1例妊娠期高三酰甘油血症降脂治疗并文献分析  

Lipid-Lowering Therapy of A Case of Gestational Hypertriglyceridemia and Literature Analysis

作　　者：沐宇 吴晓[2] 唐莲[2] 周琴[2] 李静静[2] MU Yu;WU Xiao;TANG Lian;ZHOU Qin;LI Jingjing(Xuzhou Maternity and Child Health Hospital,Xuzhou,Jiangsu,China 221000;The Affiliated Suzhou Hospital of Nanjing Medical University·Suzhou Municipal Hospital,Suzhou,Jiangsu,China 215002)

机构地区：[1]江苏省徐州市妇幼保健院,江苏徐州221000 [2]南京医科大学附属苏州医院·江苏省苏州市立医院,江苏苏州215002

出　　处：《中国药业》2023年第22期139-142,共4页China Pharmaceuticals

摘　　要：目的 为妊娠期高三酰甘油血症(HTG)的降脂治疗提供参考。方法 回顾性分析南京医科大学附属苏州医院收治的1例妊娠期HTG患者的治疗经过,结合文献总结其降脂治疗策略。结果 降脂治疗方案经动态调整后,患者的三酰甘油(TG)水平快速降至正常范围,未出现急性胰腺炎(AP)及其他并发症,且治疗过程中未出现任何不良反应,最终顺利分娩。《威廉姆斯产科学(第24版)》推荐的妊娠早、中、晚期TG的正常参考范围分别为0.45~1.80 mmol/L、0.85~4.32 mmol/L、1.48~5.12 mmol/L;TG降低的首要目标是低于11.3 mmol/L;胰岛素静脉泵入联合低分子肝素皮下注射,以及配伍口服降脂药继续治疗可获得较满意的降脂效果;胰岛素泵入过程中需密切监测血糖(尤其是夜间血糖),依诺肝素钠使用过程中注意监测出血情况、凝血功能和血小板水平,并关注使用疗程。结论 对于妊娠期HTG患者,应严格把握降脂的目标和速率,合理选择降脂药物,控制TG水平,降低AP的发生风险。Objective To provide a reference for the lipid-lowering therapy of gestational hypertriglyceridemia(HTG).Methods The therapy process of a case of gestational HTG admitted to the Affiliated Suzhou Hospital of Nanjing Medical University was analyzed retrospectively,and the lipid-lowering therapy strategy was summarized based on literature.Results After dynamic adjustment of the lipid-lowering therapy regimen,the patient′s triglyceride(TG)level rapidly decreased to the normal range,without acute pancreatitis(AP)or other complication,and no adverse reaction occurred during the therapy process.Finally,the patient delivered successfully.The normal reference range for TG in early,middle and late pregnancy recommended by the Williams Obstetrics(Twenty-Fourth Edition)was 0.45-1.80 mmol/L,0.85-4.32 mmol/L and 1.48-5.12 mmol/L respectively.The primary goal for TG reduction was to be below 11.3 mmol/L.Intravenous pumping of insulin combined with subcutaneous injection of low molecular weight heparin and oral lipid-lowering drugs for continued therapy could achieve satisfactory lipid-lowering effects.During the intravenous pumping of insulin,the blood glucose needed to be closely monitored,especially the nighttime blood glucose.During the use of enoxaparin sodium,the bleeding,coagulation function,platelet level and use course should be monitored.Conclusion For patients with gestational HTG,we should set the lipid-lowering goal and speed strictly,choose the lipid-lowering drugs rationally,control the TG level to reduce the risk of AP.

关 键 词：高三酰甘油血症 胰岛素 低分子肝素 降脂 妊娠期 

分 类 号：R969.3[医药卫生—药理学] R714.25[医药卫生—药学]