妊娠21週で高トリグリセリド血症による重症急性膵炎を発症し血漿交換療法とLDL（low density lipoprotein）吸着療法を施行した1例(A case of plasma exchange and LDL apheresis during the second trimester in a pregnant woman with hypertriglyceridemia–induced severe acute pancreatitis)

Autor: (Daisuke Yamamoto), 山本 大輔, (Jiro Kamiyama), 神山 治郎, (Keita Saiki), 齋木 啓太, (Shintaro Furuya), 古谷 慎太郎, (Kaoru Ogawa), 小川 薫, (Shigemasa Taguchi), 田口 茂正, (Kazuya Kiyota), 清田 和也
Zdroj: Journal of Japanese Association for Acute Medicine; June 2022, Vol. 33 Issue: 6 p260-265, 6p
Abstrakt: 症例は38歳，妊娠21週の女性。発熱，腹痛を主訴に絨毛膜羊膜炎の診断で入院加療していたが，改善に乏しく，血液検査と造影CTで高トリグリセリド血症（triglyceride: TG，TG値 9,922mg/dL）による急性膵炎と診断した。高TG血症に対して，薬物療法を行ったが奏功せず，血漿交換療法を施行した。その後，呼吸不全と代謝性アシドーシスが進行したため，帝王切開により妊娠を終結させた。経過中，LDL吸着療法を2回施行し，TG値は690mg/dLまで低下した。膵炎の保存的加療を継続し，第29病日に退院した。高TG血症による重症膵炎では，膵炎治療に加えて高TG血症への治療併施が重要だが，TG値に応じて異なる血液浄化療法を選択し，病態改善に寄与したと考えられた。 A 38–year–old woman who was 21–weeks pregnant was hospitalized for chorioamnionitis, but her condition did not improve. Contrast–enhanced CT scan revealed acute pancreatitis, and hypertriglyceridemia (HTG; triglyceride level 9,922mg/dL) was considered the cause. Plasma exchange was performed for HTG, but respiratory failure and metabolic acidosis ensued, and cesarean section was performed. Thereafter, LDL apheresis was performed twice, and the triglyceride level decreased to 690mg/dL. The pancreatitis was treated conservatively thereafter, and the patient was discharged from the hospital on the day 29. When severe pancreatitis is caused by HTG, it is important to combine treatment for HTG with treatment for pancreatitis. The blood purification therapy according to triglyceride levels may have contributed to the improvement in her condition.
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