Profesional

ORIGINAL ARTICLE

Acute Pancreatitis in a Cohort of 129 Patients Referred
for Severe Hypertriglyceridemia
Celia Lloret Linares, MD,* Anne Laure Pelletier, MD,Þ Sebastien Czernichow, MD, PhD,þ§
´
´
Anne Claire Vergnaud, PhD,þ Dominique Bonnefont-Rousselot, PharmD, PhD,||
Philippe Levy, MD, PhD,Þ Philippe Ruszniewski, MD, PhD,Þ and Eric Bruckert, MD, PhD¶
Objectives: The aim of this studywas to assess retrospectively the
prevalence and the predictive factors of acute pancreatitis (AP) in a
population of patients referred in our endocrinology department for
evaluation of very high triglyceride (TG) levels.
Methods: One hundred twenty-nine patients (119 with type IV
phenotypes and 10 with type V phenotypes according to Fredrickson_s
classification) were referred to our hospitalbetween 2000 and 2005.
Results: Twenty-six subjects (20.2% of the population) presented
with AP. This population was significantly younger at diagnosis of
hyperlipidemia (32 vs 40 years, P G 0.001) and at age of investigation
(43 vs 48 years, P = 0.05) and had maximum TG levels greater
than the population without AP (44.7 vs 24.5, P G 0.001). Subjects
of the third tertile of TG levels had a4.0-fold increased risk (95%
confidence interval, 1.3Y12.3) of AP compared with the first tertile.
Severe pancreatitis (need for intensive care, C-reactive protein 9150
mg/L, or Balthazar score 9C) was observed in 71.5% of the patients.
Conclusions: Twenty percent of patients with severe hypertriglyceridemia experience at least 1 attack of AP. Pancreatitis seems to
occur in young patients athigher levels of TG than previously
thought (85% of patients 930 g/L) and is associated with a severe
clinical course.
Key Words: acute pancreatitis, type IV hypertriglyceridemia,
lipoprotein lipase activity, nutrition
(Pancreas 2008;37:13Y18)

H

ypertriglyceridemia (HTG) is a common metabolic
disorder primarily due to an increase of circulating very
low-density lipoprotein (VLDL)particles (type IV hyperlipidemia). Lipids are packaged in spherical lipoprotein particles
(a complex macromolecular structure with an envelope of
phospholipids and free cholesterol and a core of triglyceride
[TG] and cholesteryl esters), which vary in origin, size, and
content. Fatty acids from alimentation are assembled into
chylomicrons inside the intestinal cell and secreted in the portalReceived for publication May 11, 2007; accepted October 29, 2007.
From the *Nutrition, Pitie Salpetriere Hospital (AP-HP), Paris; †Hepatogastro´
ˆ`
enterology, Beaujon Hospital (AP-HP), Clichy; ‡INSERM, U557, CRNH
IdF, Bobigny; §Public Health Department, Avicenne Hospital (AP-HP),
Bobigny; and ||Lipid Biochemistry Laboratory and ¶Endocrinology, Pitie
Salpetriere Hospital (AP-HP), Paris,France.
ˆ`
Reprints: Celia Lloret Linares, MD, Department of Nutrition, Pitie Salpetriere
´
´
ˆ`
Hospital (AP-HP), Paris, France (e-mail: celialloret@yahoo.fr).
Copyright * 2008 by Lippincott Williams & Wilkins

Pancreas

circulation. Very low-density lipoproteins are smaller than
chylomicrons and contain TGs synthesized by the hepatocytes
which are influenced by environmental factors:excessive
alcohol intake, high proportion of refined carbohydrates, and
obesity. Chylomicrons and VLDL particles undergo the same
catabolic pathway through lipoprotein lipase (LPL), which
hydrolyzes TGs on the luminal side of endothelial, muscle, and
adipose cells. The VLDL remnant lipoprotein (intermediatedensity lipoprotein) is further delipidated by hepatic lipase
(HL) to form low-densitylipoprotein particles.
Hyperchylomicronemia (type I phenotype according to
Fredrickson_s classification) is a rare disorder caused by a
reduced or absent LPL activity. Type IV phenotype is the most
common cause of HTG. Its prevalence in the general
population is 4% to 37%.1,2 This disorder is heterogeneous
and results from several genes with an environmental
influence. The pathogenesis of type V...