Ключові слова
підшлункова залоза, хронічний панкреатит, зовнішньосекреторна недостатність підшлункової залози, діагностика, лікування.
Як цитувати
Gubergrits, N. B., Byelyayeva, N. V., Lukashevich, G. M., Fomenko, P. G., Berezhnaya, E. V., & Rakhmetova, V. S. (2020). Доказова панкреатологія: що ми знаємо про хронічний панкреатит до 2020 року?. Вісник клубу панкреатологів, 47(2), 19-31. https://doi.org/10.33149/vkp.2020.02.02
Переглядів анотації: 615 Завантажень PDF: 313 Завантажень PDF: 172
Анотація
У статті розкрито досягнення сучасної панкреатології у сфері патогенезу, динаміки розвитку та лікування хронічного панкреатиту (ХП). Розглянуто дані генетичних досліджень, що описують різноманітні генетичні мутації, які призводять до виникнення ХП. Проаналізовано генетичні мутації, які сприяють розвитку не тільки ХП, а також раку підшлункової залози (ПЗ). Перераховано фактори ризику розвитку аутоімунного панкреатиту, описані особливості супутнього ураження нирок. Представлена концептуальна модель ХП, що передбачає фазу раннього ХП. Наведені положення Міжнародного консенсусу з раннього ХП, перераховані критерії діагностики цієї стадії ХП як з використанням клінічних/функціональних критеріїв, так і за допомогою візуалізуючих методів досліджень. Розглянуто патофізіологічні особливості фіброгенезу у ПЗ. Проаналізовано результати досліджень, що описують особливості виникнення зовнішньосекреторної недостатності ПЗ (ЗНПЗ), доцільність визначення фекальної еластази-1 як скринінгу ЗНПЗ. Розглянуто особливості виникнення ЗНПЗ при остеопенії, кардіоваскулярних захворюваннях. Описано нюанси проведення замісної ферментної терапії (ЗФТ) при стеатозі ПЗ, ожирінні, а також впливу ЗФТ на якість і тривалість життя хворих на ХП з ЗНПЗ. Перераховані переваги застосування мінімікросфер у ентеросолюбільній оболонці і можливість нівелювання клінічних проявів ЗНПЗ, збільшення маси тіла, поліпшення якості життя та її тривалості при проведенні ЗФТ. Розглянуто оптимальні дози ферментних препаратів, наведено результати рандомізованих досліджень, які доводять ефективність мінімікросферичних препаратів.
Посилання
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17. Gubergrits N., Malecka-Panas E., Lehman G. A. et al. A 6-month, open-label clinical trial of pancrelipase delayed-release capsules (Creon) in patients with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery. Aliment. Pharmacol. Ther. 2011. Vol. 33, No 10. P. 1152–1161.
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26. Layer P, Kashirskaya N, Gubergrits N. Contribution of pancreatic enzyme replacement therapy to survival and quality of life in patients with pancreatic exocrine insufficiency. World J. Gastroenterol. 2019. Vol. 25, No 20. P. 2430–2441.
27. Lin Y., Tamakoshi A., Hayakawa T., Ogawa M., Ohno Y. Cigarette smoking as a risk factor for chronic pancreatitis: a case-control study in Japan. Research Committee on Intractable Pancreatic Diseases. Pancreas. 2000. Vol. 21. P. 109–114.
28. Löhr J. M., Domínguez-Muñoz E., Rosendahl J. et al. United European Gastroenterology evidence based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterology Journal. 2017. Vol. 5, No 2. P. 153–199.
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