Доказова панкреатологія: що ми знаємо про хронічний панкреатит до 2020 року?
DOI:
https://doi.org/10.30978/MG-2020-3-96Ключові слова:
підшлункова залоза, хронічний панкреатит, зовнішньосекреторна недостатність підшлункової залози, діагностика, лікуванняАнотація
Висвітлено досягнення сучасної панкреатології в галузі патогенезу, динаміки розвитку та лікування хронічного панкреатиту (ХП). Розглянуто дані генетичних досліджень щодо генетичних мутацій, котрі призводять до виникнення ХП. Проаналізовано також генетичні мутації, які спричиняють розвиток раку підшлункової залози (ПЗ). Наведено чинники ризику розвитку автоімунного панкреатиту. Описано особливості супутнього ураження нирок. Представлено концептуальну модель ХП, яка передбачає фазу раннього ХП. Наведено положення Міжнародного консенсусу про ранній ХП і діагностику цієї стадії ХП з використанням як клінічних/функціональних критеріїв, так і візуалізувальних методів досліджень. Розглянуто патофізіологічні особливості фіброгенезу в ПЗ. Проаналізовано результати досліджень особливостей виникнення зовнішньосекреторної недостатності ПЗ (ЗНПЗ), доцільність визначення фекальної еластази‑1 для скринінгу ЗНПЗ. Розглянуто особливості виникнення ЗНПЗ при остеопенії і кардіоваскулярних захворюваннях. Висвітлено нюанси проведення замісної ферментної терапії при стеатозі ПЗ, ожирінні, а також її вплив на якість і тривалість життя хворих на ХП із ЗНПЗ. Описано переваги застосування мінімікросфер в ентеросолюбільній оболонці та можливість купірування клінічних виявів ЗНПЗ, збільшення маси тіла, поліпшення якості життя та його тривалості при проведенні замісної ферментної терапії. Розглянуто оптимальні дози ферментних препаратів при призначенні замісної терапії. Наведено результати рандомізованих досліджень, які доводять ефективність мінімікросферичних препаратів.
Посилання
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