胰腺炎相关急性呼吸窘迫综合征发病机制的研究进展

Advances in the pathogenesis of pancreatitis-related acute respiratory distress syndrome

持续恶化的器官功能衰竭是导致急性胰腺炎(acute pancreatitis,AP)尤其是重症急性胰腺炎(severe acute pancreatitis,SAP)患者死亡的主要决定因素之一,其中急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)为SAP最常见、最严重的并发症之一。近年来,国内外学者致力于SAP相关ARDS发病机制、预测及诊治等方面的研究,虽然对细胞因子的释放、细菌内毒素移位、肠-淋巴-肺轴等众多导致肺损伤的机制有了新的认识,也试图通过应用各种评分系统、细胞因子水平和肺超声等手段早期预测SAP时ARDS的发生、发展,但仍需更多的临床研究对其有效性进行验证。总之,就其机制而言,SAP并发的ARDS与其他原因所致ARDS并无明显不同,SAP时胰腺局部病变通过胰酶激活、炎症介质释放等多种方式造成肺损伤,最终导致ARDS甚至多器官功能衰竭(multiple organ failure,MOF)的发生。本文就SAP相关ARDS发病机制方面的研究进展进行综述。

The worsening organ failure is one of the main determinants for the death of patients with acute pancreatitis(AP),especially severe acute pancreatitis(SAP),among which acute respiratory distress syndrome(ARDS)is one of the most common and serious complications of SAP.In recent years,although we have gained the new understanding on many mechanisms in the pathogenesis,prediction,diagnosis and treatment of SAP-related ARDS,such as cytokine release,bacterial endotoxin translocation and lung injury caused by intestinal-lymphatic-lung axis,and try to predict the occurrence and development of ARDS during SAP by using various scoring systems,cytokine levels and lung ultrasound,but more clinical studies are needed to verify its effectiveness.In conclusion,the pathogenesis of ARDS caused by SAP is not significantly different from that caused by other causes.Pancreatitis can cause lung injury by trypsin activation,the release of inflammatory mediators and other ways,and eventually lead to ARDS and even multiple organ failure(MOF).This article reviews the recent progress in the pathogenesis of SAP-related ARDS.