanese Guidelines 2015[J].J Hepatobiliary Pancreat Sci,2015,22(6):405-432.
[37] Lesser PB,Warshaw AL.Diagnosis of pancreatitis masked by hyperlipemia[J].Ann Int Med,1975,82(2):795-798.
[38]Pan L,Feng W,Jia W,et al.Elevated serum miR-7,miR-9,miR-122,and miR-141are noninvasive biomarkers of acute pancreatitis[J].J Dis Mark,2017,2017:7293459.
[39]Gardner TB,Vege SS,Pearson RK,et al.Fluid resuscitation in acute pancreatitis[J].Clin Gastroenterol Hepatol,2008,6(10):1070-1076.
[40]Besselink M,van Santvoort H,Freeman M,et al.IAP/APA evidence-based guidelines for the management of acute pancreatitis[J].Pancreatology,2013,13(4Suppl2):e1-e15.
[41]Kadikoylu G,Yukselen V,Yavasoglu I,et al.Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia[J].Transfus Apher Sci,2010,43(3):285-289.
[42]Goldberg AS,Hegele RA.Severe hypertriglyceridemia in pregnancy[J].J Clinic Endocrinol Metab,2012;97:2589-2596.
[43]Staels B,Dallongeville J,Auwerx J,et al.Mechanism of action of brates on lipid and lipoprotein metabolism[J].Circulation,1998,98(19):2088-2093.
[44] Whitten AE,Lorenz RP,Smith JM.Hyperlipidemiaassociated pancreatitis in pregnancy managed with fenofibrate[J].Obstet Gynecol,2011,117(2):517-519.
[45]Alagozlu H,Cindoruk M,Karakan T,et al.Heparin and insulin in the treatment of hypertriglyceridemiainduced severe acute pancreatitis[J].Dig Dis Sci,2006,51(5):931-933.
[46]Monga A,Arora A,Makkar RP,et al.Hypertriglyceridemia-induced acute pancreatitis—treatment with heparin and insulin[J].Indian J Gastroenterol,2003,22(3):102-103.
[47]Henderson SR,Maitland R,Mustafa OG,et al.Severe hypertriglyceridaemia in Type 2 diabetes mellitus:beneficial effect of continuous insulin infusion[J].QJM,2013,106(4):355-359.
[48]Gubensek J,Buturovic-Ponikvar J,Marn-Pernat A,et al.Treat-ment of hyperlipidemic acute pancreatitis with plasma exchange:a single-center experience[J].Ther Apher Dial,2009,13(4):314-317.
[49]Yeh JH,Chen JH,Chiu HC.Plasmapheresis for hyperlipidemic pancreatitis[J].J Clin Apher,2003,18(4):181-185.
[50]Schwartz J,Winters JL,Padmanabhan A,et al.Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis:the sixth special issue[J].J Clin Apher,2013,28(3):145-284.
[51]Tang M,Hu G,Zhao Y,et al.A serum metabolomic investigation on lipoprotein lipase-deficient mice with hyperlipidemic pancreatitis using gas chromatography/mass spectrometry[J].Biomed Rep,2013,1(3):469-473.
[52]Liu RX,Hong J,Xu XQ,et al.Gut microbiome and serum metabolome alterations in obesity and after weight-loss intervention[J].Nat Med,2017,23(7):859-868.
[53]Lutgendorff F,Nijmeijer RM,Sandstrom PA,et al.Probiotics prevent intestinal barrier dysfunction in acute pancreatitis in rats via induction of ileal mucosal glutathione biosynthesis[J].PLoS One,2009,4(2):e4512.