Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210000, Jiangsu Province, China.
Research Institute of Critical Care Medicine and Emergency Rescue, Nanjing University, Nanjing 210000, Jiangsu Province, China.
World J Gastroenterol. 2024 Mar 7;30(9):1005-1010. doi: 10.3748/wjg.v30.i9.1005.
Approximately 20%-30% of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis (IPN), a highly morbid and potentially lethal complication. Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes. In the past two decades, several markers and predictive tools have been proposed and evaluated for this purpose. Conventional biomarkers like C-reactive protein, procalcitonin, lymphocyte count, interleukin-6, and interleukin-8, and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN. On the other hand, scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested, and the results showed that they may provide better accuracy. For early prevention of IPN, several new therapies were tested, including early enteral nutrition, antibiotics, probiotics, immune enhancement, , but the results varied. Taken together, several evidence-supported predictive markers and scoring systems are readily available for predicting IPN. However, effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition. In this editorial, we summarize evidence concerning early prediction and prevention of IPN, providing insights into future practice and study design. A more homogeneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN, thereby achieving individualized treatment.
约 20%-30%的急性坏死性胰腺炎患者会发生感染性胰腺坏死（IPN），这是一种高度致命且潜在的并发症。早期识别高危 IPN 患者可能有助于采取适当的预防措施来改善临床结局。在过去的二十年中，已经提出并评估了几种标志物和预测工具来实现这一目标。传统的生物标志物如 C 反应蛋白、降钙素原、淋巴细胞计数、白细胞介素-6 和白细胞介素-8，以及新开发的生物标志物如血管生成素-2，都与 IPN 有显著关联。另一方面，急性生理学和慢性健康评估 II 评分和胰腺炎活动评分系统等评分系统也已经过测试，结果表明它们可能提供更好的准确性。为了早期预防 IPN，已经测试了几种新的治疗方法，包括早期肠内营养、抗生素、益生菌、免疫增强等，但结果各不相同。总之，有几种有证据支持的预测标志物和评分系统可用于预测 IPN。然而，除了早期肠内营养外，仍然缺乏降低 IPN 发生率的有效治疗方法。在这篇社论中，我们总结了有关 IPN 早期预测和预防的证据，为未来的实践和研究设计提供了思路。具有可靠风险分层工具的更同质的患者人群可能有助于找到降低 IPN 风险的有效治疗方法，从而实现个体化治疗。
