Hentschel Florian, Bornscheuer Till, Lüth Stefan
Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany.
Z Gastroenterol. 2019 Aug;57(8):977-982. doi: 10.1055/a-0958-2843. Epub 2019 Aug 9.
Sclerosing Cholangitis of the Critically Ill (SC-CIP) is a relatively new entity within the spectrum of secondary cholangitis that develops in the wake of intensive care therapy with mechanical ventilation and catecholamine treatment. It is caused by ischemic or immunologic injury to small bile ducts that becomes self-aggravating and persists beyond the end of the intensive care stay. Early clinical and laboratory findings show acute cholangitis with elevated CRP, gamma GT, AP, and bilirubin. ERCP shows damaged intrahepatic bile ducts with irregular calibers and biliary casts. The following phase is chronic and oligosymptomatic. Still, all laboratory parameters will stay mildly elevated and ERCP and MRCP will show progressive loss of small bile ducts. Long-term prognosis is poor. Even with UDCA therapy, most patients will develop liver cirrhosis within months or years.
危重症患者硬化性胆管炎（SC-CIP）是继发性胆管炎范围内一种相对较新的病症，它在机械通气和儿茶酚胺治疗的重症监护治疗后发生。它是由小胆管的缺血性或免疫性损伤引起的，这种损伤会自我加重，并在重症监护期结束后持续存在。早期临床和实验室检查结果显示急性胆管炎，CRP、γ-GT、碱性磷酸酶（AP）和胆红素升高。内镜逆行胰胆管造影（ERCP）显示肝内胆管受损，管径不规则且有胆泥。接下来的阶段是慢性且症状较少的。不过，所有实验室指标仍会轻度升高，ERCP和磁共振胰胆管造影（MRCP）将显示小胆管逐渐丧失。长期预后较差。即使采用熊去氧胆酸（UDCA）治疗，大多数患者也会在数月或数年内发展为肝硬化。
