Clinical chronic pancreatitis.
Clinical chronic pancreatitis.
复制标题
DOI：
10.1097/mog.0000000000000293
复制
发表时间：
2016-09
影响因子：
2.5
通讯作者：
Park WG
中科院分区：
文献类型：
--
作者：
Park WG
总结近一年来对慢性胰腺炎(CP)的临床观察。在67%的儿童慢性胰腺炎病例中发现了易感基因突变。一个新的涉及杂交等位基因的易感基因(CEL-Hyb)与特发性CP相关。ABO血型B型和FUT2非分泌型与无症状高脂血症和慢性胰腺炎相关。饮酒会损害CFTR的活性，导致碳酸氢盐分泌减少，携带CFTR易感突变的患者可能会发展为临床胰腺炎。脑性瘫痪的CT影像表现与疼痛类型的相关性较差。超声造影特征与纤维化的相关性较差。循环上皮细胞在CP患者中存在，但在健康志愿者中不存在。在提供持久的疼痛缓解方面，手术优于内窥镜治疗(>；5年)。反复放置胰管支架和长期使用麻醉剂是自体胰岛细胞移植(TPIAT)后不良预后的术前预测因素。特发性慢性胰腺炎的新基因突变正在被发现。酒精损害CFTR活性，可能解释了胰腺炎的发病机制。目前的影像表现与脑瘫的临床疼痛表现和纤维化的相关性很差。需要新的成像方式。随着TPIAT的发展，需要严格的结果分析来推动患者的选择。
To summarize observations in clinical chronic pancreatitis (CP) in the past year. A predisposing genetic mutation was identified in 67% of cases of pediatric chronic pancreatitis. A novel susceptibility gene involving a hybrid allele (CEL-HYB) is associated with idiopathic CP. ABO blood type B and FUT2 non-secretor status is associated with asymptomatic hyperlipasemia and chronic pancreatitis. Alcohol consumption impairs CFTR activity leading to decreased bicarbonate secretion and patients with susceptible CFTR mutations can develop clinical pancreatitis. CT imaging findings in CP correlate poorly with pain patterns. EUS features correlate poorly with fibrosis. Circulating epithelial cells are present in CP patients but not healthy volunteers. Surgery is superior to endoscopic treatment in providing durable pain relief (> 5 years). Repetitive pancreatic duct stent placements and chronic narcotic use are pre-operative predictors of poor outcome after total pancreatectomy with islet cell auto transplantation (TPIAT). Novel genetic mutations for idiopathic chronic pancreatitis are being identified. Alcohol impairs CFTR activity and may explain a mechanism for pancreatitis. Current imaging modalities correlate poorly with clinical pain presentation and fibrosis in CP. Novel imaging modalities are needed. As TPIAT grows, rigorous outcomes analysis is needed to drive patient selection.