Organ Failure Due to Systemic Injury in Acute Pancreatitis
Organ Failure Due to Systemic Injury in Acute Pancreatitis
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DOI：
10.1053/j.gastro.2018.12.041
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发表时间：
2019-05-01
期刊：
影响因子：
29.4
通讯作者：
Singh, Vijay P.
中科院分区：
文献类型：
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作者：
Garg, Parmod K.;Singh, Vijay P.
急性胰腺炎可能伴有局部和全身并发症。全身性损伤表现为器官衰竭，约占所有急性胰腺炎病例的20%，并被定义为“严重急性胰腺炎”。器官衰竭通常在急性胰腺炎的早期发展，但也可能由于感染的胰腺坏死引起的败血症而发展。器官衰竭是急性胰腺炎预后最重要的决定因素。我们在此回顾目前对急性胰腺炎器官衰竭的危险因素、病理生理、时机、对结果的影响和治疗的认识。当我们讨论严重全身性损伤的病理生理学时，基于支持它们在器官衰竭中的因果关系的证据，强调了严重程度的标志物和介质之间的区别。重点放在器官衰竭的临床相关终点和病理生理扰动的机制上，这为潜在的治疗靶点提供了见解。
Acute pancreatitis may be associated with both local and systemic complications. Systemic injury manifests in the form of organ failure, which is seen in approximately 20% of all cases of acute pancreatitis and defines "severe acute pancreatitis." Organ failure typically develops early in the course of acute pancreatitis, but also may develop later due to infected pancreatic necrosis-induced sepsis. Organ failure is the most important determinant of outcome in acute pancreatitis. We review here the current understanding of the risk factors, pathophysiology, timing, impact on outcome, and therapy of organ failure in acute pancreatitis. As we discuss the pathophysiology of severe systemic injury, the distinctions between markers and mediators of severity are highlighted based on evidence supporting their causality in organ failure. Emphasis is placed on clinically relevant end points of organ failure and the mechanisms underlying the pathophysiological perturbations, which offer insight into potential therapeutic targets to treat.