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Liu Y, Cheng JP, Zhao XL. The effect of serum triglyceride levels and different lipid-lowering methods on the prognosis of hypertriglyceridemic acute pancreatitis: a single-center 12-year retrospective study by propensity score matching. Scand J Gastroenterol 2024:1-9. [PMID: 38625376 DOI: 10.1080/00365521.2024.2342406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
AIM To investigate the impact of triglyceride on hypertriglyceridemic acute pancreatitis (HTG-AP) and different lipid-lowering methods on triglyceride-lowering efficiency and HTG-AP. METHODS The patients with HTG-AP from January 2012 to December 2023 in Civil Aviation General Hospital were analyzed, retrospectively. Patients were divided and compared according to whether their triglycerides were below 5.56 mmol/L at 48 and 72 h of admission. The patients were divided into control group, insulin group, and low molecular weight heparin (LMWH)+bezafibrate group based on the different methods of lipid-lowering. Propensity score matching (PSM) was employed to balance the baseline characteristics. RESULTS There was no correlation between the severity of HTG-AP and the triglyceride at admission. The incidence of severity, local complications, and persistent organ failure (POF) were significantly decreased in patients with 48-h and 72-h triglyceride attainment. Following PSM, the incidence of infectious pancreatic necrosis (IPN) (3.3% vs. 13.3%) was significantly reduced in insulin group compared with control group (p < .05). Compared with control group, LMWH + bezafibrate group had higher lipid reduction efficiency, and the incidence of IPN (0.9% vs. 10.1%) and POF (8.3% vs. 19.3%) was significantly decreased (p < .05). There was no significant difference in the efficiency of lipid-lowering, complications, and POF between LMWH + bezafibrate group and insulin group (p > .05). CONCLUSION The severity of HTG-AP is not associated with the triglyceride levels at admission. However, rapid reduction of triglyceride levels can lower the incidence of local complications and respiratory failure. Compared with conservative treatment, insulin and LMWH + bezafibrate can both reduce the incidence of IPN in patients with HTG-AP.
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Affiliation(s)
- Yang Liu
- Department of Gastroenterology, Civil Aviation General Hospital, School of Civil Aviation Clinical Medicine, Peking University, Beijing, China
| | - Jian-Ping Cheng
- Department of Gastroenterology, Civil Aviation General Hospital, School of Civil Aviation Clinical Medicine, Peking University, Beijing, China
| | - Xiao-Lin Zhao
- Department of Gastroenterology, Civil Aviation General Hospital, School of Civil Aviation Clinical Medicine, Peking University, Beijing, China
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Zhang HF, Su ZX, Feng YH, Li SJ, Xie BY. Chaiqin Chengqi Decoction as an adjuvant treatment for mild/moderately severe hypertriglyceridemic acute pancreatitis: A retrospective study. World J Clin Cases 2024; 12:1918-1928. [PMID: 38660541 PMCID: PMC11036510 DOI: 10.12998/wjcc.v12.i11.1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/06/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Hypertriglyceridemia is the third leading cause of acute pancreatitis (AP), and its incidence is increasing. Due to its relatively insidious etiology, it is easy to be ignored in the early stages. In China, Chaiqin Chengqi Decoction (CQCQD) has long been employed for treating AP. AIM To evaluate the effectiveness of CQCQD in patients diagnosed with mild/ moderately severe hypertriglyceridemic AP (HTG-AP). METHODS In this study, the clinical data of 39 patients with HTG-AP admitted from January 2019 to November 2022 were collected. The changes of blood lipids, gastrointestinal symptoms, and abdominal pain before and after treatment were analyzed and compared between the two groups. RESULTS Twenty patients were treated with the conventional HTG-AP regimen, and 19 patients were additionally treated with CQCQD. After receiving treatment, the triglycerides (TG) level of the CQCQD group was lower than that of the CQCQD group (3.14 ± 0.25 mmol/L vs 4.96 ± 0.47 mmol/L, P < 0.01). After 3 d of treatment, the patients in the CQCQD group had more bowel movements than the control group (2.51 ± 0.25 times vs 1.00 ± 0.17 times, P = 0.01). The gastrointestinal function of most patients returned to normal, and the acute gastrointestinal injury score was significantly lower than that of the control group (0.11 ± 0.07 vs 0.42 ± 0.11, P < 0.01). CONCLUSION In patients with HTG-AP, CQCQD can significantly reduce the TG level, shorten the recovery time of defecation, significantly improve the gastrointestinal function.
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Affiliation(s)
- Hai-Fu Zhang
- Department of Internal Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, Zhejiang Province, China
| | - Ze-Xuan Su
- Department of Internal Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, Zhejiang Province, China
| | - Yong-Hang Feng
- Department of Internal Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, Zhejiang Province, China
| | - Shuo-Jun Li
- Department of Internal Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, Zhejiang Province, China
| | - Bi-Yun Xie
- Department of Internal Medicine, The First People's Hospital of Fuyang, Hangzhou 311400, Zhejiang Province, China
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Wang L, Ren Y, Xu T, Geng J, Yang N, Wang R. Triglycerides: A Sensitizer but Not a Trigger for Hypertriglyceridemic Acute Pancreatitis. Dig Dis Sci 2024:10.1007/s10620-024-08412-x. [PMID: 38609542 DOI: 10.1007/s10620-024-08412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) is increasing. Although the guideline defines the diagnostic criteria as triglyceride (TG) greater than 11.3 mmol/L, there is actually no specific threshold. Many people with hypertriglyceridemia (HTG) or obvious chyloid blood do not develop acute pancreatitis (AP). AIMS To explore the role of HTG in the pathogenesis of AP. METHODS Thirty-six male SD rats were randomly assigned into normal control, AP, HTG, HTG-AP, low-dose fenofibrate and high-dose fenofibrate groups. Serum indices and cytokine levels in serum, and pathological changes in pancreatic tissues were observed. The expression levels of TLR4 and NF-κBp65 in pancreatic tissues were detected by immunohistochemistry and Western blot. RESULTS In normal rats, HTG alone did not induce AP. However, after establishing the HTG-AP model with Poloxam 407 and L-arginine, serum-free fatty acid and TG levels were positively correlated with the levels of lipase, amylase, IL-1β, IL-6, pancreatic inflammation scores, and the expressions of TLR4 and NF-κBp65 (all P < 0.001). Expressions of TLR4 and NF-κBp65 were significantly increased in the pancreatic tissues of HTG-AP rats. Fenofibrate effectively decreased TG levels in HTG-AP rats and reduced the expression of TLR4 and NF-κBp65 (all P < 0.001). CONCLUSIONS HTG does not directly cause AP, but rather increases the susceptibility to AP or aggravates the inflammatory response. It is more like a sensitizer of inflammation rather than an activator.
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Affiliation(s)
- Lu Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu, P. R. China
| | - Yutang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, P. R. China
| | - Ting Xu
- Department of Gastroenterology, Daqing Oilfield Central Hospital, No. 9 Zhongkang Road, Daqing, 163000, Heilongjiang, P. R. China
| | - Jinting Geng
- Gastrointestinal Interal Medicine and Digestive Endoscopy Center, Second Affiliated Hospital, Jilin University, No. 4026 Yatai Street, Changchun, 130000, Jilin, P. R. China
| | - Ning Yang
- Department of Gastroenterology, Heilongjiang Provincial Hospital, 82 Zhongshan Road, Harbin, 150000, Heilongjiang, P. R. China
| | - Ruifeng Wang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, P. R. China.
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Tu X, Liu Q, Chen L, Li J, Yu X, Jiao X, Wang N, Hu L, Yuan Y, Gong W, Ding Y, Shi X, Xiao W, Lu G. Number of recurrences is significantly associated with the post-acute pancreatitis diabetes mellitus in a population with hypertriglyceridemic acute pancreatitis. Lipids Health Dis 2023; 22:82. [PMID: 37386421 DOI: 10.1186/s12944-023-01840-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Twenty-three percent of patients are diagnosed with diabetes mellitus after the first episode of acute pancreatitis. The incidence of post-acute pancreatitis diabetes mellitus is significantly higher than that of type 1 diabetes mellitus. Some studies have concluded that the all-cause mortality and worse prognosis of diabetes after pancreatitis are higher. We predicted that number of recurrences of pancreatitis would be significantly associated with the incidences of metabolic syndrome, abdominal obesity, and post-acute pancreatitis diabetes mellitus. METHODS Patients admitted to our hospital for hypertriglyceridemic acute pancreatitis from 2013-2021 were selected for a cross-sectional study. Statistical analysis methods were used to analyze the effect of recurrences on the long-term prognosis of patients with hypertriglyceridemic acute pancreatitis. RESULTS In this study, 101 patients with hypertriglyceridemic acute pancreatitis were included: 60 (59.41%) in the recurrent acute pancreatitis group and 41 (40.59%) in the only one episode of acute pancreatitis group. Among all hypertriglyceridemic acute pancreatitis patients, approximately 61.4% were diagnosed with abdominal obesity, 33.7% of patients are diagnosed with metabolic syndrome, 34.7% of patients are diagnosed with diabetes mellitus, and 21.8% of patients are diagnosed with post-acute pancreatitis diabetes mellitus. Recurrent acute pancreatitis were independent risk factors for post-acute pancreatitis diabetes mellitus in patients with hypertriglyceridemic acute pancreatitis (odds ratio [OR] = 3.964, 95% confidence interval [CI] = 1.230-12.774) and the risk of post-acute pancreatitis diabetes mellitus in patients with three or more recurrent episodes was 6.607 times higher than that in patients without recurrent episodes (OR = 6.607, 95% CI = 1.412-30.916). CONCLUSIONS Recurrence is an independent risk factor for the development of post-acute pancreatitis diabetes mellitus and is significantly associated with the number of recurrences.
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Affiliation(s)
- Xiamin Tu
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Qingxie Liu
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Lin Chen
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Jie Li
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Xiaoping Yu
- Health Management Centre, Yangzhou University Affiliated Hospital, Yangzhou, 225000, Jiangsu, China
| | - Xiuping Jiao
- Health Management Centre, Yangzhou University Affiliated Hospital, Yangzhou, 225000, Jiangsu, China
| | - Ningzhi Wang
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Lianghao Hu
- Department of Gastroenterology, Changhai Hospital of the Second Military Medical University, Shanghai, 200433, China
| | - Yuan Yuan
- Department of Nursing, Yangzhou University Affiliated Hospital, Yangzhou, 225000, Jiangsu, China
| | - Weijuan Gong
- College of Medicine, Yangzhou University, Yangzhou, 225000, Jiangsu, China
| | - Yanbing Ding
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China
| | - Xiaolei Shi
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China.
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China.
| | - Weiming Xiao
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China.
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China.
| | - Guotao Lu
- Pancreatic Center of Gastroenterology, Affiliated Hospital of Yangzhou University, No.368, Hanjiang Middle Road, Yangzhou, 225100, Jiangsu Province, China.
- Yangzhou Key Laboratory of Pancreas in Jiangsu Province, Yangzhou, 225000, Jiangsu, China.
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Yang QY, Zhao Q, Hu JW. Incidence and clinical treatment of hypertriglyceridemic acute pancreatitis: A few issues. World J Clin Cases 2023; 11:479-481. [PMID: 36686359 PMCID: PMC9850974 DOI: 10.12998/wjcc.v11.i2.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Hypertriglyceridemia is a well-recognized etiology of acute pancreatitis, and the incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased in frequency worldwide in response to lifestyle changes. It is crucial to identify hypertriglyceridemia as the cause of pancreatitis and initiate appropriate treatment. Insulin treatment produces effective lowering of triglycerides, but in our opinion, non-diabetic patients with HTG-AP require separate consideration to avoid hypoglycemia.
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Affiliation(s)
- Qun-Ying Yang
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Qian Zhao
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Jian-Wen Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
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Gubensek J. Insulin therapy in hypertriglyceridemia-associated acute pancreatitis - Some considerations. Pancreatology 2022; 22:1061-1062. [PMID: 36369232 DOI: 10.1016/j.pan.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jakob Gubensek
- Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Lin XY, Zeng Y, Zhang ZC, Lin ZH, Chen LC, Ye ZS. Incidence and clinical characteristics of hypertriglyceridemic acute pancreatitis: A retrospective single-center study. World J Gastroenterol 2022; 28:3946-3959. [PMID: 36157550 PMCID: PMC9367230 DOI: 10.3748/wjg.v28.i29.3946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) has increased yearly, but updated population-based estimates on the incidence of HTG-AP are lacking. Reducing serum triglyceride (TG) levels quickly is crucial in the early treatment of HTG-AP. Decreased serum TG levels are treated by non-invasive methods, which include anti-lipidemic agents, heparin, low-molecular weight heparin, and insulin, and invasive methods, such as blood purification including hemoperfusion (HP), plasmapheresis, and continuous renal replacement therapy. However, authoritative guidelines have not been established. Early selection of appropriate treatment is important and beneficial in controlling the development of HTG-AP.
AIM To evaluate the effect between patients treated with intravenous insulin (INS) and HP to guide clinical treatment.
METHODS We retrospectively reviewed 371 patients with HTG-AP enrolled in the Department of Fujian Provincial Hospital form April 2012 to March 2021. The inpatient medical and radiologic records were reviewed to determine clinical features, severity, complications, mortality, recurrence rate, and treatment. Multivariate logistic regression analyses were used to analyze risk factors for severe HTG-AP. Propensity score matching was used to compare the clinical outcomes of INS and HP.
RESULTS A total of 371 patients met the HTG-AP criteria. The incidence of HTG-AP was increased by approximately 2.6 times during the 10 years (8.4% in April 2012-March 2013 and 22.3% in April 2020-March 2021). The highest incidence rate of acute pancreatitis was observed for men in the age group of 30-39 years. The amylase level was elevated in 80.1% of patients but was only three times the normal value in 46.9% of patients. The frequency of severe acute pancreatitis (26.9%), organ failure (31.5%), rate of recurrence (32.9%), and mortality (3.0%) of HTG-AP was high. Improved Marshall score, modified computed tomography severity index score, baseline TG, baseline amylase, C-reactive protein (CRP), albumin, aspartate aminotransferase, low-density lipoprotein cholesterol, urea nitrogen, creatinine, calcium, hemoglobin, free triiodothyronine, admission to intensive care unit, and mortality were significantly different between patients with different grades of severity (P < 0.050). Multivariate logistic regression analysis confirmed that high CRP [P = 0.005, odds ratio (OR) = 1.011, 95%CI: 1.003-1.019], low calcium (P = 0.003, OR = 0.016, 95%CI: 0.001-0.239), and low albumin (P = 0.023, OR = 0.821, 95%CI: 0.693-0.973) were risk factors of severe HTG-AP. After propensity score matching adjusted by sex, age, severity of HTG-AP, and baseline TG, the serum TG significantly decreased in patients treated with INS (P < 0.000) and HP (P < 0.000) within 48 h. However, the clearance rate of TG (57.24 ± 33.70% vs 56.38 ± 33.61%, P = 0.927) and length of stay (13.04 ± 7.92 d vs 12.35 ± 6.40 d, P = 0.730) did not differ between the two groups.
CONCLUSION The incidence of HTG-AP exhibited a significant increase, remarkable severity, and recurrent trend. Patients with mild and moderately severe acute pancreatitis can be treated effectively with INS safely and effectively without HP.
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Affiliation(s)
- Xue-Yan Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Yi Zeng
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zheng-Chao Zhang
- Department of Emergency Surgery, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Zhi-Hui Lin
- Department of Gastroenterology, Fujian Provincial Hospital, Fujian Medical University Provincial of Clinical Medicine, Fuzhou 350001, Fujian Province, China
| | - Lu-Chuan Chen
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zai-Sheng Ye
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China
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Abstract
At present, the incidence of hypertriglyceridemic acute pancreatitis (HTG-AP) is on the rise, the age of onset tends to be younger, and severe HTG-AP is more common. HTG has become the second major cause of acute pancreatitis (AP) in China. Previous studies have demonstrated that the severity of hypertriglyceridemia correlates with the severity of AP. However, the pathogeneses of HTG and HTG-AP are still unknown. The treatments for HTG-AP include low-calorie diet, insulin, heparin, lipid-lowering drugs, and blood purification. Although these treatments, especially blood purification measures represented by plasma exchange, have been proven to reduce blood lipid levels, they still need to be confirmed by high-quality randomized controlled trials to improve the prognosis of HTG-AP. The value of gene diagnosis and therapy in the diagnosis and treatment of HTG-AP has attracted more and more attention, which may be an important direction of HTG-AP research in the future.
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Affiliation(s)
- Yun Sun
- Department of Critical Care Medicine, the Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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