重症急性胰腺炎早期免疫抑制的研究进展

Advances in immunosuppression for early severe acute pancreatitis

重症急性胰腺炎(SAP)在ICU临床管理中具有诸多挑战,病情严重程度往往取决于早期炎症反应,约30%的SAP患者因严重的细菌感染或器官衰竭而死亡。研究显示SAP患者早期就已发生全身免疫抑制和肠道黏膜免疫损伤,可导致感染性坏死性胰腺炎、菌血症等感染并发症,与病程加长,病死率增加相关。然而临床上经常忽视SAP早期免疫抑制,缺少被证实安全、有效的免疫干预措施,导致最佳治疗时间错过和感染相关并发症增加。本文总结近年来SAP早期免疫抑制的研究热点,为及时识别免疫抑制和免疫干预研究提供参考,减少病程早期和后期的感染并发症,改善患者预后。

Severe acute pancreatitis(SAP)has many challenges in the clinical management of ICU.The severity and prognosis of the disease often depend on the early inflammatory reaction.About 30%of patients die of severe bacterial infection or organ failure.Studies have shown that SAP patients have suffered from systemic immunosuppression and intestinal immune barrier damage in the early course of disease,which may lead to infectious complications such as infectious necrotizing pancreatitis and bacteremia,and is associated with a longer disease course and increased mortality.However,the early immunosuppression of SAP is often ignored in clinic,and the optimal time for treatment is missed,which leads to progressive aggravation of secondary infection.This article summarizes the researches of early immunosuppression SAP in recent years to provide reference for early identification of immunosuppression and timely immune intervention to reduce the infection complications at the early and late stages of the disease course and improve the prognosis of patients.