Current status of the research on nonalcoholic fatty pancreatic disease
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摘要: 非酒精性脂肪性胰腺病(NAFPD)被定义为在无显著饮酒情况下与肥胖相关的胰腺脂肪沉积,其发病机制尚不十分明确。NAFPD与非酒精性脂肪性肝病、2型糖尿病、胰腺炎、胰腺肿瘤、胰十二指肠术后胰瘘等密切相关,其能够增强胰腺癌细胞扩散,促使胰腺癌患者早期死亡。NAFPD主要依赖于胰腺活组织病理学检查和影像学检查来评估与诊断,但临床实际中存在检测技术与诊断水平的局限性。NAFPD的主要防治手段包括减轻体质量、减肥手术及药物治疗。由于既往NAFPD相关文献报道较少,且在临床中未予以足够重视,导致其临床诊疗与处理存在明显差异,鉴于此,阐述了NAFPD的研究现状与诊疗进展。Abstract: Nonalcoholic fatty pancreatic disease ( NAFPD) is defined as pancreatic fat deposition associated with obesity in the absence of significant drinking, and its pathogenesis remains unclear. NAFPD is closely associated with nonalcoholic fatty liver disease ( NAFLD) , type2 diabetes, pancreatitis, pancreatic tumor, and pancreatic fistula after pancreaticoduodenal surgery and can promote the spread of pancreatic cancer cells and result in the early death of patients with pancreatic cancer. The diagnosis and evaluation of NAFPD mainly rely on pathological biopsy and imaging examination, but their clinical application is limited by detection techniques and diagnostic level. Major prevention and treatment methods for NAFPD include a reduction in body weight, bariatric surgery, and pharmacotherapy. Since there are few articles on NAFPD and it is not taken seriously in clinical practice, there are significant differences in the clinical diagnosis and treatment of this disease. Therefore, this article elaborates on the current status of research on NAFPD and the advances in its diagnosis and treatment.
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Key words:
- nonalcoholic fatty pancreatic disease /
- epidemiology /
- disease attributes /
- diagnosis /
- therapy /
- review
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[1] TARIQ H, NAYUDU S, AKELLA S, et al. Non-alcoholic fatty pancreatic disease:A review of literature[J]. Gastroenterology Res, 2016, 9 (6) :87-91. [2] CATANZARO R, CUFFARI B, ITALIA A, et al. Exploring the metabolic syndrome:Nonalcoholic fatty pancreas disease[J]. World J Gastroenterol, 2016, 22 (34) :7660-7675. [3] GUGLIELMI V, SBRACCIA P. Type 2 diabetes:Does pancreatic fat really matter?[J]. Diabetes Metab Res Rev, 2018, 34 (2) :e2955. [4] YU TY, WANG CY. Impact of non-alcoholic fatty pancreas disease on glucose metabolism[J]. J Diabetes Investig, 2017, 8 (6) :735-747. [5] PHAM YH, BINGHAM BA, BELL CS, et al. Prevalence of pancreatic steatosis at a pediatric tertiary care center[J]. South Med J, 2016, 109 (3) :196-198. [6] WENG S, ZHOU J, CHEN X, et al. Prevalence and factors associated with nonalcoholic fatty pancreas disease and its severity in China[J]. Medicine (Baltimore) , 2018, 97 (26) :e11293. [7] LÊKA, VENTURA EE, FISHER JQ, et al. Ethnic differences in pancreatic fat accumulation and its relationship with other fat depots and inflammatory markers[J]. Diabetes Care, 2011, 34 (2) :485-490. [8] LUMENG CN, SALTIEL AR. Inflammatory links between obesity and metabolic disease[J]. J Clin Invest, 2011, 121 (6) :2111-2117. [9] MIRRAKHIMOV AE. Nonalcoholic fatty pancreatic disease and cardio-metabolic risk:Is there is a place for obstructive sleep apnea?[J]. Cardiovasc Diabetol, 2014, 13:29. [10] SANDBERG MB, FRIDRIKSSON J, MADSEN L, et al. Glucose-induced lipogenesis in pancreatic beta-cells is dependent on SREBP-1[J]. Mol Cell Endocrinol, 2005, 240 (1-2) :94-106. [11] FRAULOB JC, OGG-DIAMANTINO R, FERNANDES-SANTOS C, et al. A mouse model of metabolic syndrome:Insulin resistance, fatty liver and non-alcoholic fatty pancreas disease (NAFPD) in C57BL/6 mice fed a high fat diet[J]. J Clin Biochem Nutr, 2010, 46 (3) :212-223. [12] ZENG XP, HU LX, LI ZS. Progress in research on fatty pancreas[J]. Chin J Pancreatol, 2016, 16 (1) :68-72. (in Chinese) 曾祥鹏, 胡良嗥, 李兆申.脂肪胰的研究进展[J].中华胰腺病杂志, 2016, 16 (1) :68-72. [13] NUNEZ-DURAN E, CHANCLON B, SUTT S, et al. Protein kinase STK25 aggravates the severity of non-alcoholic fatty pancreas disease in mice[J]. J Endocrinol, 2017, 234 (1) :15-27. [14] van GEENEN EJ, SMITS MM, SCHREUDER TC, et al. Nonalcoholic fatty liver disease is related to nonalcoholic fatty pancreas disease[J]. Pancreas, 2010, 39 (8) :1185-1190. [15] CHOI CW, KIM GH, KANG DH, et al. Associated factors for a hyperechogenic pancreas on endoscopic ultrasound[J].World J Gastroenterol, 2010, 16 (34) :4329-4334. [16] KHAN NA, AMIN MS, ISLAM MZ. Pancreatic lipomatosis with massive steatorrhea[J]. Mymensingh Med J, 2011, 20 (4) :712-714. [17] KIM SY, KIM H, CHO JY, et al. Quantitative assessment of pancreatic fat by using unenhanced CT:Pathologic correlation and clinical implications[J]. Radiology, 2014, 271 (1) :104-112. [18] LIM S, BAE JH, CHUN EJ, et al. Differences in pancreatic volume, fat content, and fat density measured by multidetector-row computed tomography according to the duration of diabetes[J]. Acta Diabetol, 2014, 51 (5) :739-748. [19] HU HH, KIM HW, NAYAK KS, et al. Comparison of fat-water MRI and single-voxel MRS in the assessment of hepatic and pancreatic fat fractions in humans[J]. Obesity (Silver Spring) , 2010, 18 (4) :841-847. [20] HENI M, MACHANN J, STAIGER H, et al. Pancreatic fat is negatively associated with insulin secretion in individuals with impaired fasting glucose and/or impaired glucose tolerance:A nuclear magnetic resonance study[J]. Diabetes Metab Res Rev, 2010, 26 (3) :200-205. [21] PATEL NS, PETERSON MR, BRENNER DA, et al. Association between novel MRI-estimated pancreatic fat and liver histology-determined steatosis and fibrosis in non-alcoholic fatty liver disease[J]. Aliment Pharmacol Ther, 2013, 37 (6) :630-639. [22] DELLA CC, MOSCA A, MAJO F, et al. Nonalcoholic fatty pancreas disease and Nonalcoholic fatty liver disease:More than ectopic fat[J]. Clin Endocrinol (Oxf) , 2015, 83 (5) :656-662. [23] CARTER R, MOURALIDARANE A, SOEDA J, et al. Non-alcoholic fatty pancreas disease pathogenesis:A role for developmental programming and altered circadian rhythms[J].PLo S One, 2014, 9 (3) :e89505. [24] WANG CY, OU HY, CHEN MF, et al. Enigmatic ectopic fat:Prevalence of nonalcoholic fatty pancreas disease and its associated factors in a Chinese population[J]. J Am Heart Assoc, 2014, 3 (1) :e297. [25] LEE JS, KIM SH, JUN DW, et al. Clinical implications of fatty pancreas:Correlations between fatty pancreas and metabolic syndrome[J]. World J Gastroenterol, 2009, 15 (15) :1869-1875. [26] TUSHUIZEN ME, BUNCK MC, POUWELS PJ, et al. Pancreatic fat content and beta-cell function in men with and without type 2 diabetes[J]. Diabetes Care, 2007, 30 (11) :2916-2921. [27] CHEN DL, LIESS C, POLJAK A, et al. Phenotypic characterization of insulin-resistant and insulin-sensitive obesity[J].J Clin Endocrinol Metab, 2015, 100 (11) :4082-4091. [28] ACHARYA C, NAVINA S, SINGH VP. Role of pancreatic fat in the outcomes of pancreatitis[J]. Pancreatology, 2014, 14 (5) :403-408. [29] SMITS MM, van GEENEN EJ. The clinical significance of pancreatic steatosis[J]. Nat Rev Gastroenterol Hepatol, 2011, 8 (3) :169-177. [30] NAVINA S, ACHARYA C, DELANY JP, et al. Lipotoxicity causes multisystem organ failure and exacerbates acute pancreatitis in obesity[J]. Sci Transl Med, 2011, 3 (107) :107r-110r. [31] ACHARYA C, CLINE RA, JALIGAMA D, et al. Fibrosis reduces severity of acute-on-chronic pancreatitis in humans[J]. Gastroenterology, 2013, 145 (2) :466-475. [32] di CIAULA A, PORTINCASA P. Fat, epigenome and pancreatic diseases. Interplay and common pathways from a toxic and obesogenic environment[J]. Eur J Intern Med, 2014, 25 (10) :865-873. [33] HORI M, TAKAHASHI M, HIRAOKA N, et al. Association of pancreatic fatty infiltration with pancreatic ductal adenocarcinoma[J]. Clin Transl Gastroenterol, 2014, 5:e53. [34] REBOURS V, GAUJOUX S, D'ASSIGNIES G, et al. Obesity and fatty pancreatic infiltration are risk factors for pancreatic precancerous lesions (Pan IN) [J]. Clin Cancer Res, 2015, 21 (15) :3522-3528. [35] MATHUR A, ZYROMSKI NJ, PITT HA, et al. Pancreatic steatosis promotes dissemination and lethality of pancreatic cancer[J]. J Am Coll Surg, 2009, 208 (5) :989-994, 994-996. [36] MATHUR A, HERNANDEZ J, SHAHEEN F, et al. Preoperative computed tomography measurements of pancreatic steatosis and visceral fat:Prognostic markers for dissemination and lethality of pancreatic adenocarcinoma[J]. HPB (Oxford) , 2011, 13 (6) :404-410. [37] FUKS D, PIESSEN G, HUET E, et al. Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy:Incidence, prognosis, and risk factors[J]. Am J Surg, 2009, 197 (6) :702-709. [38] TRANCHART H, GAUJOUX S, REBOURS V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy[J]. Ann Surg, 2012, 256 (1) :139-145. [39] SOREIDE K, LABORI KJ. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery:A comprehensive review[J]. Scand J Gastroenterol, 2016, 51 (10) :1147-1154. [40] HONKA H, KOFFERT J, HANNUKAINEN JC, et al. The effects of bariatric surgery on pancreatic lipid metabolism and blood flow[J]. J Clin Endocrinol Metab, 2015, 100 (5) :2015-2023. [41] JIA DM, FUKUMITSU KI, TABARU A, et al. Troglitazone stimulates pancreatic growth in congenitally CCK-A receptordeficient OLETF rats[J]. Am J Physiol Regul Integr Comp Physiol, 2001, 280 (5) :r1332-r1340. [42] SOUZA-MELLO V, GREGORIO BM, RELVAS-LUCAS B, et al. Pancreatic ultrastructural enhancement due to telmisartan plus sitagliptin treatment in diet-induced obese C57BL/6mice[J]. Pancreas, 2011, 40 (5) :715-722. [43] ZOU X, LIU DL, LU FE, et al. Effect of jiaotai pill on pancreatic fat accumulation and islet cell apoptosis in rats with type 2diabetes[J]. China J Chin Mater Med, 2014, 39 (11) :2106-2111. (in Chinese) 邹欣, 刘德亮, 陆付耳, 等.交泰丸对2型糖尿病大鼠胰腺脂肪沉积和胰岛细胞凋亡的影响[J].中国中药杂志, 2014, 39 (11) :2106-2111. [44] ZHAO L, JIANG SJ, LU FE, et al. Effects of berberine and cinnamic acid on palmitic acid-induced intracellular triglyceride accumulation in NIT-1 pancreatic beta cells[J]. Chin J Integr Med, 2016, 22 (7) :496-502. [45] HUI S, WONG S, AI Q, et al. Observed changes in brown, white, hepatic and pancreatic fat after bariatric surgery:Evaluation with MRI[J]. Eur Radiol, 2019, 29 (2) :849-856.
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