摘要
急性胰腺炎(acute pancreatitis,AP)是消化系统常见急腹症之一,AP的总死亡率约5%-10%.而重症急性胰腺炎(severe acute pancreatitis,SAP)的死亡率约30%-40%.近年来AP的总体死亡率变化不大,但AP的发病率却在逐年上升.在胃肠科的住院患者中,AP已然成为患者住院的第二大病因,是住院花费最高疾病之一,故应该引起临床重视.根据2012年亚特兰大分类标准修订版本,并根据AP的严重程度将其分为轻症急性胰腺炎(mild acute pancreatitis,MAP)、中重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)及SAP,其中约60%病例是MAP,病情为自限性,恢复良好,几乎不产生任何并发症,死亡率极低;然而大约30%的患者会发生MSAP,约10%会发生SAP,持续器官衰竭(persistent organ failure,POF)是SAP主要决定因素,也是早期死亡的主要原因,胰腺坏死继发感染是后期AP的主要死因,死亡率极高.AP病情进展及预后与疾病的早期治疗及干预息息相关,而AP的发病机制的复杂性又影响着疾病的早期治疗的疗效,但目前AP的发病机制尚未完全阐明,故缺乏特异性治疗,现今公认发病机制有“白细胞过度激活-炎性因子级联瀑布学说”、“肠道细菌移位与二次打击学说”、“细胞凋亡学说”、“胰腺微循环障碍学说”等,这些理论的提出表明AP的发病机制是复杂、多因素参与的病理生理过程.近年来,肾素-血管紧张素系统中的活性物质-血管紧张素Ⅱ(angiotensin-Ⅱ,Ang-Ⅱ)在AP发生发展中的作用逐渐受到学者们的重视.因此深入研究Ang-Ⅱ与AP的关系可能有助于临床进一步认识及治疗AP,本文就Ang-Ⅱ与AP的关系进行如下综述.
Acute pancreatitis(AP)is one of the most common acute abdominal diseases in the digestive system.The total mortality of AP is about 5%-10%;however,the mortality of severe acute pancreatitis(SAP)is about 30%-40%.In recent years,the overall mortality rate of AP has not changed much,but the incidence rate of AP is increasing year by year.AP has become the second major cause of hospitalization in department of gastroenterology,and also is one of the most expensive diseases.According to the revised Atlanta classification criteria in 2012,AP can be divided into mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP),and SAP.About 60%of AP cases are MAP,which is often self-limited,has no complications,and is associated with a low mortality rate;however,about 30%of AP patients had MSAP,about 10%of which could get worse to turn to SAP.Persistent organ failure(POF)is the main cause of the progression of SAP,and also is the main cause of death in the early stage of AP.Pancreatic necrosis with secondary infection is the main cause of death in the late stage of AP.The progression and prognosis of AP are closely related to the early treatment and intervention,but the complicated pathogenesis of AP affects the efficacy of early treatment.Since the pathogenesis of AP has not been fully elucidated,there is a lack of specific treatment.At present,the pathogenesis of AP is generally recognized as“cascade waterfall of leukocyte over-activationinflammatory factors”,“intestinal bacterial translocation and secondary attack”,“apoptosis”,“pancreatic microcirculation disorder”,etc.These theories indicate that the pathogenesis of AP is a complex and multifactorial pathophysiological process.In recent years,the role of angiotensin-Ⅱ(Ang-Ⅱ),an active substance in the renin-angiotensin system,in the occurrence and development of AP has gradually attracted the attention of scholars.Therefore,an in-depth study of the relationship between Ang-Ⅱand AP may contribute to the clinical understanding and treatment of AP.In this paper,we review the relationship between Ang-Ⅱand AP.
作者
黄子俊
吕永才
雷静静
刘琦
Zi-Jun Huang;Yong-Cai Lv;Jing-Jing Lei;Qi Liu(Guizhou Medical University,Guiyang 550004,Guizhou Province,China;Department of Gastroenterology,Zhenning Buyi and Miao Autonomous County People’s Hospital,Zhenning 561200,Guizhou Province,China;Department of Gastroenterology,Affiliated Baiyun Hospital of Guizhou Medical University,Guiyang 550014,Guizhou Province,China;Department of Gastroenterology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China)
出处
《世界华人消化杂志》
CAS
2021年第1期34-40,共7页
World Chinese Journal of Digestology
基金
贵阳市白云区科技计划项目,No.[2017]50
贵阳市科技局大健康科技合作计划项目,No.[2018]1-72.
