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ENGLISH ABSTRACT
全身炎症反应综合征在急性胰腺炎肺损伤中的研究进展
曹均强
汤礼军
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1673-9752.2015.11.019
Research progress of systemic inflammatory response syndrome in acute pancreatitis-associated lung injury
Cao Junqiang
Tang Lijun
Authors Info & Affiliations
Cao Junqiang
Department of General Surgery, General Hospital of Chengdu Military Command, Chengdu 610083, China
Tang Lijun
·
DOI： 10.3760/cma.j.issn.1673-9752.2015.11.019
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摘要

作为急性胰腺炎早期炎症反应放大的结果，全身炎症反应综合征(SIRS)是导致胰腺炎肺损伤发生的主要原因，而早期合并的急性肺损伤或ARDS是导致急性胰腺炎患者高病死率的主要原因。一系列炎症介质及细胞因子在SIRS及胰腺炎肺损伤的发生发展过程中起着重要作用。因此，恢复炎症反应平衡状态成为目前治疗胰腺炎肺损伤的关键环节。

急性胰腺炎;急性肺损伤;全身炎症反应综合征
ABSTRACT

As a result of the early amplification of the inflammatory response in the acute pancreatitis, systemic inflammatory response syndrome (SIRS) is a main cause of acute pancreatitis-associated lung injury (APALI), while early combined acute lung injury or acute respiratory distress syndrome causes a high mortality of acute pancreatitis. A series of inflammatory mediators and cytokines play important roles in the process of SIRS and APALI, therefore, inflammatory reaction restoring a balance becomes a key point of the treatment of pancreatitis lung injury.

Acute pancreatitis;Acute lung injury;Systemic inflammatory response syndrome
Tang Lijun, Email: mocdef.3ab611521jltjhw
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引用本文

曹均强,汤礼军. 全身炎症反应综合征在急性胰腺炎肺损伤中的研究进展[J]. 中华消化外科杂志,2015,14(11)：975-979.

DOI:10.3760/cma.j.issn.1673-9752.2015.11.019

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急性胰腺炎是胃肠外科常见急腹症之一，不同地区每年发病率为(5～100)/10万人次 [ 1 , 2 , 3 ]。而在病情严重程度上同样也存在较大差异。根据最新亚特兰大标准，急性胰腺炎可分为：轻症急性胰腺炎、中重度急性胰腺炎和重症急性胰腺炎 [ 4 ]。临床上，大多数急性胰腺炎患者为轻症急性胰腺炎，通过内科保守治疗即可痊愈出院。然而，约20%的急性胰腺炎患者表现为重症急性胰腺炎，病死率为7%～15% [ 5 ]。
在急性胰腺炎整个病程中，早期的主要特征为全身炎症反应综合征(systemic inflammatory response syndrome，SIRS)及器官功能障碍，后期主要是胰腺坏死、感染等并发症。传统观点认为急性胰腺炎后期的诸多并发症是导致患者死亡的主要原因，但近年来，越来越多的研究结果证实：早期并发的器官功能障碍才是导致患者高病死率的主要原因，如果在急性胰腺炎早期即存在持续性器官功能障碍，患者病死率为25%～35% [ 6 , 7 ]。已有的研究结果显示：入院48 h之内，约30%的胰腺炎患者会出现SIRS，作为导致器官功能障碍发生的主要原因，SIRS一方面可导致全身毛细血管通透性增加，大量体液外渗，以致血容量减少，器官灌注不足，另一方面，大量释放的促炎介质及细胞因子也会对器官功能造成损害 [ 6 , 8 ]。
肺是急性胰腺炎时最易受损的胰腺外器官，当出现功能障碍，表现为急性肺损伤，急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS) [ 9 ]。已有的研究结果显示：在所有的急性胰腺炎死亡患者中，超过20%患者的死因为急性肺损伤 [ 10 , 11 ]。当急性胰腺炎并发SIRS时，中性粒细胞、单核细胞及其他免疫细胞所释放的大量促炎介质及细胞因子是导致肺损伤发生的主要原因 [ 12 , 13 ]。因此，如何有效抑制早期SIRS反应，避免ALI、ARDS和MODS的发生成为目前研究热点。本文就急性胰腺炎时SIRS是如何导致急性肺损伤的发生以及胰腺炎肺损伤的防治做一综述。
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备注信息
A
汤礼军，Email： mocdef.3ab611521jltjhw
B
国家自然科学基金 (81302068)
四川省青年科技创新研究团队资助计划 (2011JTDO010)
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