Ospedale Sant'Orsola-Malpighi, Dipartimento di Medicina Interna e Gastroenterologia, Bologna, Italy.
Expert Opin Pharmacother. 2009 Dec;10(18):2999-3014. doi: 10.1517/14656560903382630.
Our knowledge of acute pancreatitis is still far from complete and there is no unanimous agreement concerning the pathophysiological processes leading to typical alterations during the course of acute pancreatitis. We reviewed the paper published in the last decade on the pathophysiology and treatment of acute pancreatitis. It is difficult to translate the experimental therapeutic results into clinical practice. For example, lexipafant was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on severe acute pancreatitis in humans. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of designing clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings. Thus, analgesia, supportive care, and treatment of the pulmonary and renal complications remain the cornerstones of the treatment of acute pancreatitis, especially in the severe form of the disease.
我们对急性胰腺炎的认识仍远不完整，对于导致急性胰腺炎病程中典型改变的病理生理过程尚无一致意见。我们复习了近十年来关于急性胰腺炎病理生理学和治疗的研究论文。将实验治疗结果转化为临床实践非常困难。例如，lexipafant 可有效降低大鼠致命性胰腺炎的严重程度和死亡率，但对人类重症急性胰腺炎似乎没有影响。因此，急性胰腺炎的主要问题，特别是在疾病的严重形式中，是设计临床研究的困难，这些研究能够就先前在实验环境中测试的各种治疗药物的益处提供可靠的、具有统计学意义的答案。因此，镇痛、支持性治疗以及肺部和肾脏并发症的治疗仍然是急性胰腺炎治疗的基石，特别是在疾病的严重形式中。
