Progress in the treatment of hyperlipidemia acute pancreatitis_West China Medical Journal

Authors：

PAN Xiaoyan ^1,2 ,  DAI Xiaoyu ¹ , SHI Zhuohua ³ , REN Kaiyan ⁴

1. Department of Nephrology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;
2. School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan 610500, P. R. China;
3. School of Clinical Medicine, Guangxi Medical University, Nanning, Guangxi 530000, P. R. China;
4. Department of Nephrology, Beichuan Qiang Autonomous County People’s Hospital, Beichuan, Sichuan 622750, P. R. China;

Corresponding author：

DAI Xiaoyu, Email: daixy001@163.com

Keywords：

Hyperlipidemia acute pancreatitis; plasma exchange; acute pancreatitis; treatment

DOI：

10.7507/1002-0179.202106046

Video：

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In recent years, the incidence of hyperlipidemia acute pancreatitis (HLAP) has been increasing year by year, but its pathogenesis has not been completely clear. There are many clinical treatment methods for HLAP, such as lipid-lowering drugs, low molecular weight heparin, insulin, and plasma exchange. Actively reducing serum triglyceride is the core of treatment. Plasma exchange can quickly and effectively reduce the level of triglyceride, and its application in the treatment of HLAP is gradually increasing. This article reviews the recent advances in the pathogenesis, clinical characteristics, diagnosis, and treatment of HLAP, focusing on the mechanism, indications, timing, and disadvantages of plasma exchange therapy for HLAP.

Citation： PAN Xiaoyan, DAI Xiaoyu, SHI Zhuohua, REN Kaiyan. Progress in the treatment of hyperlipidemia acute pancreatitis. West China Medical Journal, 2022, 37(1): 120-124. doi: 10.7507/1002-0179.202106046 Copy

1.	Garber A, Frakes C, Arora Z, et al. Mechanisms and management of acute pancreatitis. Gastroenterol Res Pract, 2018, 2018: 6218798.
2.	van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
3.	Lu J, Xie Y, Du J, et al. Penta-therapy for severe acute hyperlipidemic pancreatitis. Am J Emerg Med, 2018, 36(10): 1789-1795.
4.	Ge P, Luo Y, Okoye CS, et al. Intestinal barrier damage, systemic inflammatory response syndrome, and acute lung injury: a troublesome trio for acute pancreatitis. Biomed Pharmacother, 2020, 132: 110770.
5.	Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
6.	高甘油三酯血症性急性胰腺炎诊治急诊共识专家组. 高甘油三酯血症性急性胰腺炎诊治急诊专家共识. 中华急诊医学杂志, 2021, 30(8): 937-947.
7.	Zheng CB, Zheng ZH, Zheng YP. Therapeutic plasma exchange for hyperlipidemic pancreatitis: current evidence and unmet needs. World J Clin Cases, 2021, 9(21): 5794-5803.
8.	Uyar S, Harmandar F, Kok M, et al. Management of hypertriglyceridemia induced acute pancreatitis and therapeutic plasmapheresis: report of nine cases and review of literature. Acta Gastroenterol Belg, 2017, 80(1): 71-74.
9.	Hofbauer B, Friess H, Weber A, et al. Hyperlipaemia intensifies the course of acute oedematous and acute necrotising pancreatitis in the rat. Gut, 1996, 38(5): 753-758.
10.	马江辰, 保志军. 高脂血症性急性胰腺炎发病机制的研究进展. 国际消化病杂志, 2017, 37(1): 24-27.
11.	Pothoulakis I, Paragomi P, Archibugi L, et al. Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium). Pancreatology, 2020, 20(3): 325-330.
12.	Inoue NT, Hanafusa T, Hirohata A, et al. Eruptive xanthoma with acute pancreatitis in a patient with hypertriglyceridemia and diabetes. Ann Dermatol, 2016, 28(1): 136.
13.	Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol, 1995, 90(12): 2134-2139.
14.	Vipperla K, Somerville C, Furlan A, et al. Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis. J Clin Gastroenterol, 2017, 51(1): 77-85.
15.	Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med, 2016, 375(20): 1972-1981.
16.	Garg R, Rustagi T. Management of hypertriglyceridemia induced acute pancreatitis. Biomed Res Int, 2018, 2018: 4721357.
17.	Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
18.	杜奕奇, 陈其奎, 李宏宇, 等. 中国急性胰腺炎诊治指南(2019 年, 沈阳). 临床肝胆病杂志, 2019, 35(12): 2706-2711.
19.	Adiamah A, Psaltis E, Crook M, et al. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr, 2018, 37(6 Pt A): 1810-1822.
20.	杨立新, 杜丽川, 刘欣, 等. 四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用. 中华内科杂志, 2016, 55(9): 695-699.
21.	Jin M, Peng JM, Zhu HD, et al. Continuous intravenous infusion of insulin and heparin vs plasma exchange in hypertriglyceridemia-induced acute pancreatitis. J Dig Dis, 2018, 19(12): 766-772.
22.	Jain P, Rai RR, Udawat H, et al. Insulin and heparin in treatment of hypertriglyceridemia-induced pancreatitis. World J Gastroenterol, 2007, 13(18): 2642-2643.
23.	Jain D, Zimmerschied J. Heparin and insulin for hypertriglyceridemia-induced pancreatitis: case report. Sci World J, 2009, 9: 1230-1232.
24.	韩叶叶. 高脂血症急性胰腺炎血液净化治疗的探究. 大连: 大连医科大学, 2018.
25.	Yu S, Yao D, Liang X, et al. Effects of different triglyceride-lowering therapies in patients with hypertriglyceridemia-induced acute pancreatitis. Exp Ther Med, 2020, 19(4): 2427-2432.
26.	Biberci KE, Koçhan K, Köker İH, et al. The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis. Eur J Gastroenterol Hepatol, 2019, 31(6): 674-677.
27.	Betteridge DJ, Bakowski M, Taylor KG, et al. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange. Lancet, 1978, 1(8078): 1368.
28.	Click B, Ketchum AM, Turner R, et al. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: a systematic review. Pancreatology, 2015, 15(4): 313-320.
29.	Ruiz-Rodríguez JC, Chiscano-Camón LS, Palmada C, et al. Plasmapheresis for the treatment of acute pancreatitis due to severe hypertriglyceridemia. Blood Purif, 2021, 50(4/5): 572-574.
30.	Joury A, Alshehri M, Mahendra A, et al. Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: a literature review of available therapies and case series. J Clin Apher, 2020, 35(2): 131-137.
31.	Mao E. Intensive management of severe acute pancreatitis. Ann Transl Med, 2019, 7(22): 687.
32.	张琪月, 朱如萍, 唐国都, 等. 血液净化治疗高脂血症性胰腺炎的研究进展. 国际消化病杂志, 2020, 40(2): 109-112, 118.
33.	Kyriakidis AV, Raitsiou B, Sakagianni A, et al. Management of acute severe hyperlipidemic pancreatitis. Digestion, 2006, 73(4): 259-264.
34.	Gubensek J, Buturovic-Ponikvar J, Romozi K, et al. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One, 2014, 9(7): e102748.
35.	Dehal H, Adashek M. Total plasma exchange in hypertriglyceridemia-induced pancreatitis: case report and literature review. Case Rep Med, 2018, 2018: 4017573.
36.	Miyamoto K, Horibe M, Sanui M, et al. Plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis. Intensive Care Med, 2017, 43(6): 949-951.
37.	He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: a prospective randomized controlled trial. J Clin Gastroenterol, 2016, 50(9): 772-778.
38.	Winters JL, American Society for Apheresis. American Society for Apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner. J Clin Apher, 2014, 29(4): 191-193.

1. Garber A, Frakes C, Arora Z, et al. Mechanisms and management of acute pancreatitis. Gastroenterol Res Pract, 2018, 2018: 6218798.
2. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
3. Lu J, Xie Y, Du J, et al. Penta-therapy for severe acute hyperlipidemic pancreatitis. Am J Emerg Med, 2018, 36(10): 1789-1795.
4. Ge P, Luo Y, Okoye CS, et al. Intestinal barrier damage, systemic inflammatory response syndrome, and acute lung injury: a troublesome trio for acute pancreatitis. Biomed Pharmacother, 2020, 132: 110770.
5. Scherer J, Singh VP, Pitchumoni CS, et al. Issues in hypertriglyceridemic pancreatitis: an update. J Clin Gastroenterol, 2014, 48(3): 195-203.
6. 高甘油三酯血症性急性胰腺炎诊治急诊共识专家组. 高甘油三酯血症性急性胰腺炎诊治急诊专家共识. 中华急诊医学杂志, 2021, 30(8): 937-947.
7. Zheng CB, Zheng ZH, Zheng YP. Therapeutic plasma exchange for hyperlipidemic pancreatitis: current evidence and unmet needs. World J Clin Cases, 2021, 9(21): 5794-5803.
8. Uyar S, Harmandar F, Kok M, et al. Management of hypertriglyceridemia induced acute pancreatitis and therapeutic plasmapheresis: report of nine cases and review of literature. Acta Gastroenterol Belg, 2017, 80(1): 71-74.
9. Hofbauer B, Friess H, Weber A, et al. Hyperlipaemia intensifies the course of acute oedematous and acute necrotising pancreatitis in the rat. Gut, 1996, 38(5): 753-758.
10. 马江辰, 保志军. 高脂血症性急性胰腺炎发病机制的研究进展. 国际消化病杂志, 2017, 37(1): 24-27.
11. Pothoulakis I, Paragomi P, Archibugi L, et al. Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international, multicenter, prospective cohort (APPRENTICE consortium). Pancreatology, 2020, 20(3): 325-330.
12. Inoue NT, Hanafusa T, Hirohata A, et al. Eruptive xanthoma with acute pancreatitis in a patient with hypertriglyceridemia and diabetes. Ann Dermatol, 2016, 28(1): 136.
13. Fortson MR, Freedman SN, Webster PD 3rd. Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol, 1995, 90(12): 2134-2139.
14. Vipperla K, Somerville C, Furlan A, et al. Clinical profile and natural course in a large cohort of patients with hypertriglyceridemia and pancreatitis. J Clin Gastroenterol, 2017, 51(1): 77-85.
15. Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med, 2016, 375(20): 1972-1981.
16. Garg R, Rustagi T. Management of hypertriglyceridemia induced acute pancreatitis. Biomed Res Int, 2018, 2018: 4721357.
17. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut, 2013, 62(1): 102-111.
18. 杜奕奇, 陈其奎, 李宏宇, 等. 中国急性胰腺炎诊治指南(2019 年, 沈阳). 临床肝胆病杂志, 2019, 35(12): 2706-2711.
19. Adiamah A, Psaltis E, Crook M, et al. A systematic review of the epidemiology, pathophysiology and current management of hyperlipidaemic pancreatitis. Clin Nutr, 2018, 37(6 Pt A): 1810-1822.
20. 杨立新, 杜丽川, 刘欣, 等. 四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用. 中华内科杂志, 2016, 55(9): 695-699.
21. Jin M, Peng JM, Zhu HD, et al. Continuous intravenous infusion of insulin and heparin vs plasma exchange in hypertriglyceridemia-induced acute pancreatitis. J Dig Dis, 2018, 19(12): 766-772.
22. Jain P, Rai RR, Udawat H, et al. Insulin and heparin in treatment of hypertriglyceridemia-induced pancreatitis. World J Gastroenterol, 2007, 13(18): 2642-2643.
23. Jain D, Zimmerschied J. Heparin and insulin for hypertriglyceridemia-induced pancreatitis: case report. Sci World J, 2009, 9: 1230-1232.
24. 韩叶叶. 高脂血症急性胰腺炎血液净化治疗的探究. 大连: 大连医科大学, 2018.
25. Yu S, Yao D, Liang X, et al. Effects of different triglyceride-lowering therapies in patients with hypertriglyceridemia-induced acute pancreatitis. Exp Ther Med, 2020, 19(4): 2427-2432.
26. Biberci KE, Koçhan K, Köker İH, et al. The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis. Eur J Gastroenterol Hepatol, 2019, 31(6): 674-677.
27. Betteridge DJ, Bakowski M, Taylor KG, et al. Treatment of severe diabetic hypertriglyceridaemia by plasma exchange. Lancet, 1978, 1(8078): 1368.
28. Click B, Ketchum AM, Turner R, et al. The role of apheresis in hypertriglyceridemia-induced acute pancreatitis: a systematic review. Pancreatology, 2015, 15(4): 313-320.
29. Ruiz-Rodríguez JC, Chiscano-Camón LS, Palmada C, et al. Plasmapheresis for the treatment of acute pancreatitis due to severe hypertriglyceridemia. Blood Purif, 2021, 50(4/5): 572-574.
30. Joury A, Alshehri M, Mahendra A, et al. Therapeutic approaches in hypertriglyceridemia-induced acute pancreatitis: a literature review of available therapies and case series. J Clin Apher, 2020, 35(2): 131-137.
31. Mao E. Intensive management of severe acute pancreatitis. Ann Transl Med, 2019, 7(22): 687.
32. 张琪月, 朱如萍, 唐国都, 等. 血液净化治疗高脂血症性胰腺炎的研究进展. 国际消化病杂志, 2020, 40(2): 109-112, 118.
33. Kyriakidis AV, Raitsiou B, Sakagianni A, et al. Management of acute severe hyperlipidemic pancreatitis. Digestion, 2006, 73(4): 259-264.
34. Gubensek J, Buturovic-Ponikvar J, Romozi K, et al. Factors affecting outcome in acute hypertriglyceridemic pancreatitis treated with plasma exchange: an observational cohort study. PLoS One, 2014, 9(7): e102748.
35. Dehal H, Adashek M. Total plasma exchange in hypertriglyceridemia-induced pancreatitis: case report and literature review. Case Rep Med, 2018, 2018: 4017573.
36. Miyamoto K, Horibe M, Sanui M, et al. Plasmapheresis therapy has no triglyceride-lowering effect in patients with hypertriglyceridemic pancreatitis. Intensive Care Med, 2017, 43(6): 949-951.
37. He WH, Yu M, Zhu Y, et al. Emergent triglyceride-lowering therapy with early high-volume hemofiltration against low-molecular-weight heparin combined with insulin in hypertriglyceridemic pancreatitis: a prospective randomized controlled trial. J Clin Gastroenterol, 2016, 50(9): 772-778.
38. Winters JL, American Society for Apheresis. American Society for Apheresis guidelines on the use of apheresis in clinical practice: practical, concise, evidence-based recommendations for the apheresis practitioner. J Clin Apher, 2014, 29(4): 191-193.

West China Medical Journal

Progress in the treatment of hyperlipidemia acute pancreatitis

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