中国普外基础与临床杂志

中国普外基础与临床杂志

免疫应答在重症急性胰腺炎相关感染中的作用

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目的 总结免疫应答在重症急性胰腺炎(SAP)并发感染中的作用及研究进展,为给予 SAP 适当的免疫靶向治疗提供依据。 方法 对近年来免疫应答在 SAP 并发感染中作用的研究进展进行综述。 结果 SAP 早期胰腺损伤导致免疫激活,一方面炎症细胞大量聚集并释放炎性因子而引发级联炎症反应,另一方面机体代偿性地释放抗炎因子来对抗级联炎症反应过程中产生的炎症因子,随后抗炎因子释放而引起代偿性抗炎反应综合征,此时机体呈免疫抑制状态,从而使感染发生率明显增加。 结论 代偿性抗炎反应综合征是 SAP 发生感染的主要原因之一。目前,SAP 的治疗以补液、禁食、肠外营养等对症支持治疗为主。若能针对 SAP 发生感染的免疫机制进行相对应的免疫治疗,即早期给予适当的免疫抑制治疗同时动态监测机体免疫系统状态,当机体免疫状态趋于抑制时适当的免疫刺激疗法将有可能降低 SAP 的病死率并改善其预后。

Objective To summarize progress of immune response in severe acute pancreatitis (SAP) and to provide a basis for appropriate immunotheraphy. Method The relevant literatures about the effect of immune response in the SAP with infectious complications in recent years were reviewed. Results The inflammatory cascade reaction occurred in the early stage of SAP. Subsequently, the compensatory anti-inflammatory response syndrome (CARS) arised and immune response of the organism was suppressed. At this stage, the rate of infection was higher than before. Conclusions CARS is one of major reasons in SAP with infectious complications. At present, fluid infusion, fasting, parenteral nutrition and like are major therapies in SAP. If corresponding immunotherapy could be carried out according to immune mechanism of SAP infection, that is, early appropriate immunosuppressive therapy and dynamic monitoring of body's immune system state should be performed, when it is found that immunosuppression is present, appropriate immunostimulus therapy will be possible to reduce mortality of SAP and improve its prognosis.

关键词: 重症急性胰腺炎; 感染; 免疫抑制; 预后

Key words: severe acute pancreatitis; infection; immunosuppression; prognosis

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