Differential roles of inflammatory cells in pancreatitis
Differential roles of inflammatory cells in pancreatitis
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DOI：
10.1111/j.1440-1746.2011.07011.x
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发表时间：
2012-03-01
影响因子：
4.1
通讯作者：
Lerch, Markus M.
中科院分区：
文献类型：
--
作者：
Mayerle, Julia;Dummer, Annegret;Lerch, Markus M.
每10万人口中急性胰腺炎的发病率在5到80之间。1024%的患者死于出血坏死性胰腺炎。在所有的急性胰腺炎病例中，80%的病因与过度饮酒导致胆结石有关。到今天为止，还没有针对急性胰腺炎的特殊因果治疗方法。C反应蛋白水平升高超过130毫克/L也可以预测急性胰腺炎的严重病程。纠正低血容量是治疗急性胰腺炎的基本药物。预防性抗生素应仅限于坏死性胰腺炎、感染性坏死或其他感染性并发症的患者。然而，由于细胞内蛋白水解酶的过早激活被认为是急性胰腺炎的主要事件。重症急性胰腺炎以早期炎症免疫反应综合征(SIRS)和随后的代偿性抗炎反应综合征(CARS)为特征，其严重程度与蛋白酶激活一样严重。CARS抑制免疫系统，促进医院感染，包括感染的胰腺坏死，这是这种疾病最可怕的并发症之一。已经进行了许多尝试来抑制早期的全身炎症反应，但即使这些机制在动物模型中被发现是有益的，它们在日常临床实践中也是失败的。
The incidence of acute pancreatitis per 100 000 of population ranges from 5 to 80. Patients suffering from hemorrhagic-necrotizing pancreatitis die in 1024% of cases. 80% of all cases of acute pancreatitis are etiologically linked to gallstone disease immoderate alcohol consumption. As of today no specific causal treatment for acute pancreatitis exists. Elevated C-reactive protein levels above 130 mg/L can also predict a severe course of acute pancreatitis. The essential medical treatment for acute pancreatitis is the correction of hypovolemia. Prophylactic antibiotics should be restricted to patients with necrotizing pancreatitis, infected necrosis or other infectious complications. However, as premature intracellular protease activation is known to be the primary event in acute pancreatitis. Severe acute pancreatitis is characterized by an early inflammatory immune response syndrome (SIRS) and a subsequent compensatory anti-inflammatory response syndrome (CARS) contributing to severity as much as protease activation does. CARS suppresses the immune system and facilitates nosocomial infections including infected pancreatic necrosis, one of the most feared complications of the disease. A number of attempts have been made to suppress the early systemic inflammatory response but even if these mechanisms have been found to be beneficial in animal models they failed in daily clinical practice.