N-乙酰半胱氨酸治疗中度重症急性胰腺炎临床疗效观察

目的 探讨N-乙酰半胱氨酸（NAC）治疗中度重症急性胰腺炎（MSAP）的有效性.方法 将38例中度重症胰腺炎患者随机分为N-乙酰半胱氨酸治疗组和常规治疗组,每组19例,N-乙酰半胱氨酸治疗组在常规治疗的基础上加用N-乙酰半胱氨酸,静脉滴注7天,观察N-乙酰半胱氨酸治疗前和治疗7天后的急性生理与慢性健康评分（APACHE-Ⅱ）、血清白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α、C反应蛋白（CRP）、超氧化物歧化酶（SOD）等指标水平和住院时间.结果 N-乙酰半胱氨酸治疗组在治疗7天后APACHEⅡ评分、CT严重指数、血清IL-6、TNF-α和CRP明显低于常规治疗组（P＜0.05）,SOD值明显高于常规治疗组（P＜0.05）.结论 N-乙酰半胱氨酸治疗MSAP时能有效减轻炎症反应.     

Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)

Acute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diag...     

Prediction of moderately severe and severe acute pancreatitis in pregnancy: Several issues

We reviewed a study addressing the development and validation of a prediction model for moderately severe and severe acute pancreatitis in pregnancy. We identified some statistical deficiencies in this article. In addition, we believe that the role of cholesterol as a predictor should be described in more detail.     

重症急性胰腺炎治疗研究进展

重症急性胰腺炎是一种累及多种脏器的全身性疾病,并发症多,病死率高.由于病情的复杂性,其治疗方法涉及内科、外科、中医和内镜治疗等方面,在选择治疗方法时需要判断患者的病情,给予全面综合及个体化治疗.本文就重症急性胰腺炎各类治疗措施的研究进展及治疗的新观念作一综述.     

Development and validation of a prediction model for moderately severe and severe acute pancreatitis in pregnancy

BACKGROUNDThe severity of acute pancreatitis in pregnancy (APIP) is correlated with higher risks of maternal and fetal death.AIMTo develop a nomogram that could predict moderately severe and severe acute pancreatitis in pregnancy (MSIP).METHODSPatients with APIP admitted to West China Hospital between January 2012 and December 2018 were included in this study. They were divided into mild acute pancreatitis in pregnancy (MAIP) and MSIP. Characteristic parameters and laboratory results were collected. The training set and test set were randomly divided at a ratio of 7:3. Least absolute shrinkage and selection operator regression was used to select potential prognostic factors. A nomogram was developed by logistic regression. A random forest model was used to validate the stability of the prediction factors. Receiver operating characteristic curves and calibration curves were used to evaluate the model’s predictive performance. RESULTSA total of 190 patients were included in this study. A total of 134 patients (70.5%) and 56 patients (29.5%) were classified as having MAIP and MSIP, respectively. Four independent predictors (lactate dehydrogenase, triglyceride, cholesterol, and albumin levels) were identified for MSIP. A nomogram prediction model based on these factors was established. The model had areas under the curve of 0.865 and 0.853 in the training and validation sets, respectively. The calibration curves showed that the nomogram has a good consistency. CONCLUSIONA nomogram including lactate dehydrogenase, triglyceride, cholesterol, and albumin levels as independent predictors was built with good performance for MSIP prediction.     

临床指南公布对急性心肌梗死患者早期住院治疗及预后影响

目的评价我国2001年12月中华医学会心血管病学分会等制订的急性心肌梗死(AMI)诊断和治疗指南(简称2001年指南)公布对AMI患者住院早期治疗及预后的影响.方法回顾性研究我院1998-01-2000-12、2003-01-2005-12两个不同时期住院的所有AMI病例,依据我国指南公布时间将患者分为两组,A组(1998-01-2000-12:指南公布前组)、B组(2003-01-2005-12:指南公布后组).结果共有780例患者入选,A组347例,B组433例.指南公布前后两组AMI患者的临床特征比较无统计学差异(P均>0.05).指南公布后患者早期再灌注治疗率(66.42%vs48.43%,P<0.001)和住院期间β受体阻滞剂(BB)(40.92%vs75.29%,P<0.001)、血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻断剂(ARB)类药物(40.34%vs72.98%,P<0.001)、他汀类药物(26.22%vs67.90%,P<0.001)和肝素(59.94%vs88.91%,P<0.05)等药物的使用率均较指南发布前增加,差异有统计学意义;硝酸酯类和抗血小板药物的使用率与指南发布前比较也有所增加,但差异未达统计学意义(P均>0.05);指南公布后住院期间梗死后心绞痛、心力衰竭、心室颤动发生率和病死率较发布前明显降低(分别为27.71%vs41.50%,P<0.001;17.55%vs31.12%,P<0.001;6.00%vs11.82%,P<0.05;6.47%vs11.82%,P<0.05);心源性休克、梗死延展或再梗死也有所降低,但未达显著统计学差异(6.24%vs8.65%,P>0.05;1.39%vs2.88%,P>0.05).结论我国急性心肌梗死诊断和治疗指南对我院AMI患者住院早期治疗影响显著,治疗较前趋于规范化,并显著降低了住院期间一些并发症的发生率和病死率.     

Increase in serum chloride and chloride exposure are associated with acute kidney injury in moderately severe and severe acute pancreatitis patients

Objective

We aimed to evaluate whether early (first 48?h) hyperchloremia and/or the change of serum chloride concentration are associated with acute kidney injury (AKI) in patients with moderately severe and severe acute pancreatitis (MSAP and SAP).

善得定治疗急性胰腺炎临床对照分析

目的 探讨善得定治疗急性胰腺炎的临床疗效。方法 将34例急性胰腺炎患者随机分为2组,17例用善得定每小时25μg,另17例不用善得定,对照临床症状改善情况及Ranson预后指标。结果 善得定治疗组中腹痛完全消失者较多,镇痛药应用较少,且48h后不良预后指标较少,包括血球压积降低10％以上和血钙＜8mg/dL的患者显著少于对照组。结论 用善得定治疗急性胰腺炎可减轻症状,减少并发症,并防止病情恶化。     

Indications for surgery in severe acute pancreatitis

The decision to operate on a patient with severe acute pancreatitis is often difficult and requires mature clinical judgment. Those indications that are widely accepted include:

急性胰腺炎787例分析

目的分析急性胰腺炎(acute pancreatitis,AP)的病因、诊断及治疗。方法回顾性分析武汉市中心医院2008年1月-2013年5月收治的787例AP患者的临床资料。结果 787例患者中重症急性胰腺炎(SAP)136(17.28%)例,轻症急性胰腺炎(MAP)651(82.72%)例;两组中发病原因均以胆源性多见。手术治疗121例,内镜下治疗113例,余552例经药物综合治疗,762(96.8%)例治愈或好转,共死亡25例,其中SAP组12例,MAP组13例。结论针对AP病因、分型在综合治疗的基础上采用个体化治疗方案可以有效降低死亡率、提高治愈率。     

Peritoneal lavage with aprotinin in patients with severe acute pancreatitis

Summary Conclusion Although high-dose aprotinin given intraperitoneally to patients with severe acute pancreatitis seems to inhibit activated trypsin in the peritoneal cavity, the treatment has little effect on the balance between proteases and antiproteases. Plasma levels of leukocyte proteases were high in all the patients, indicating leukocyte activation to be an important feature of the pathophysiology of severe acute pancreatitis. A surprise finding was that the patients had higher peritoneal levels of pancreatic secretory trypsin inhibitor (PSTI) after the lavage procedure. Background Although most studies have shown protease inhibitor therapy to have little or no effect on acute pancreatitis, in an earlier study we found that very high doses of the protease inhibitor aprotinin given intraperitoneally to patients with severe acute pancreatitis seemed to reduce the need of surgical treatment for pancreatic necrosis. In the present study we have further analyzed plasma and peritoneal samples from the same patients to ascertain whether the aprotinin treatment affects the balance between proteases and endogenous antiproteases. Methods In a prospective double-blind randomized multicenter trial, 48 patients with severe acute pancreatitis were treated with intraperitoneal lavage. One group (aprotinin group,n=22) was also treated with high doses (20 million KIU given over 30 h) of aprotinin intraperitoneally. The remaining 26 patients made up the control group. The protease-antiprotease balance was studied by measuring immunoreactive anionic trypsin (irAT), cationic trypsin (irCT), complexes between cationic trypsin and alpha 1-protease inhibitor (irCT-α1PI), leukocyte elastase and neutrophil proteinase 4 (NP4), as well as the endogenous protease inhibitors, pancreatic secretory trypsin inhibitor (PSTI), alpha 2-macroglobulin (α 2M), alpha 1-protease inhibitor (α 1PI), antichymotrypsin (ACHY), and secretory leukocyte protease inhibitor (SLPI). Intraperitoneal levels were studied before and after the lavage procedure, and plasma levels were followed for 21 d. Results The control group had lower plasma levels of SLPI and analysis of peritoneal fluid showed the reduction of irCT-α 1PI to be more pronounced in the aprotinin group. None of the other variables measured differed significantly between the two groups. All patients had very high levels of leukocyte elastase and NP4 both in peritoneal exudate and in plasma. Peritoneal levels of PSTI were higher after the lavage procedure in contrast to the other measured variables that all showed lower peritoneal levels after the lavage.     

连续性静脉-静脉血液滤过在重症胰腺炎治疗中的价值

目的 观察在传统治疗重症急性胰腺炎(SAP)的同时行连续性静脉-静脉血液滤过(CVVH)的疗效。方法 53例SAP患者在接受传统治疗的同时行CVVH,每次至少持续24h。监测CVVH前后病情及血清淀粉酶、脂肪酶的变化,行动脉血气分析和APACHlE Ⅱ评分,测血中内毒素水平。结果 CVVH治疗后患者心动过速、呼吸窘迫、腹痛、腹胀等症状明显缓解,APACHEⅡ评分明显降低,淀粉酶、脂肪酶、尿素氮、肌酐明显降低,酸中毒、低氧血症纠正。CVVH治疗6h后,血中内毒素水平下降,24h后又恢复至治疗前的水平。53例患者中38例痊愈出院,存活率为71．7％。结论 在传统治疗SAP的同时行CVVH,能提高抢救的成功率,降低病死率。     

Effectiveness and therapeutic value of phytochemicals in acute pancreatitis: A review

BackgroundAcute pancreatitis (AP) is an inflammatory disorder of the pancreas that can lead to local and systemic complications. Repeated attacks of AP can lead to chronic pancreatitis, which markedly increases the probability of developing pancreatic cancer. Although many researchers have attempted to identify the pathogenesis involved in the initiation and aggravation of AP, the disease is still not fully understood, and effective treatment is limited to supportive therapy.MethodsWe aim to summarize available literature focused on phytochemicals (berberine, chlorogenic acid, curcumin, emblica officinalis, ellagic acid, cinnamtannin B-1, resveratrol, piperine and lycopene) and discuss their effectiveness and therapeutic value for improving AP.ResultsThis study is based on pertinent papers that were retrieved by a selective search using relevant keywords in PubMed and ScienceDirect databases.ConclusionsMany phytochemicals hold potential in improving AP symptoms and may be a valuable and effective addition to standard treatment of AP. It has already been proven that the crucial factor for reducing the severity of AP is stimulation of apoptosis along with/or inhibition of necrosis. Supplementation of phytochemicals, which target the balance between apoptosis and necrosis can be recommended in ongoing clinical studies.     

高脂血症性急性胰腺炎与胆源性胰腺炎的临床对比分析

目的对比分析高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis,HLAP）与急性胆源性胰腺炎（acute biliary pancreatitis,ABP）的临床特点。方法回顾性对比分析我院2005年8月～2010年8月间收治的28例HLAP和64例ABP患者的临床资料。结果 HLAP组BMI、重症患者比例、Ranson评分≥3、CT分级为D、E及APACHEII≥8分者均较ABP组高（P〈0.05）。HLAP组血清TG、GLU、UA均显著高于ABP组,而ALT、AKP、TBIL、DBIL及血AMY均显著低于ABP组（P〈0.05）。两组患者平均住院时间无统计学差异（P〉0.05）。HLAP组患者死亡率为14.3%）,显著高于ABP组的1.5%（P〈0.05）。结论与ABP组相比,HLAP组通常病情较重,多为SAP且常不伴有血淀粉酶的显著升高,且死亡率高。     

川芎嗪诱导急性胰腺炎胰腺细胞凋亡及其机制的初步研究

目的研究川芎嗪（tetramethylpyrazine,TMP）对大鼠急性胰腺炎（acutepancreatitis,AP）的治疗作用,并探讨川TMP治疗AP的机理。方法采用腹腔内注射蛙皮素制备急性水肿型胰腺炎（acuteedematouspancreatitis,AEP）模型,腹腔内注射TMP,端口标记法（triphosphate-biotinnick-endlabeling,TUNEL）检测胰腺腺泡细胞凋亡,免疫组化法检测Bax基因表达,同时观察IL-6、TNF-α、CRP、AMY等变化,并进行胰腺组织形态学检查。结果采用蛙皮素腹腔注射造成AEP,发现AEP胰腺存在明显细胞凋亡。TMP可以抑制IL-6、TNF-α、CRP等表达,上调促凋亡基因Bax的表达,诱导AEP胰腺细胞凋亡。结论TMP对AEP有明显疗效,其机制与降低IL-6、TNF-α含量,抑制CRP等表达,上调促凋亡基因Bax表达,促进胰腺细胞凋亡有关。     

Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

BackgroundUnwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis.MethodsFour methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals.ResultsThe systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy.ConclusionsThe authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making.     

Inflammation and immunosuppression in severe acute pancreatitis

Acute pancreatitis(AP) is a common disease,which usually exists in its mild form.However,in a fifth of cases,the disease is severe,with local pancreatic complications or systemic organ dysfunction or both.Because the development of organ failure is the major cause of death in AP,early identification of patients likely to develop organ failure is important.AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas.Destruction of the pancreatic parenchyma first indu...     

Different profiles of cytokine expression during mild and severe acute pancreatitis

AIM:To study secretion patterns of proand anti-in-flammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.METHODS: We have conducted a prospective obser-vational study. One hundred and eight patients with a diagnosis of acute pancreatitis and onset of the disease within last 72 h were included in this study. The mRNA expression of 25 different types of cytokines in white blood cells was determined by quantitative real time polymerase chain reaction. Levels of 8 dif...