Гипоксия поджелудочной железы в патогенезе фиброза при хроническом панкреатите

Патогенез хронического панкреатита (ХП) и болевого синдрома до конца не изучен. Цель исследования – оценить взаимосвязь фиброзных изменений паренхимы поджелудочной железы (ПЖ), ее гипоксии и панкреатической протоковой гипертензии в патогенезе ХП. В проспективном исследовании проведено морфологическое, иммунногистохимическое изучение препаратов ПЖ, интраоперационно изучены показатели тканевой оксиметрии и панкреатического протокового давления у 40 пациентов, оперированных по поводу ХП. Установлено, что по мере прогрессирования фиброзных изменений в ткани ПЖ пациентов с ХП отмечаются увеличение экспрессии TGF-β1 (р < 0,001), рост количества панкреатических звездчатых клеток (r = 0,32, р < 0,05), снижение содержания гликогена (маркера гипоксии). При интраоперационном прямом измерении наблюдаются высокие показатели внутрипротокового давления: 34,2 (26,6; 45,3) мм рт. ст., снижение оксигенация ткани ПЖ, которые коррелируют со степенью фиброза. Ткани ПЖ при ХП испытывают хроническую гипоксию, связанную с фиброзом и панкреатической протоковой гипертензией. В свою очередь, вторичная ишемия ПЖ может быть значимым фактором в прогрессировании фиброза и хронического болевого синдрома при ХП.

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