Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention
Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention
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DOI：
10.3748/wjg.v16.i17.2094
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发表时间：
2010-05-07
影响因子：
4.3
通讯作者：
Andersson, Roland
中科院分区：
文献类型：
--
作者：
Zhou, Meng-Tao;Chen, Cheng-Shui;Andersson, Roland
急性胰腺炎的急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）仍然是一个重要的问题，死亡率在30%-40%的范围内。本文综述了ALI和ARDS的病理生理机制及其潜在的临床意义。ALI和ARDS的不同阶段涉及多种介质和病理生理途径。最初的渗出期以弥漫性肺泡损伤、微血管损伤和炎性细胞内流为特征。该阶段之后是具有肺修复、II型肺细胞发育不全和成纤维细胞增殖的纤维增殖阶段。来自多形核白细胞的蛋白酶、各种促炎介质和磷脂酶都参与其中。促进胰腺炎相关性ALI的因素可能存在于肠道和肠系膜血管。对潜在的机制缺乏全面的了解，通过提高我们的知识，可以开发新的预防和干预工具，从而有助于改善结果。(C)2010年百世登。All rights reserved.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem, with a mortality rate in the range of 30%-40%. The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical implications. Several mediators and pathophysiological pathways are involved during the different phases of ALI and ARDS. The initial exudative phase is characterized by diffuse alveolar damage, microvascular injury and influx of inflammatory cells. This phase is followed by a fibro-proliferative phase with lung repair, type II pneumocyte hypoplasia and proliferation of fibroblasts. Proteases derived from polymorphonuclear neutrophils, various pro-inflammatory mediators, and phospholipases are all involved, among others. Contributing factors that promote pancreatitis-associated ALI may be found in the gut and mesenteric lymphatics. There is a lack of complete understanding of the underlying mechanisms, and by improving our knowledge, novel tools for prevention and intervention may be developed, thus contributing to improved outcome. (C) 2010 Baishideng. All rights reserved.