高トリグリセリド血症
Hypertriglyceridemia/ja
| Hypertriglyceridemia | |
|---|---|
| Other names | Elevated levels of triglycerides |
 | |
| 極度の高トリグリセリド血症を呈した若年患者の血液サンプル | |
| Specialty | 内分泌学 |
| Complications | Heart disease/ja, pancreatitis/ja |
| Risk factors | Non-alcoholic fatty liver disease/ja, atherosclerosis/ja, alcoholism/ja, metabolic syndrome/ja |
| Differential diagnosis | 高脂血症, atheroma/ja, hypercholesterolemia/ja, hypercalcemia/ja |
高トリグリセリド血症とは、血液中に多量のトリグリセリドが存在することである。トリグリセリドは、ほとんどの生物において最も豊富な脂肪分子である。 高トリグリセリド血症は様々な生理学的状態や様々な疾患で起こり、高トリグリセリド値は高コレステロール血症（高コレステロール値）がなくてもアテローム性動脈硬化症と関連し、心血管系疾患の素因となる。
慢性的に上昇した血清トリグリセリド値はメタボリックシンドロームと非アルコール性脂肪肝疾患（NAFLD）の構成要素であり、どちらも典型的には肥満を伴い、2021年現在、先進国における心血管死亡率に大きく寄与している。極端なトリグリセリド値は急性膵炎のリスクも高める。
高トリグリセリド血症自体は通常無症状であるが、高値の場合は黄色腫として知られる皮膚病変を伴うことがある。
Signs and symptoms
Most people with elevated triglycerides experience no symptoms. Some forms of primary hypertriglyceridemia can lead to specific symptoms: both familial chylomicronemia and primary mixed hyperlipidemia include skin symptoms (eruptive xanthoma), eye abnormalities (lipemia retinalis), hepatosplenomegaly (enlargement of the liver and spleen), and neurological symptoms. Some experience attacks of abdominal pain that may be mild episodes of pancreatitis. Eruptive xanthomas are 2–5 mm papules, often with a red ring around them, that occur in clusters on the skin of the trunk, buttocks and extremities. Familial dysbetalipoproteinemia causes larger, tuberous xanthomas; these are red or orange and occur on the elbows and knees. Palmar crease xanthomas may also occur.
The diagnosis is made on blood tests, often performed as part of screening. Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.
Acute pancreatitis may occur in people whose triglyceride levels are above 1000 mg/dL (11.3 mmol/L). Hypertriglyceridemia is associated with 1–4% of all cases of pancreatitis. The symptoms are similar to pancreatitis secondary to other causes, although the presence of xanthomas or risk factors for hypertriglyceridemia may offer clues.
Causes
- Overeating
- Obesity
- Diabetes mellitus and insulin resistance - it is one of the defined components of metabolic syndrome (along with central obesity, hypertension, and hyperglycemia)
- Excess alcohol consumption
- Kidney failure, nephrotic syndrome
- Genetic predisposition; some forms of familial hyperlipidemia such as familial combined hyperlipidemia i.e. Type II hyperlipidemia
- Lipoprotein lipase deficiency - Deficiency of this water-soluble enzyme, that hydrolyzes triglycerides in lipoproteins, leads to elevated levels of triglycerides in the blood.
- Lysosomal acid lipase deficiency or Cholesteryl ester storage disease
- Certain medications e.g. isotretinoin, hydrochlorothiazide diuretics, beta blockers, protease inhibitors
- Hypothyroidism (underactive thyroid)
- Lupus and associated autoimmune responses
- Glycogen storage disease type 1.
- Propofol
- HIV medications
Diagnosis
The diagnosis is made on blood tests, often performed as part of screening. The normal triglyceride level is less than 150 mg/dL (1.7 mmol/L). Once diagnosed, other blood tests are usually required to determine whether the raised triglyceride level is caused by other underlying disorders ("secondary hypertriglyceridemia") or whether no such underlying cause exists ("primary hypertriglyceridaemia"). There is a hereditary predisposition to both primary and secondary hypertriglyceridemia.
Screening
In 2016, the United States Preventive Services Task Force concluded that testing the general population under the age of 40 without symptoms is of unclear benefit.
Treatment
Lifestyle changes including weight loss, exercise and dietary modification may improve hypertriglyceridemia. This may include dietary changes such as restriction of fat and carbohydrates (specifically fructose), and increased consumption of omega-3 fatty acids from algae, nuts, and seeds.
The decision to treat hypertriglyceridemia with medication depends on the levels and on the presence of other risk factors for cardiovascular disease. Very high levels that would increase the risk of pancreatitis is treated with a drug from the fibrate class. Niacin and omega-3 fatty acids as well as drugs from the statin class may be used in conjunction, with statins being the main drug treatment for moderate hypertriglyceridemia where reduction of cardiovascular risk is required. Medications are recommended in those with high levels of triglycerides that are not corrected with lifestyle modifications, with fibrates being recommended first. Epanova (omega-3-carboxylic acids) is another prescription drug used to treat very high levels of blood triglycerides.
Epidemiology
As of 2006, the prevalence of hypertriglyceridemia in the United States was 30%.
Research
Analysis of the genes in depression and anxiety showed those linked solely to depression were also linked to hypertriglyceridemia.
語源
高トリグリセリド血症という言葉は、hyper-の結合形を用いている。+triglycerideを使用する。+ -emia'を用いているため、「血中のトリグリセリド濃度が高い」または「血中のトリグリセリドが多すぎる」に相当する。
こちらも参照
外部リンク
- Lowering Triglycerides (EMedicineHealth.com; October 2020)