中国普外基础与临床杂志

中国普外基础与临床杂志

慢性胰腺炎时胰腺内、外分泌功能不全的发生机制及处理

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目的 总结慢性胰腺炎时胰腺内、外分泌功能不全的发生机制及处理方法的研究进展。 方法 检索近年来国内外有关慢性胰腺炎时胰腺内、外分泌功能不全研究的相关文献并对其研究进展作一综述。 结果 近几年对慢性胰腺炎时出现胰腺内、外分泌功能不全有了很多新的研究和发现。慢性胰腺炎时胰腺外分泌功能不全的发生机制主要是因为患者胰酶分泌减少;胰腺内分泌功能不全的发生机制主要是由于慢胰时胰腺外分泌腺体及胰岛组织的损伤导致胰腺内分泌细胞、其他内分泌细胞的破坏以及肠-胰岛轴紊乱,继而出现各种激素(胰岛素、胰高血糖素、胰多肽等)的紊乱,最终表现出糖耐量异常或显性糖尿病。当前的治疗方法胰腺外分泌功能不全包括针对病因治疗、饮食调节及胰酶替代治疗;胰腺内分泌功能不全应提倡使用动态血糖监测系统,2 型糖尿病的管理治疗方案可以用于慢性胰腺炎糖尿病,强化胰岛素治疗方案仍是慢性胰腺炎糖尿病的首选。 结论 目前虽然对慢性胰腺炎时胰腺内、外分泌功能不全已经有了一定程度的了解,但其有关发病机制、诊疗方案尚无突破性的进展,缺乏大样本、多中心的临床对照研究的疗效,探索更加优化的检测手段,建立完善的治疗体系,是未来的发展趋势及研究的重点。

Objective To summarizecurrent research advances of mechanism and treatment of pancreatic endocrine and exocrine insufficiency in chronic pancreatitis. Methods The related literatures about the research progress of the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis in recent years were retrieve and review. Results In recent years, it had been many new studies and discoveries on the pancreatic endocrine and exocrine insufficiency in the chronic pancreatitis. The mechanism of the pancreatic exocrine dysfunction was mainly due to the decrease of the pancreatin secretion in the patients with chronic pancreatitis. The mechanism of the pancreatic endocrine insufficiency was mainly due to the damage of the pancreatic exocrine gland and islet tissue in the chronic pancreas, which leaded to the destruction of the pancreatic endocrine cells, the other endocrine cells, and the disturbance of intestine-islet axis, followed by the disorder of the various hormones (insulin, glucagon, pancreatic polypeptide, etc.), and eventually manifested the glucose tolerance or dominant diabetes. Conclusion At present, although there was a certain degree understanding for pancreatic and exocrine insufficiency in chronic pancreatitis, there are no breakthroughs in its mechanism and treatment, and effect is lack of large sample and multicenter clinical control study. Exploring more optimized detection methods and establishing a perfect treatment system isgoal of future development and research.

关键词: 慢性胰腺炎; 内分泌功能不全; 外分泌功能不全; 发生机制

Key words: chronic pancreatitis; endocrine insufficiency; exocrine insufficiency; mechanism

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