Schmid S, Uhl W, Büchler M W
Dept. of Visceral and Transplantation Surgery, University Hospital of Bern, Switzerland.
Scand J Gastroenterol Suppl. 1996;219:47-50. doi: 10.3109/00365529609105000.
A number of pancreatic enzymes have been suggested as the initiating factor for acute pancreatitis. In particular, the relationship between proteases and antiproteases has been examined extensively, based on the suspicion that an imbalance between them is the central factor in the pathogenesis of acute pancreatitis. Animal studies with antiproteolytic agents in models of acute pancreatitis have shown an improvement in outcome. However, more recently, prospective, randomized, multicentre trials treating human acute pancreatitis with antiproteolytic drugs (aprotinin, gabexate mesilate, and even fresh frozen plasma) have failed to show any benefit in the clinical setting. Thus, clinically, it seems likely that antiproteolytic therapy has no effect on the course of severe acute pancreatitis. Today, the mortality in severe acute pancreatitis is determined by septic complications due to infected pancreatic necroses in the late phase 2-3 weeks after the onset of the disease. Death in the early phase of the disease has become increasingly rare where an imbalance between proteases and antiproteases may be involved.
多种胰腺酶被认为是急性胰腺炎的起始因素。特别是，基于蛋白酶和抗蛋白酶之间失衡是急性胰腺炎发病机制的核心因素这一怀疑，它们之间的关系已得到广泛研究。在急性胰腺炎模型中使用抗蛋白酶药物的动物研究显示结果有所改善。然而，最近，用抗蛋白酶药物（抑肽酶、甲磺酸加贝酯，甚至新鲜冷冻血浆）治疗人类急性胰腺炎的前瞻性、随机、多中心试验在临床环境中未显示出任何益处。因此，在临床上，抗蛋白酶治疗似乎对重症急性胰腺炎的病程没有影响。如今，重症急性胰腺炎的死亡率取决于疾病发作后2 - 3周后期感染性胰腺坏死引起的感染性并发症。在疾病早期因蛋白酶和抗蛋白酶失衡而导致的死亡已越来越罕见。
