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[囊性纤维化的腹部表现:临床综述]

[Abdominal manifestations in cystic fibrosis : Clinical review].

作者信息

Sommerburg Olaf, Schenk Jens-Peter

机构信息

Sektion für Pädiatrische Pneumologie & Allergologie und Mukoviszidosezentrum, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland.

Zentrum für Translationale Lungenforschung Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Universitätsklinikum Heidelberg, Heidelberg, Deutschland.

出版信息

Radiologe. 2020 Sep;60(9):781-790. doi: 10.1007/s00117-020-00729-8.

Abstract

Cystic fibrosis (CF) is the most common fatal autosomal recessive disease in the Caucasian population. A mutation in the cystic fibrosis transmembrane regulator protein (CFTR) gene leads to the production of abnormally viscous mucus and secretions in the lungs of these patients. A similar pathology also occurs in other organs. In the abdomen, among others the gastrointestinal tract, the pancreas, and the hepatobiliary system are affected. The involvement of the pancreas leads to its exocrine and endocrine insufficiency. Hepatic manifestations include hepatic steatosis, focal biliary and multilobular cirrhosis, and portal hypertension. Biliary complications include cholelithiasis, microgallbladder, and sclerosing cholangitis. In the gastrointestinal tract, complications such as the distal intestinal obstruction syndrome, invaginations, chronic constipation, wall thickening, and fibrosis in the colon may occur. An important renal manifestation is nephrolithiasis. With currently rapidly increasing life expectancy of patients with cystic fibrosis, complications of extrapulmonary cystic fibrosis manifestations including hepatic and gastrointestinal malignancy could be an increasing cause of morbidity and mortality of these patients. It is therefore important for radiologists to know and recognize these clinical patterns and to monitor these manifestations in follow-up exams. Previous therapy of extrapulmonary manifestations has been largely symptomatic. Fortunately, the new CFTR modulators seem to represent an effective causal therapeutic approach here.

摘要

囊性纤维化(CF)是白种人群中最常见的致死性常染色体隐性疾病。囊性纤维化跨膜传导调节蛋白(CFTR)基因突变导致这些患者肺部产生异常黏稠的黏液和分泌物。类似的病理变化也发生在其他器官。在腹部,胃肠道、胰腺和肝胆系统等会受到影响。胰腺受累会导致其外分泌和内分泌功能不全。肝脏表现包括肝脂肪变性、局灶性胆汁性和多叶性肝硬化以及门静脉高压。胆道并发症包括胆结石、小胆囊和硬化性胆管炎。在胃肠道,可能会出现诸如远端肠梗阻综合征、肠套叠、慢性便秘、肠壁增厚和结肠纤维化等并发症。一个重要的肾脏表现是肾结石。随着目前囊性纤维化患者的预期寿命迅速增加,肺外囊性纤维化表现的并发症,包括肝脏和胃肠道恶性肿瘤,可能成为这些患者发病率和死亡率增加的一个原因。因此,放射科医生了解和认识这些临床模式并在随访检查中监测这些表现非常重要。以前对肺外表现的治疗主要是对症治疗。幸运的是,新的CFTR调节剂似乎在这里代表了一种有效的病因治疗方法。

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