PDF(Pubmed)
Abstract：
This is the first case report of a very low-carbohydrate, high-fat ketogenic diet for the treatment of chylothorax. A 61-year-old female with recurrent chylothorax following thoracic surgery was refractory to a very low-fat diet managed by a hospital dietitian. She required repeated palliative thoracentesis to the point where she was scheduled for a thoracic duct embolization. Prior to the embolization, she was placed on a very low-carbohydrate (<20 total grams daily), high-fat, ketogenic diet. Metabolic markers and imaging were obtained regularly. The patient had improvements in her serum triglycerides, triglyceride/HDL ratio, and triglyceride-glucose index, as well as clinical and radiographic improvements in her chylothorax as assessed by a chest X-ray and CT scan. Within three months of starting her ketogenic diet, imaging revealed complete resolution of the chylous pleural effusion. This case suggests that metabolic optimization to decrease insulin resistance, improve chylomicron metabolism, decrease lymphatic permeability, and lower serum triglycerides, as occurs with a ketogenic diet, should be considered for conservative treatment of chylothorax and warrants further study.
摘要：
这是首次报道一种非常低的碳水化合物,高脂生酮饮食治疗乳糜胸.一名61岁的女性在胸外科手术后复发性乳糜胸，对医院营养师管理的极低脂饮食难以治疗。她需要反复进行姑息性胸腔穿刺术，以达到计划进行胸导管栓塞的程度。在栓塞之前,她被放置在非常低的碳水化合物（每天<20克），高脂肪,生酮饮食。定期获得代谢标志物和成像。病人的血清甘油三酯有所改善，甘油三酯/HDL比率，和甘油三酯-葡萄糖指数，以及通过胸部X射线和CT扫描评估的乳糜胸的临床和影像学改善。在她开始生酮饮食的三个月内，影像学显示乳糜性胸腔积液完全消退。这种情况表明，代谢优化以减少胰岛素抵抗，改善乳糜微粒代谢，降低淋巴通透性，降低血清甘油三酯，就像生酮饮食一样，乳糜胸的保守治疗值得考虑，值得进一步研究。
