目的:探讨慢性胰腺炎致胰管结石的可能发病机制.方法:从2000年8月至2008年10月将我科收治的67例慢性胰腺炎、62例胰管结石及43例胰腺外伤的手术病例分成3组,术前采用计算机断层扫描(CT)或逆行胰胆管造影(ERCP)检查明确诊断,经手术探查及活检证实,并抽取胰液检查胰石蛋白(PSP)、乳铁蛋白(LF)和钙离子(Ca2+)浓度.结果:慢性胰腺炎(CP组)者仅有胰腺缩小变硬、表面呈结节状改变、胰管扩张,胰管结石(PS组)者除此之外,扩张的胰管内有大小不一形态各异的结石,胰腺外伤(PI组)病例示胰腺不同部位、不同程度的断裂伤,胰周积液或积血.与对照组(PI组)相比,PS组、CP组的PSP浓度均明显升高(P<0.05),且CP组升高更明显,LF及Ca2+浓度亦明显升高(P<0.05),但PS组升高更明显.结论:慢性胰腺炎至胰管结石的发展过程中,胰液中PSP浓度降低、LF及Ca2+浓度增加可能起着非常重要的作用.%Objective To determine the possible mechanism for chronic pancreatitis causing pancreatic duct stones. Methods A total of 172 patients with chronic pancreatitis (n=67) , pan-creatic duct stones (n=62) , and pancreatic injury (n=43) , admitted to from August 2000 to October 2008, preoperatively diagnosed by endoscopic retrograde cholangiopancreatograpby (ERCP) or computed tomography (CT) , and intraoperatively confirmed by exploration and biopsy, were divid-ed into 3 groups. Pancreatic fluid was drawn to test the concentrations of pancreatic stone protein (PSP), lactoferrin (LF) and Ca2+. Results The chronic pancreatitis (the CP group) presented hard consistency, shrinkage and nodular fibrosis of the pancreas; besides the above symptoms, the pancreatic duct stones (the PS group) presented dilatation of the pancreatic ductal system with vari-ous stones ; pancreatic injury (the PI group) presented broken pancreas of different grades with fluid or blood. Compared with that of the PI group, PSP concentration of both the PS group and the CP group was elevated (P<0.05), and was more apparent in the CP group. Concentrations of LF and Ca2+ were also elevated (P<0.05) , which were more obvious in the PS group. Conclusion De-creased concentrations of PSP and increased concentrations of LF and Ca2+ may play very important roles in chronic pancreatitis causing pancreatic stones.
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