Panek Józefa, Zasada Jakub, Poźniczek Marek
II Katedra Chirurgii, Uniwersytetu Jagielloński, Collegium Medicum, Kraków.
Przegl Lek. 2007;64(6):435-7.
Although as many studies are sacrificed to acute pancreatitis (AP), the pathogenesis of the disease remains undiscovered. The microcirculatory disturbances during AP as a cause of necrotic changes in the parenchyma of the gland, described first time by Panum in 1886, have become again a very attractive theory. In the last decades, several studies were done to prove that microcirculatory impairment plays a crucial role in pathogenesis of severe AP. It had been proved that many mediators play important roles in this process including nitric oxide and endothelin balance. Vasoconstriction and vasodilatation named "vascular game" caused by cytokine accumulation and lower oxygenation of the tissue gives very interesting basis for theories about creating pancreatic necrosis. The severity of the course of AP also determinates damage of the microcirculation of the lungs, the liver and the bowels which leads to SIRS, MODS and MOF. The new experimental dates seems to be very promising and can became a basis for developing a new strategy of treatment in the most severe cases of AP. In this article we present up-to-date information about these theories and concepts.
尽管有许多研究致力于急性胰腺炎（AP），但其发病机制仍未被揭示。1886年帕努姆首次描述的AP期间的微循环障碍作为腺体实质坏死性改变的一个原因，再次成为一个非常有吸引力的理论。在过去几十年里，进行了多项研究以证明微循环障碍在重症AP的发病机制中起关键作用。已经证明许多介质在这个过程中发挥重要作用，包括一氧化氮和内皮素平衡。由细胞因子积累和组织低氧引起的血管收缩和血管舒张被称为“血管博弈”，为胰腺坏死形成的理论提供了非常有趣的基础。AP病程的严重程度还决定了肺、肝和肠道微循环的损伤，进而导致全身炎症反应综合征（SIRS）、多器官功能障碍综合征（MODS）和多器官功能衰竭（MOF）。新的实验数据似乎很有前景，可为最严重AP病例制定新的治疗策略奠定基础。在本文中，我们介绍了有关这些理论和概念的最新信息。
