【作者】 胡玲；

【导师】 唐承薇；

【作者基本信息】 四川大学 ， 内科学， 2007， 硕士

【摘要】 研究背景急性胰腺炎(acute pancreatits，AP)是临床常见的疾病，病因多为胆石症和酒精。但胆囊结石患者在接受胆囊摘除术后，仍有部分患者发生急性胰腺炎，由于这些患者多有不同程度的胆总管扩张，其发生急性胰腺炎的病因常难以确定。生长抑素(somatostatin，SST)系内源性抗炎多肽，除其抑制胰酶外，在预防或改善多器官功能障碍中具有重要作用，因此在重症急性胰腺炎(severe acute pancreatitis，SAP)的治疗中得到广泛应用。但在AP或SAP患者外周血中SST发生了怎样的改变?尚未引起关注。目的分析胆囊摘除术后发生AP的原因；探讨SST在轻症或重症急性胰腺炎患者外周血中发生了怎样的改变，外源性补充SST对轻症和重症急性胰腺炎的发展有何作用。方法根据胆囊摘除术后发生急性胰腺炎患者的超声及内镜下逆行胰胆管造影术(endoscopic retrograde holangiopancreatography, ERCP)的结果，分析其病因；利用放射免疫分析法检测MAP或SAP患者外周血中SST水平。结果单纯胆囊摘除术后发生急性胰腺炎患者43例，其中胆总管扩张伴胆总管结石的几率为66.7％(24／36)，与胆总管无扩张时发生胆总管结石的几率(4／7)无显著差别(p＞0.05)，超声未发现结石患者中，十二指肠乳头炎发生率为37.9％(11／29)。急性胰腺炎起病后SAP患者外周血SST水平明显下降，而轻症急性胰腺炎与之相反，血SST水平升高。急性胰腺炎患者血SST水平越低，发生SAP的概率增加。常规剂量SST治疗后24h内所有急性胰腺炎患者血SST水平均有提高，但SAP患者血SST水平上升程度仍低于正常水平。当血SST＜100pg／ml时，对SAP预测的敏感度为72.7％，特异性为77.2％。结论胆囊摘除术后发生急性胰腺炎的病因中以胆总管结石为主，其次为十二指肠乳头炎。急性胰腺炎发生时，如果血SST水平较低，发生重症急性胰腺炎的概率较高，用SST及其类似物治疗急性胰腺炎后，可以提高血SST水平，对于血SST水平显著降低的重症急性胰腺炎应增大剂量。更多还原

【Abstract】 BackgroundAcute pancreatitis(AP) is a common clinical condition withcholelithiasis and alcohol as major causes. Some patients develop acutepancreatitis even after cholecystectomy. The causes are hard to determine asthe patients all have variable dilation of common bile duct.Somatostatin is an endogenous anti-inflammatory polypeptide. Besidesinhibiting pancreatic enzyme, it plays an important role in preventing andimproving multiple organ dysfunction syndrome(MODS),Thus it isextensively applied in the treatment of severe acute pancreatitis(SAP).However, the changes of plasma somatostatin level during mild acutepancreatitis(MAP) or SAP have not been identified.ObjectiveTo analyze etiology of AP in patients status post(s/p) cholecystectomy;To investigate the changes of plasma somatostatin level in differentstages of acute pancreatitis, and the effects on AP with supplementingsomatostatin.. MethodsThe retrospective analysis is based on etiologic studies of AP usingultrasonic exam and endoscopic retrograde cholangiopancreatography(ERCP);The plasma somatostatin levels were measured by radioimmunoassay.ResultsAmong 43 AP patients s/p cholecystectomy, the rate of stone formationwith common bile duct dilation was 66.7%(24/36), whereas the rate of stonefomation patients without common bile duct dilation was 57.1%(4/7).Nosignificant deference is observed between them(p＜0.05). The rate ofduodenal papillitis in patients without cholelithiasis was 37.9% (11/29).The plasma somatostatin level of SAP was remarkably reduced, whilethat of the mild acute pancreatitis was opposite. The lower the plasmasomatostatin level was, the higher the morbidity of SAP was. Within 24hours of somatostatin supplementation, the plasma somatostatin level wasincreased. However that of SAP was still lower than the normal level. Takingplasma-somatostatin-level 100pg/ml as a cut-off for SAP, it has sensibility of72.7%, specificity of 77.2%.ConclusionsThe number one cause of AP in patients s/p cholecystectomy wascommon duct stone, followed by duodenal papillitis.Once AP occurs, the low plasma somatostatin level predicts the highmorbility of SAP. Somatostatin and its analog has a significant effect on SAP, and should be elevated in SAP with low plasma somatostatin levels. Theplasma somatostatin level is a valuable predictive factor of SAP.更多还原