Muhammet Yener AKPINAR, Erkin ÖZTAŞ, Zeki Mesut Yalın KILIÇ, MUSTAFA KAPLAN, Volkan GÖKBULUT, Ertuğrul KAYAÇETİN

Hipertrigliseridemiye bağlı akut pankreatitli hastalarımız ve plazmaferez deneyimimiz

Giriş ve Amaç: Akut pankreatitin %1-5 nedeni hipertrigliseridemidir. İnsülin infüzyonu, heparin infüzyonu ve plazmaferez hipertrigliseridemiye bağlı Akut pankreatitin tedavisinde yer almaktadır. Biz bu çalışmamızda hipertrigliseridemiye bağlı oluşan Akut pankreatitli hastalarımızın demografik özelliklerini, pankreatitlerinin seyrini, uygulanan tedavi yöntemlerini ve plazmaferezin etkinliğini araştırdık. Gereç ve Yöntem: Türkiye Yüksek İhtisas Hastanesi Gastroenteroloji Kliniği’nde 2012-2016 yılları arasında akut pankreatit tanısı konulan hastalar retrospektif olarak tarandı. İlk başvuruda trigliserid değeri 900 mg/dl ve üzeri olan hastalar, diğer etiyolojik nedenlerin yokluğunda hipertrigliseridemiye bağlı Akut pankreatit olarak kabul edildi. Hastaların medikal bilgilerine hasta dosyaları ve hastane otomasyon bilgi sisteminden ulaşıldı. Bulgular: Toplam 10 hasta (E/K: 4/6, yaş ortalaması 41,4 (26-51) çalışmaya alındı. Hastalarımızda akut pankreatit atak sıklığı 1,4 (1-3) olarak bulundu. Akut pankreatit şiddetini belirlemede BISAP skorlaması kullanıldı. BISAP skoru yüksek olan hastalara plasmaferez uygulandı (4 hasta). Bu hastaların 3 tanesinde psödokist ve walled-off nekroz oluştuğu görüldü. Walled-off nekroz oluşan bir hastaya perkütan drenaj yapıldı. Toplamda hiçbir hastada mortalite izlenmedi. Sonuç: Hipertrigliseridemi, diğer nedenlere kıyasla akut pankreatite nadiren yol açar. Bu hastaların erken tanınması ve uygun tedavisi hastalık ilişkili morbidite ve mortalitenin azalmasına yol açar. Plazmaferez özellikle ciddi seyreden hastalarda etkili bir tedavi yöntemidir.

Anahtar Kelimeler:

Akut pankreatit, hipertrigliseridemi, plazmaferez

Our Experience on Patients with Hypertriglyceridemia-Induced Acute Pancreatitis and Plasmapheresis

Background and Aims: Hypertriglyceridemia is an etiologic cause of acute pancreatitis, with a frequency of 1%-5%. Insulin infusion, heparin infusion, and plasmapheresis can be used for the treatment of acute pancreatitis related to hypertriglyceridemia. The aim of our study was to share our experience with the treatment, clinical course, and demographic features of patients with acute pancreatitis related to hypertriglyceridemia and the effectiveness of plasmapheresis. Material and Methods: Patients with acute pancreatitis diagnosed and treated at Türkiye Yüksek İhtisas Training and Research Hospital during 2014-2016 were screened. Those who had hypertriglyceridemia with levels >900 mg/dl without any potential cause of acute pancreatitis were included in the study as patients with hypertriglyceridemia-induced acute pancreatitis. Medical data were collected from patients’ files and the hospital computer automation system. Results: A total of 10 patients [male/female: 4/6, median age: 41.4 (26-51) years] were included in the study. The frequency of acute pancreatitis was 1.4. The Bedside Index of Severity in Acute Pancreatitis scoring system was used to establish the severity of acute pancreatitis. Patients with a high Bedside Index of Severity in Acute Pancreatitis score were treated with plasmapheresis (n=4). In this group, three patients developed walled off necrosis and pseudocysts. Percutaneous drainage was applied in one patient with walled off necrosis. No mortality was observed in our patients. Conclusion: Hypertriglyceridemia is a rare cause of acute pancreatitis. Early diagnosis and appropriate treatment are important in this group for decreasing the disease-related morbidity and mortality. Plasmapheresis is an effective treatment modality, especially in patients with severe hypertriglyceridemia-induced acute pancreatitis.

Keywords:

Acute pancreatitis, hypertriglyceridemia, plasmapheresis,

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