Wallig M A
University Department of Veterinary Pathobiology, College of Veterinary Medicine, Urbana, Ill., USA.
Digestion. 1998;59 Suppl 4:13-24. doi: 10.1159/000051439.
Chronic pancreatitis, although relatively rare in the Western World, is common in certain tropical zones where staple crops such as cassava are rich in cyanogenic glycosides. This paper reviews the evidence for a cyanide connection, with reference to experimental studies using another plant nitrile, crambene; and then examines the hypothesis that chronic pancreatitis represents a manifestation of uncoordinated detoxification reactions between pancreatic cytochrome P450 mono-oxygenases and phase II conjugating enzymes, resulting in the irreversible consumption of glutathione in the acinar cell. The conclusion is that the central role of disrupted pancreatic glutathione status, as a result of 'xenobiotic stress', in the evolution of chronic pancreatitis cannot be overestimated. This position contrasts with that in acute pancreatitis, in which glutathione depletion has a pivotal role too, but occurs as a result of 'stress' from reactive oxygen species.
慢性胰腺炎在西方世界相对少见，但在某些热带地区很常见，这些地区的主食作物如木薯富含氰苷。本文回顾了与氰化物关联的证据，并参考了使用另一种植物腈（克拉烯）的实验研究；然后检验了这样一种假说，即慢性胰腺炎是胰腺细胞色素P450单加氧酶与II相缀合酶之间解毒反应不协调的一种表现，导致腺泡细胞中谷胱甘肽的不可逆消耗。结论是，由于“外源性应激”导致胰腺谷胱甘肽状态紊乱，在慢性胰腺炎的发展过程中所起的核心作用再怎么强调也不为过。这一观点与急性胰腺炎不同，在急性胰腺炎中，谷胱甘肽耗竭也起关键作用，但它是由活性氧的“应激”导致的。
