慢性胰腺炎。
Chronic pancreatitis.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-0682, USA.
出版信息
Curr Opin Gastroenterol. 2011 Sep;27(5):452-9. doi: 10.1097/MOG.0b013e328349e333.
PURPOSE OF REVIEW
We review important new clinical observations in chronic pancreatitis made in the past year.
RECENT FINDINGS
Tropical pancreatitis associates with SPINK1 and/or CFTR gene mutations in approximately 50% of patients, similar to the frequency in idiopathic chronic pancreatitis. Corticosteroids increase secretin-stimulated pancreatic bicarbonate concentrations in autoimmune pancreatitis (AIP) by restoring mislocalized CFTR protein to the apical ductal membrane. Most patients with asymptomatic hyperenzymemia have pancreatic lesions of unclear significance or no pancreatic lesions. Common pitfalls in the use of diagnostic tests for exocrine pancreatic insufficiency (EPI) confound interpretation of findings in irritable bowel syndrome and severe renal insufficiency. Further study is needed to improve the accuracy of endoscopic ultrasonography (EUS) to diagnose chronic pancreatitis. Celiac plexus block provides short-term pain relief in a subset of patients.
SUMMARY
Results of this year's investigations further elucidated the genetic associations of tropical pancreatitis, a reversible mislocalization of ductal CFTR in AIP, the association of asymptomatic pancreatic hyperenzymemia with pancreatic disorders, limitations of diagnostic tests for EPI, diagnosis of chronic pancreatitis by EUS and endoscopic pancreatic function testing and treatment of pain.
目的综述
我们回顾了过去一年中在慢性胰腺炎方面的重要临床新观察。
最新发现
热带性胰腺炎与 SPINK1 和/或 CFTR 基因突变相关，约占患者的 50%，与特发性慢性胰腺炎的频率相似。皮质类固醇通过将错误定位的 CFTR 蛋白恢复到胰腺导管的顶膜，增加自身免疫性胰腺炎（AIP）中促胰液素刺激的胰腺碳酸氢盐浓度。大多数无症状高酶血症患者有胰腺病变，但意义不明或无胰腺病变。外分泌胰腺功能不全（EPI）诊断试验的使用中的常见错误会混淆对肠易激综合征和严重肾功能不全的发现的解释。需要进一步研究来提高超声内镜（EUS）诊断慢性胰腺炎的准确性。腹腔神经丛阻滞在一部分患者中提供短期的疼痛缓解。
总结
今年的研究结果进一步阐明了热带性胰腺炎的遗传关联、AIP 中导管 CFTR 的可逆定位错误、无症状性胰腺高酶血症与胰腺疾病的关联、EPI 诊断试验的局限性、EUS 和内镜胰腺功能检查对慢性胰腺炎的诊断以及疼痛治疗。
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