Tsujimoto Tatsuhiro, Kawaratani Hideto, Yoshiji Hitoshi, Uemura Masahito, Fukui Hiroshi
Third Department of Internal Medicine, Nara Medical University, Nara, Japan.
Curr Drug Abuse Rev. 2008 Jun;1(2):197-202. doi: 10.2174/1874473710801020197.
Chronic pancreatitis is a progressive inflammatory condition characterized by repeated attacks of abdominal pain, and the destruction and fibrosis of the pancreatic parenchyma which causes to reduced exocrine and endocrine functions. Alcohol is the most common cause of chronic pancreatitis. Although abstinence is usually considered a prerequisite for successful treatment of alcoholic chronic pancreatitis, we often encounter patients who have repeated attacks from the compensated stage through the transitional stage. In alcoholic chronic pancreatitis, continued alcohol consumption causes changes in the digestive hormones and vagal nerve function that induce the pancreatic acinar cells to oversecrete protein, increasing the protein concentration and viscosity of the pancreatic juice. This induces protein sedimentation from the pancreatic juice and formation of protein plugs within the pancreatic duct, triggering repeated attacks of acute pancreatitis. The treatment of alcoholic chronic pancreatitis includes alleviation of symptoms, particularly abdominal pain, elimination of trigger factors, prevention of recurrence and disease progression, adjuvant therapies for pancreatic exocrine and endocrine failure. Recently, the main constituent proteins in these protein plugs have been identified, enabling trials of several therapies, such as the administration of secretin formulations and endoscopic removal. Bromhexine hydrochloride, a bronchial mucolytic, has an affinity for the pancreatic acinar cells, inducing them to secrete pancreatic juice of low viscosity. In this review, we summarize the most recent thoughts about alcoholic chronic pancreatitis, and the new treatments, and in particular, we present our findings concerning the efficacy of bromhexine hydrochloride in the treatment of this disease.
慢性胰腺炎是一种进行性炎症性疾病，其特征为反复出现腹痛，以及胰腺实质的破坏和纤维化，进而导致外分泌和内分泌功能减退。酒精是慢性胰腺炎最常见的病因。尽管戒酒通常被认为是成功治疗酒精性慢性胰腺炎的先决条件，但我们经常遇到从代偿期到过渡期反复发作的患者。在酒精性慢性胰腺炎中，持续饮酒会导致消化激素和迷走神经功能发生变化，促使胰腺腺泡细胞过度分泌蛋白质，增加胰液中的蛋白质浓度和黏度。这会导致胰液中的蛋白质沉淀，并在胰管内形成蛋白栓，引发急性胰腺炎的反复发作。酒精性慢性胰腺炎的治疗包括缓解症状，尤其是腹痛，消除触发因素，预防复发和疾病进展，以及针对胰腺外分泌和内分泌功能衰竭的辅助治疗。最近，这些蛋白栓中的主要组成蛋白已被确定，这使得一些治疗方法的试验成为可能，如给予促胰液素制剂和内镜下清除。盐酸氨溴索是一种支气管黏液溶解剂，对胰腺腺泡细胞具有亲和力，可促使其分泌低黏度的胰液。在本综述中，我们总结了关于酒精性慢性胰腺炎的最新观点和新的治疗方法，特别是我们展示了关于盐酸氨溴索治疗该病疗效的研究结果。
