抗高甘油三酯血症中药的研究进展

随着经济的迅猛发展和人们生活水平的日益提高,高脂血症已经成为不容忽视的问题,其中高甘油三酯血症也是动脉粥样硬化的重要影响因素。目前临床降胆固醇的药物很多,降甘油三酯的药物相对较少;并且降甘油三酯的药物以贝特类和烟酸类药物居多,而中成药较少,文章综述了近年来国内外学者在中草药抗高甘油三酯血症方面的研究进展及相关的作用机制,分析了从天然产物中寻找和发现有价值的药效成份的应用前景,为抗高甘油三酯血症药物的研究与开发提供参考。

Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis

AIM： To investigate the effect of admission hypertriglyceridemia （HTG） on the episodes of severe acute pancreatitis （SAP）. METHODS： One hundred and seventy-six patients with SAP were divided into HTG group （n = 45） and control group （n = 131） according to admission triglyceride （TG） ≥ 5.65 mmol/L and 〈 5.65 retool/L, respectively. Demographics, etiology, underlying diseases, biochemical parameters, Ranson＇ s score, acute physiology and chronic heath evaluation Ⅱ （APACHE Ⅱ） score, Balthazar＇s computed tomography （CT） score, complications and mortality were compared. Correlation between admission TG and 24-h APACHE Ⅱ score was analyzed. RESULTS： SAP patients with HTG were younger （40.8 ± 9.3 years vs 52.6 ± 13.4 years, P 〈 0.05） with higher etiology rate of overeating, high-fat diet （40.0% vs 14.5%, P 〈 0.05） and alcohol abuse （46.7% vs 23.7%, P 〈 0.01）, incidence rate of hypocalcemia （86.7% vs 63.4%, P 〈 0.01） and hypoalbuminemia （84.4% vs 60.3%, P 〈 0.01）, 24-h APACHE Ⅱ score （13.6 ± 5.7 vs 10.7 ± 4.6, P 〈 0.01） and admission serum glucose （17.7 ± 7.7 vs 13.4 ± 6.1, P 〈 0.01）, complication rate of renal failure （51.1% vs 16.8%, P 〈 0.01）, shock （37.9% vs 14.5%, P 〈 0.01） and infection （37.4% vs 18.3%, P 〈 0.01） and mortality （13.1% vs 9.1%, P 〈 0.01）. Logistic regression analysis showed a positive correlation between admission TG and 24-h APACHE Ⅱ score （r = 0.509, P = 0.004）.CONCLUSION： The clinical features of SAP patients with HTG are largely consistent with previous studies, HTG aggravates the episodes of SAP.

Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type Ⅴ hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels.The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis.Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist,exhibiting a relief of abdominal symptoms.As in the present cases with acute abdomen following the ingestion of fatty food,the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen,when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.

Gender and metabolic differences of gallstone diseases

AIM： To investigate the risk factors for gallstone disease in the general population of Chengdu, China. METHODS： This study was conducted at the West China Hospital. Subjects who received a physical examination at this hospital between January and December 2007 were included. Body mass index, blood pressure, fasting plasma glucose, serum lipid and lipoproteins concentrations were analyzed. Gallstone disease was diagnosed by ultrasound or on the basis of a history of cholecystectomy because of gallstone disease. Unconditional logistic regression analysis was used to investigate the risk factors for gallstone disease, and the Chi-square test was used to analyze differences in the incidence of metabolic disorders between subjects with and without gallstone disease. RESULTS： A total of 3573 people were included, 10.7% （384/3573） of whom had gallstone diseases. Multiple logistic regression analysis indicated that the incidence of gallstone disease in subjects aged 40-64 or ≥65 years was significantly different from that in those aged 18-39 years （P 〈 0.05）; the incidence was higher in women than in men （P 〈 0.05）. In men,a high level of fasting plasma glucose was obvious in gallstone disease （P 〈 0.05）, and in women, hypertriglyceridemia or obesity were significant in gallstone disease （P 〈 0.05）. CONCLUSION： We assume that age and sex are profoundly associated with the incidence of gallstone disease; the metabolic risk factors for gallstone disease were different between men and women.

Hypertriglyceridemia is positively correlated with the development of colorectal tubular adenoma in Japanese men

AIM： To determine the real association between serum lipid levels and colonic polyp formation. METHODS： We performed a large scale retrospective study to analyze the correlation between the incidence of colorectal adenoma or carcinoma and the fasting serum levels of total cholesterol （TC） and triglycerides （TG） in patients who underwent total colonoscopy for screening for colon cancer. RESULTS： Both levels were significantly elevated in patients with adenomas as compared with patients without any neoplastic lesion （TC 207.6 ± 29.5 vs 199.5 ±34.3, n= 4883, p〈 0.001; TG 135.0 ± 82.2 vs 108.7± 71.5, n= 4874, p〈 0.001）. The difference was significant in patients with tubular adenoma but not in those with villous or serrated adenoma. Multiple logistic regression analysis including age and sex revealed that TG was an independent correlation factor in male （p〈0.01）, but not in female patients. The level of TG in patients with invasive carcinoma did not show a significant elevation from that in patients with adenoma. These findings suggest that hypertriglyceridemia is an independent risk factor for colonic adenoma in men. CONCLUSION： Although a high level of serum triglyceride does not appear to be mechanically involved in the development of carcinoma, reduction of serum TG and intensive surveillance with total colonoscopy may have benefit in men with hypertriglyceridemia.

Insulin and heparin in treatment of hypertriglyceridemia-induced pancreatitis

TO THE EDITOR We read with great interest the case report, “Hypertriglyceridernia -induced pancreatitis： A case-based review” by Gan eta]11 in the November 2006 issue of World Journal of Gastroenterology. We agree that in acute setting, pancreatitis due to hyper- triglyceridemia （HTG） should be ruled out as it is a treat-able and preventable condition. It needs to be treated conservatively along with measures to lower the triglyceride level. The various modalities to treat hypertriglyceridemia are plasmapheresis, insulin and heparin, purified apo C Ⅱ, and fibric acid derivatives^[2-5]. Plasmapheresis and purified apo C Ⅱ infusion are not easily available. There is limited literature about the efficacy of intravenous insulin and heparin, both of which can enhance lipoprotein lipase activity.

Major influence of renal function on hyperlipidemia after living donor liver transplantation

AIM:To investigate the impact of renal and graft function on post-transplant hyperlipidemia(PTHL) in living donor liver transplantation(LDLT).METHODS:A total of 115 adult patients undergoing LDLT from January 2007 to May 2009 at a single center were enrolled.Data were collected and analyzed by the China Liver Transplant Registry retrospectively.PTHL was defined as serum triglycerides ≥ 150 mg/dL or serum cholesterol ≥ 200 mg/dL or the need for pharmacologic treatment at the sixth month after LDLT.Early renal dysfunction(ERD) was defined as serum creatinine ≥ 2 mg/dL and/or the need for renal replacement therapy in the first post-transplant week.RESULTS:In 115 eligible patients,the incidence of PTHL was 24.3%.Recipients with PTHL showed a higher incidence of post-transplant cardiovascular events compared to those without PTHL(17.9% vs 4.6%,P = 0.037).Serum creatinine showed significant positive correlations with total serum triglycerides,both at posttransplant month 1 and 3(P < 0.01).Patients with ERD had much higher pre-transplant serum creatinine levels(P < 0.001) and longer duration of pre-transplant renal insufficiency(P < 0.001) than those without ERD.Pretransplant serum creatinine,graft-to-recipient weight ratio,graft volume/standard liver volume ratio,body mass index(BMI) and ERD were identified as risk factors for PTHL by univariate analysis.Furthermore,ERD [odds ratio(OR) = 9.593,P < 0.001] and BMI(OR = 6.358,P = 0.002) were identified as independent risk factors for PTHL by multivariate analysis.CONCLUSION:Renal function is closely associated with the development of PTHL in LDLT.Post-transplant renal dysfunction,which mainly results from pre-transplant renal insufficiency,contributes to PTHL.

Octreotide in Hennekam syndrome-associated intestinal lymphangiectasia

A number of disorders have been described to cause protein losing enteropathy (PLE) in children. Primary intestinal lymphangiectasia (PIL) is one mechanism leading to PLE. Few syndromes are associated with PIL; Hennekam syndrome (HS) is one of them. The principal treatment for PIL is a high protein, low fat diet with medium chain triglycerides supplementation. Supportive therapy includes albumin infusion. Few publications have supported the use of octreotide to diminish protein loss and minimize hypoalbuminemia seen in PIL. There are no publications on the treatment of PIL with octreotide in patients with HS. We report two children with HS and PLE in which we used octreotide to decrease intestinal protein loss. In one patient, octreotide increased serum albumin to an acceptable level without further need for albumin infusions. The other patient responded more dramatically with near normal serum albumin levels and cessation of albumin infusions. In achieving a good response to octreotide in both patients, we add to the publications supporting the use of octreotide in PIL and suggest that octreotide should be tried in patients with PIL secondary to HS. To the best of our knowledge, this is the first case report on the use of octreotide in HS-associated PIL.

EFFECT OF ACUPUNCTURE TREATMENT ON CELLULAR HEMORHEOLOGY, CHOLESTEROL AND TRIGLYCERIDE OF SIMPLE OBESITY PATIENTS

Objective: To observe the effect of acupuncture on simple obesity and cellular hemorheology. Methods: Thirty-two cases of simple obesity patients were enrolled into this study. Acupoints of the Stomach Meridian and Spleen Meridian as Zhongwan (中脘 CV 12), Liangmen (梁门 ST 21), Tianshu (天枢 ST 25), Guayuan (关元 CV 4), etc. were punctured, once daily in the first 5 days, and once every other day afterwards, with 10 sessions being a therapeutic course. Before treatment and after 3 courses of treatment, the body weight, waistline, weight index, seam cholesterol (CH), triglyceride and aggregation index of red blood cell (RBC) were detected. Results: After acupuncture treatment, all the indexes of body weight, waistline, weight index, serum CH, triglyceride and aggregation index of RBC decreased significantly in comparison with those of pre-treatment(P< 0.05). Conclusion: Acupuncture can apparently improve cellular hemorheology, reduce body weight, serum cholesterol and TG levels in simple obesity patients.

胰腺衍生因子与非酒精性脂肪性肝病

非酒精性脂肪性肝病（NAFLD）是一种与全身糖脂代谢紊乱、心脑血管疾病、肝脏纤维化进展甚至肝脏肿瘤发生和发展密切相关的系统性疾病.在其发病过程中，糖脂代谢产物、细胞的氧化应激、非感染性免疫反应以及细胞的质膜系统稳态失衡起到重要作用。现有的假说在理解肝脏发生脂肪变之后的损伤过程方面已经有了比较深入的认识，

机关干部中脂肪肝及其相关致病因素的探讨

为探讨当前机关干部中的脂肪肝及其相关致病因素,我们分析了1997年1319名健康检查者的资料;脂肪肝的诊断由B型超声波检查仪作出:共检出脂肪肝229例(17.4%),其相关致病因素依次如下:高甘油三酯血症(80.3%)、慢性酗酒(19.2%)、肥胖症(12.2%)、糖尿病(7.9%),脂肪肝组与非脂肪肝组血清甘油三酯(TG)水平分别为2.32±1.1和1.70±0.8(P<0.01).而血糖为4.84=0.85和4.56±0.62(P<0.05).与3年前同一受检人群相比,脂肪肝的发生率增长了3%.脂肪肝现已成为常见的疾病,且有随着年龄而增加的趋势,其最相关的致病因素为高甘油三酯血症.