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成人慢性胰腺炎的临床表现和诊断

Author
Steven D Freedman, MD, PhD
Section Editor
David C Whitcomb, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

引言

慢性胰腺炎是一种胰腺的慢性进展性炎症改变的综合征，导致胰腺结构永久性损害，引起外分泌和内分泌功能不全[1]。虽然这种疾病与急性胰腺炎(一种损伤胰腺的急性炎症反应，且通常为非进展性)不同，但两者可能重叠。急性胰腺炎反复发作，可能随着时间推移发展为慢性胰腺炎。

急、慢性胰腺炎可通过几个特征进行区分。

  • 慢性胰腺炎可长时间无症状，可表现为纤维化肿块或可能有胰腺功能不全症状而不伴腹痛。急性胰腺炎几乎都有腹痛。
  • 慢性胰腺炎患者的血清淀粉酶和脂肪酶水平基本在正常范围，但是急性胰腺炎患者的这两项指标几乎总会升高。
  • 形态学方面，慢性胰腺炎表现为斑片状、局灶性改变，其特征为单个核细胞浸润和纤维化(图片 1)。而急性胰腺炎会弥漫性侵袭整个胰腺的大部分，以中性粒细胞为主的炎症反应。

本专题将讨论慢性胰腺炎的临床特征和诊断。该疾病成人患者的病因、发病机制、并发症和治疗将单独讨论。 (参见“急性胰腺炎的病因”和“慢性胰腺炎的治疗”)

临床表现

慢性胰腺炎的两种主要临床表现为腹痛和胰腺功能不全。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-02.
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