糖皮质激素治疗重症急性胰腺炎的研究进展
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摘要
重症急性胰腺炎(SAP)是消化系统疾病中的常见危急重症之一,其发生发展与机体炎症反应密切相关。在内科综合治疗基础上,有效抑制SAP患者机体炎症反应起重要作用。糖皮质激素(GC)常用于危重患者,但其对SAP的治疗作用一直存在争议。临床上,因GC存在许多不良反应,其使用会降低机体免疫力、加重感染、引发脓毒症,加重病情,所以一直慎用于SAP治疗。但GC能拮抗SAP炎症反应、抑制全身炎症反应综合征的发生发展,从而改善SAP的预后,故引起广泛关注。未来,需进一步深入研究并证实GC治疗SAP的最佳剂量及时机,为临床使用提供充分依据。
Severe acute pancreatitis( SAP) is one of the most serious digestive diseases,and its development is closely related to the body's inflammatory response. Based on comprehensive medical treatment,effective inhibition of the inflammatory response plays a vital role in SAP patients. Glucocorticoids( GC) are commonly used in serious illness patient,but the therapeutic effect of GC on SAP has been controversial. In clinical,because GC has many adverse reactions,such as reducing the body's immunity,aggravating infection,causing sepsis and aggravating the condition,it has been used cautiously in the treatment of SAP. However,GC can antagonize the inflammatory response of SAP,inhibit the occurrence and development of systemic inflammatory response syndrome,thereby improve the prognosis of SAP,therefore has aroused widespread concern. In the future,it is necessary to further study and confirm the optimal dose and timing of GC in the treatment of SAP in order to provide sufficient evidence for the clinical use.
Severe acute pancreatitis( SAP) is one of the most serious digestive diseases,and its development is closely related to the body's inflammatory response. Based on comprehensive medical treatment,effective inhibition of the inflammatory response plays a vital role in SAP patients. Glucocorticoids( GC) are commonly used in serious illness patient,but the therapeutic effect of GC on SAP has been controversial. In clinical,because GC has many adverse reactions,such as reducing the body's immunity,aggravating infection,causing sepsis and aggravating the condition,it has been used cautiously in the treatment of SAP. However,GC can antagonize the inflammatory response of SAP,inhibit the occurrence and development of systemic inflammatory response syndrome,thereby improve the prognosis of SAP,therefore has aroused widespread concern. In the future,it is necessary to further study and confirm the optimal dose and timing of GC in the treatment of SAP in order to provide sufficient evidence for the clinical use.
引文
[1]谢睿,杨晓钟,高成城,等.糖皮质激素治疗重症急性胰腺炎的临床观察[J].江苏医药,2012,33(5):608-609.
[2]Yu M,Yang Z,Zhu Y,et al.Efficacy of glucocorticoids in rodents of severe acute pancreatitis:A meta-analysis[J].Int J Clin Exp Pathol,2014,7(7):3647-3661.
[3]Zhang X,Chen L,Luo L,et al.Study of the protective effects of dexamethasone on ileum mucosa injury in rats with severe acute pancreatitis[J].Pancreas,2008,37(3):e74-82.
[4]尚娟,李鹏飞.大剂量地塞米松在重症急性胰腺炎治疗中的临床应用研究[J].成都医学院学报,2015,10(1):88-90.
[5]糖皮质激素类药物临床应用指导原则(节选)[J].药物不良反应杂志,2011,13(1):40-44.
[6]Ou JM,Zhang XP,Wu CJ,et al.Effects of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis[J].J Zhejiang Univ Sci B,2012,13(11):919-931.
[7]Zhang XP,Chen L,Hu QF,et al.Effects of large dose of dexamethasone on inflammatory mediators and pancreatic cell apoptosis of rats with severe acute pancreatitis[J].World J Gastroenterol,2007,13(41):5506-5511.
[8]Zhang JW,Zhang GX,Chen HL,et al.Therapeutic effect of Qingyi decoction in severe acute pancreatitis-induced intestinal barrier injury[J].World J Gastroenterol,2015,21(12):3537-3546.
[9]Jakkampudi A,Jangala R,Reddy BR,et al.NF-kappaB in acute pancreatitis:Mechanisms and therapeutic potential[J].Pancreatology,2016,16(4):477-488.
[10]周海鸥,余跃,施燕,等.不同剂量乌司他丁对急性胰腺炎患者血清TNF-α,IL-1,IL-6及IL-8水平的影响[J].现代生物医学进展,2017,17(21):4096-4099.
[11]金燕,龚镭,唐学军,等.急性胰腺炎患者血清NF-κB和相关细胞因子表达的变化[J].江苏医药,2014,40(5):559-561.
[12]杨继让,高文平.地塞米松和干扰素α联合应用于重症急性胰腺炎的疗效分析[J].山西职工医学院学报,2014,24(6):32-34.
[13]Dong LH,Liu ZM,Wang SJ,et al.Corticosteroid therapy for severe acute pancreatitis:A meta-analysis of randomized,controlled trials[J].Int J Clin Exp Pathol,2015,8(7):7654-7660.
[14]凌颖.SAP合并急性肺损伤的机制及地塞米松的防治作用研究[D].南充:川北医学院,2012.
[15]邓超.重症急性胰腺炎中微循环障碍的研究进展[J].西南国防医药,2015,25(11):1266-1268.
[16]侯斐,刘瑞霞,阴赪宏.炎症介质在急性胰腺炎微循环障碍中的作用[J].临床和实验医学杂志,2015,14(16):1399-1401.
[17]向瑞清.甲泼尼龙联合奥曲肽治疗重症急性胰腺炎的疗效观察[J].中国医药指南,2014,12(35):205-206.
[18]潘慧波,杨继武.肿瘤坏死因子-α在急性胰腺炎中的作用[J].中国现代医生,2014,52(7):159-160.
[19]谭超超,朱燕,罗文婷,等.内毒素在急性胰腺炎早期炎症反应中的作用[J].中国卫生检验杂志,2016,26(7):974-977.
[20]董瑞,王自法,吕毅,等.早期大剂量地塞米松治疗重症急性胰腺炎的实验研究[J].肝胆外科杂志,2005,13(1):58-60.
[21]Jingmin O,Xiping Z,Chun W,et al.Study of dexamethasone,baicalin and octreotide on brain injury of rats with severe acute pancreatitis[J].Inflamm Res,2012,61(3):265-275.
[22]牟来旭.小剂量糖皮质激素对急性胰腺炎大鼠HMGB-1、TERM-1、MPO、BALF的影响[J].海南医学院学报,2016,22(13):1336-1338,1342.
[23]张桂信,陈海龙,纪军,等.地塞米松对重症急性胰腺炎大鼠胰腺腺泡细胞凋亡的影响[J].现代诊断与治疗,2012,23(5):385-387.
[24]柯华婧.大剂量短程糖皮质激素治疗早期合并全身炎症反应综合征的急性胰腺炎的临床研究[D].南昌:南昌大学,2015.
[25]林宪政,陈玉林.氢化可的松在肾上腺皮质功能不全危重患者治疗中的应用[J/CD].中华损伤与修复杂志(电子版),2010,5(3):397-407.
[26]贺小旭,王旭东.危重症患者肾上腺功能不全[J].中国医刊,2013,48(9):1-4.
[27]谢剑锋,邱海波.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J/CD].中华重症医学电子杂志(网络版),2017,3(1):18-25.
[28]任珊,赵鹤龄.拯救脓毒症运动:2012严重脓毒症和脓毒症休克管理指南要点[J].河北医药,2013,35(8):1233-1236.
[29]杨齐华,秦丽君,郑拓.激素相关性胰腺炎的12例分析[J].现代实用医学,2011,23(3):328-329.
[30]谢鹏雁.糖皮质激素治疗常见消化疾病临床要点[J].中国实用内科杂志,2013,33(10):768-770.
[31]华占楼,孙继妹,谢金春.早期小剂量地塞米松对急性胰腺炎治疗效果的影响[J].内科,2014,9(5):531-533.
[32]蒲光春,杨东.地塞米松及利多卡因预防急性重症胰腺炎致肺损伤的临床观察[J].中国呼吸与危重监护杂志,2003,2(3):192.
[33]中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013,上海)[J].中国实用内科杂志,2013,33(7):530-535.
[34]李亮,曹昌魁,聂时南.小剂量氢化可的松治疗严重脓毒症患者的疗效观察[J].东南国防医药,2016,18(5):455-457,482.
[35]Annane D,Bellissant E,Bollaert PE,et al.Corticosteroids for treating sepsi[J/CD].Cochrane Database Syst Rev,2015(12):CD002243.
[36]程彤,吴志茹,申丽旻,等.《拯救脓毒症运动:2008严重脓毒症和脓毒症休克管理指南》解读(四)糖皮质激素、活化蛋白C和血液制品在脓毒症休克治疗中的应用[J].临床荟萃,2008,23(10):754-756.
[37]Lv QQ,Gu XH,Chen QH,et al.Early initiation of low-dose hydrocortisone treatment for septic shock in adults:A randomized clinical trial[J].Am J Emerg Med,2017,35(12):1810-1814.
[38]郭蒙蒙,马茂源,于小勇,等.短程大剂量甲泼尼龙辅治早期重症急性胰腺炎[J].南昌大学学报(医学版),2016,56(5):70-72.
[39]Annane D,Sébille V,Charpentier C,et al.Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock[J].JAMA,2002,288(7):862-871.
[40]Huh JW,Choi HS,Lim CM,et al.Low-dose hydrocortisone treatment for patients with septic shock:A pilot study comparing 3days with 7days[J].Respirology,2011,16(7):1088-1095.
[41]黄衔,钟志旭,陈明武,等.早期小剂量甲泼尼龙治疗高脂血症性中度重症急性胰腺炎疗效观察[J].中华胰腺病杂志,2017,17(4):267-269.
[42]罗文杰.急性胰腺炎早期糖皮质激素干预的临床研究[J].中外医学研究,2018,16(1):161-163.
[2]Yu M,Yang Z,Zhu Y,et al.Efficacy of glucocorticoids in rodents of severe acute pancreatitis:A meta-analysis[J].Int J Clin Exp Pathol,2014,7(7):3647-3661.
[3]Zhang X,Chen L,Luo L,et al.Study of the protective effects of dexamethasone on ileum mucosa injury in rats with severe acute pancreatitis[J].Pancreas,2008,37(3):e74-82.
[4]尚娟,李鹏飞.大剂量地塞米松在重症急性胰腺炎治疗中的临床应用研究[J].成都医学院学报,2015,10(1):88-90.
[5]糖皮质激素类药物临床应用指导原则(节选)[J].药物不良反应杂志,2011,13(1):40-44.
[6]Ou JM,Zhang XP,Wu CJ,et al.Effects of dexamethasone and Salvia miltiorrhiza on multiple organs in rats with severe acute pancreatitis[J].J Zhejiang Univ Sci B,2012,13(11):919-931.
[7]Zhang XP,Chen L,Hu QF,et al.Effects of large dose of dexamethasone on inflammatory mediators and pancreatic cell apoptosis of rats with severe acute pancreatitis[J].World J Gastroenterol,2007,13(41):5506-5511.
[8]Zhang JW,Zhang GX,Chen HL,et al.Therapeutic effect of Qingyi decoction in severe acute pancreatitis-induced intestinal barrier injury[J].World J Gastroenterol,2015,21(12):3537-3546.
[9]Jakkampudi A,Jangala R,Reddy BR,et al.NF-kappaB in acute pancreatitis:Mechanisms and therapeutic potential[J].Pancreatology,2016,16(4):477-488.
[10]周海鸥,余跃,施燕,等.不同剂量乌司他丁对急性胰腺炎患者血清TNF-α,IL-1,IL-6及IL-8水平的影响[J].现代生物医学进展,2017,17(21):4096-4099.
[11]金燕,龚镭,唐学军,等.急性胰腺炎患者血清NF-κB和相关细胞因子表达的变化[J].江苏医药,2014,40(5):559-561.
[12]杨继让,高文平.地塞米松和干扰素α联合应用于重症急性胰腺炎的疗效分析[J].山西职工医学院学报,2014,24(6):32-34.
[13]Dong LH,Liu ZM,Wang SJ,et al.Corticosteroid therapy for severe acute pancreatitis:A meta-analysis of randomized,controlled trials[J].Int J Clin Exp Pathol,2015,8(7):7654-7660.
[14]凌颖.SAP合并急性肺损伤的机制及地塞米松的防治作用研究[D].南充:川北医学院,2012.
[15]邓超.重症急性胰腺炎中微循环障碍的研究进展[J].西南国防医药,2015,25(11):1266-1268.
[16]侯斐,刘瑞霞,阴赪宏.炎症介质在急性胰腺炎微循环障碍中的作用[J].临床和实验医学杂志,2015,14(16):1399-1401.
[17]向瑞清.甲泼尼龙联合奥曲肽治疗重症急性胰腺炎的疗效观察[J].中国医药指南,2014,12(35):205-206.
[18]潘慧波,杨继武.肿瘤坏死因子-α在急性胰腺炎中的作用[J].中国现代医生,2014,52(7):159-160.
[19]谭超超,朱燕,罗文婷,等.内毒素在急性胰腺炎早期炎症反应中的作用[J].中国卫生检验杂志,2016,26(7):974-977.
[20]董瑞,王自法,吕毅,等.早期大剂量地塞米松治疗重症急性胰腺炎的实验研究[J].肝胆外科杂志,2005,13(1):58-60.
[21]Jingmin O,Xiping Z,Chun W,et al.Study of dexamethasone,baicalin and octreotide on brain injury of rats with severe acute pancreatitis[J].Inflamm Res,2012,61(3):265-275.
[22]牟来旭.小剂量糖皮质激素对急性胰腺炎大鼠HMGB-1、TERM-1、MPO、BALF的影响[J].海南医学院学报,2016,22(13):1336-1338,1342.
[23]张桂信,陈海龙,纪军,等.地塞米松对重症急性胰腺炎大鼠胰腺腺泡细胞凋亡的影响[J].现代诊断与治疗,2012,23(5):385-387.
[24]柯华婧.大剂量短程糖皮质激素治疗早期合并全身炎症反应综合征的急性胰腺炎的临床研究[D].南昌:南昌大学,2015.
[25]林宪政,陈玉林.氢化可的松在肾上腺皮质功能不全危重患者治疗中的应用[J/CD].中华损伤与修复杂志(电子版),2010,5(3):397-407.
[26]贺小旭,王旭东.危重症患者肾上腺功能不全[J].中国医刊,2013,48(9):1-4.
[27]谢剑锋,邱海波.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J/CD].中华重症医学电子杂志(网络版),2017,3(1):18-25.
[28]任珊,赵鹤龄.拯救脓毒症运动:2012严重脓毒症和脓毒症休克管理指南要点[J].河北医药,2013,35(8):1233-1236.
[29]杨齐华,秦丽君,郑拓.激素相关性胰腺炎的12例分析[J].现代实用医学,2011,23(3):328-329.
[30]谢鹏雁.糖皮质激素治疗常见消化疾病临床要点[J].中国实用内科杂志,2013,33(10):768-770.
[31]华占楼,孙继妹,谢金春.早期小剂量地塞米松对急性胰腺炎治疗效果的影响[J].内科,2014,9(5):531-533.
[32]蒲光春,杨东.地塞米松及利多卡因预防急性重症胰腺炎致肺损伤的临床观察[J].中国呼吸与危重监护杂志,2003,2(3):192.
[33]中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013,上海)[J].中国实用内科杂志,2013,33(7):530-535.
[34]李亮,曹昌魁,聂时南.小剂量氢化可的松治疗严重脓毒症患者的疗效观察[J].东南国防医药,2016,18(5):455-457,482.
[35]Annane D,Bellissant E,Bollaert PE,et al.Corticosteroids for treating sepsi[J/CD].Cochrane Database Syst Rev,2015(12):CD002243.
[36]程彤,吴志茹,申丽旻,等.《拯救脓毒症运动:2008严重脓毒症和脓毒症休克管理指南》解读(四)糖皮质激素、活化蛋白C和血液制品在脓毒症休克治疗中的应用[J].临床荟萃,2008,23(10):754-756.
[37]Lv QQ,Gu XH,Chen QH,et al.Early initiation of low-dose hydrocortisone treatment for septic shock in adults:A randomized clinical trial[J].Am J Emerg Med,2017,35(12):1810-1814.
[38]郭蒙蒙,马茂源,于小勇,等.短程大剂量甲泼尼龙辅治早期重症急性胰腺炎[J].南昌大学学报(医学版),2016,56(5):70-72.
[39]Annane D,Sébille V,Charpentier C,et al.Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock[J].JAMA,2002,288(7):862-871.
[40]Huh JW,Choi HS,Lim CM,et al.Low-dose hydrocortisone treatment for patients with septic shock:A pilot study comparing 3days with 7days[J].Respirology,2011,16(7):1088-1095.
[41]黄衔,钟志旭,陈明武,等.早期小剂量甲泼尼龙治疗高脂血症性中度重症急性胰腺炎疗效观察[J].中华胰腺病杂志,2017,17(4):267-269.
[42]罗文杰.急性胰腺炎早期糖皮质激素干预的临床研究[J].中外医学研究,2018,16(1):161-163.