急性胰腺炎中微循环障碍相关研究进展

Advances of microcirculatory disturbance in acute pancreatitis

急性胰腺炎(acute pancreatitis,AP)是由多种炎症因子异常激活而引起胰腺损伤的多因子疾病,以胰腺水肿、坏死为主要特征,可导致胰腺局部甚至系统性炎症。急性胰腺炎作为临床上消化系统疾病中常见的急危重症之一,因其起病急、病情重、易合并多器官功能障碍,且发病率有逐年升高的趋势,重症患者病死率较高等原因而受到广大学者们的极大重视。然而,其病因和发病机制至今尚未完全明确。传统的观点认为胰腺的自身消化、机体的过度炎症反应、全身微循环障碍以及肠道菌群易位与急性胰腺炎的发生和发展密切相关。近年来,从微循环障碍角度探索其发病机制逐渐成为研究热点之一。机体微血管的结构和功能改变、血液流变学改变以及血管活性介质的释放等在急性胰腺炎微循环障碍的发生、发展中起着重要作用,各因素之间既相互独立又相互渗透,共同促进急性胰腺炎的发生和发展。急性胰腺炎虽原发病灶位于胰腺,却能造成肠道、肝脏、肾脏、肺等全身多脏器功能损伤,而微循环障碍则是导致胰腺以及胰外脏器损伤的重要原因。本文就急性胰腺炎微循环障碍发生的机制及全身主要脏器微循环障碍的相关研究进展予以综述,以期为广大学者对急性胰腺炎微循环障碍相关研究提供一个基本的认识,进而寻求广大学者对急性胰腺炎微循环障碍的机制进行更加深入的研究,为众多的急性胰腺炎患者带来福音。

Acute pancreatitis（AP） is an inflammatory disease of the pancreas, characterized by the activation of various inflammatory factors, followed by local inflammation of pancreas, and some serious patients can occur in systemic inflam- matory response syndrome（SIRS）. As one of the most common acute and severe diseases in digestive system diseases, AP has been received much attention because of its rapid onset, severe illness, easily complicated with multiple organ dysfunc- tion, and there is an increasing trend in the incidence, causes higher mortality in critically ill patients. However the etiolo- gy and pathogenesis of AP has not yet been fully clarified. The traditional view is that there is a close correlation between the pancreas self digestion,the body＇ s excessive inflammatory response,systemic microcirculation disturbance and intesti- nal flora translocation and the occurrence and development of acute pancreatitis. In recent years, it has gradually become one of the hottest spots to explore its pathogenesis from the point of view of microcirculation disturbance. The changes of microvascular structure and function, blood rheology and release of vasoactive mediators play an important role in the oc- currence and development of microcireulatory disturbance in acute pancreatitis. Various factors separately and jointly pro- mote the initiation and progression of the disease. Although acute pancreatitis originated in the pancreas,it can cause mul- tiple organ damage, and the disturbance of microcirculation is the important cause of the injury of the pancreas and the ex- ternal organs. In this review, the advances of mechanism of microcirculation disturbance in acute pancreatitis and the relat- ed microcirculation disturbance of main organs are reviewed in order to provide a basic understanding for the majority of scholars on the microcirculation disturbance in acute pancreatitis related research, then seek the exact nlechanism of mi- crocirculation disturbance in acute pancreatitis,to bring the gospel to many of the patients with acute pancreatitis.