重症急性胰腺炎肝损伤的研究进展

Research progress in liver injury induced by severe acute pancreatitis

重症急性胰腺炎(severeacute pancreatitis,SAP)是临床常见的急腹症,具有发病急、病情重、进展快等特点。常常引起胰外器官损伤,肝脏是主要受损器官之一,其损害的不断加重可导致胰腺炎病情恶化,甚至导致全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)和多器官功能障碍综合征(multiple organ dysfunction syndrome,MCDS)。肝损伤后主要通过影响毒素代谢、释放大量炎症介质等途径进一步加重全身炎症反应,增加病死率。目前对重症急性胰腺炎肝损伤的发病机制尚无统一确切结论,开展对Kupffer细胞、细胞因子、氧化应激对SAP肝损伤的相关细胞信号调控机制研究,既能发现相应的干预靶点,还能为临床治疗提供新思路。文中就重症急性胰腺炎并发肝损伤的病因及发病机制作一综述。

Severe acute pancreatitis is a common clinical acute abdomen,and has the features of acute onset, severe illness, rapid progress, etc. SAP often causes extrapancreatic organ damage. The liv- er is one of the main damaged organs, and the increased injury of liver will lead to deterioration of pancreatitis,and even lead to systemic inflammatory response syndrome （SIRS） and multiple organ dysfunction syndrome. After liver injury, the systemic inflammatory response is further aggravated by affecting the metabolism of toxins and releasing a large amount of inflammatory mediators,which increases the mortality rate. The Kupffer cells, cytokines and oxidative stress play important roles in the pathogenesis of SAP-associated liver injury. However, the specific pathogenesis of severe acute pancreatitis complicated with liver injury remains uncertain. Therefore, efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in SAP, which could not only identify novel therapeutic targets, but also provide new insight into improving the clinical treatment. Here our review discusses the recent research progress in the etiology, and pathology of liver injury in SAP.