Malagelada J R
Pancreas. 1986;1(3):270-8. doi: 10.1097/00006676-198605000-00011.
The causal relationship between alcohol abuse and pancreatitis is undisputed. However, why some alcoholics manifest pancreatitis whereas others do not remains unexplained. Epidemiological data increasingly point toward an adjuvant role for genetic, dietary, and environmental factors. Significant advances have taken place in the last several years in the characterization of the pathophysiology of both experimental and human alcoholic pancreatitis. However, the pathogenesis of alcoholic pancreatitis remains unsettled. Toxic effects of alcohol on pancreatic acinar cells, "plugging" of pancreatic ductules by proteinaceous material, and reflux of bilio-duodenal juice into the pancreatic ducts have been suggested as putative pathogenetic mechanisms. Whereas at the present time only hypotheses can be formulated, it seems likely that the genesis of alcohol-related pancreatitis follows one or several of these proposed mechanisms. Pain in alcoholic pancreatitis is common and yet unexplained. Understanding the mechanism of pain in such patients is the key to our ability to manage it successfully. In this review, I have attempted to summarize and critically analyze our current understanding of these challenging problems.
酒精滥用与胰腺炎之间的因果关系是无可争议的。然而，为何一些酗酒者会患胰腺炎而另一些人却不会，这一点仍无法解释。流行病学数据越来越多地表明遗传、饮食和环境因素起到辅助作用。在过去几年里，实验性和人类酒精性胰腺炎的病理生理学特征研究取得了重大进展。然而，酒精性胰腺炎的发病机制仍未明确。酒精对胰腺腺泡细胞的毒性作用、蛋白质物质对胰腺小导管的“堵塞”以及胆汁-十二指肠液反流至胰管，都被认为是可能的发病机制。虽然目前只能提出一些假说，但酒精相关性胰腺炎的发生似乎遵循这些提出的机制中的一种或几种。酒精性胰腺炎中的疼痛很常见，但原因不明。了解此类患者的疼痛机制是我们成功治疗的关键。在这篇综述中，我试图总结并批判性地分析我们目前对这些具有挑战性问题的理解。
