国内急性胰腺炎病因与病情严重程度的Meta分析

Meta-analysis of aetiology and the severity of acute pancreatitis about Chinese clinical trials

目的探讨我国急性胰腺炎（AP）常见的病因与AP病情严重程度之间的关系。方法通过计算机检索中国知网数据库（1989．1—2015．3）、万方数据库（1999．1—2015．3）、维普数据库（1994．1—2015．3）、学术期刊网络出版总库中的文献。收集关于AP病因与疾病严重程度的临床资料，对符合要求的相关文献从胆源性、酒精性及高脂血症性AP与病情严重程度进行Meta分析。结果最终共纳入24篇符合要求的临床研究，共17359例患者符合纳入要求，其中胆源性AP8673例，急性水肿性胰腺炎（MAP）6690例，急性坏死性胰腺炎（ANP）1983例；酒精性AP1408例，MAP1022例，ANP386例；高脂血症AP1753例，MAP1107例，ANP646例；其他病因AP5525例，MAP4179例，ANP1346例。Meta分析结果显示：不同病因AP发生ANP的情况，胆源性AP同酒精性AP比较差异有统计学意义（OR=0．65，95％CI：0．45～0．93，P〈0．05），胆源性AP同高脂血症AP比较差异有统计学意义（OR=0．51，95％CI：0．33～0．79，P〈0．05），酒精性AP同高脂血症AP比较差异无统计学意义（OR=0．70，95％CI：0．46～1．05，P〉0．05）。结论我国常见不同病因AP的病情轻重程度存在差异，酒精性AP与高脂血症性AP较胆源性AP更易发生ANP，但需要进一步的临床研究来证实。

Objective To investigate the characteristics of common causes of acute pancreatitis （AP） in China and to evaluate the association of the aetiology with the severity of disease. Methods The relevant literature was searched from the China National Knowledge Infrastructure （CNKI） database （ 1989. 1 - 2015.3 ）, WANFANG database （ 1999.1 - 2015.3 ）, VIP database （ 1994.1 - 2015.3 ）, and China Academic Journal Network Publishing Database （CAJD）. To collect related literature about aetiology and the severity of acute pancreatitis, Meta analysis was performed for gallstone, alcohol, hyperlipidemia and other AP from the aspects of the severity of disease in the literature which reaches the criteria. Results The Meta analysis included 24 clinical articles which were accordance with the criteria, totally 17359 pa- tients, including 8673 cases of biliary AP [6690 cases of mild acute pancreatitis （MAP）, 1983 cases of a- cute necrotizing pancreatitis （ANP） ], 1408 cases of alcoholic AP （ 1022 cases of MAP, 386 cases of ANP）, 1753 cases of hyperlipidemia AP （1107 cases of MAP, 646 cases of ANP） , and 5525 cases of other aetiology （4179 cases of MAP, 1346 cases of ANP）. The Meta analysis showed that among the common causes which was developed to AP, there was significant difference between biliary AP and alcohol AP （ OR =0. 65., 95% CI ：0.45 -0. 93, P 〈0. 05）. There was significant difference between biliary AP and hyperlipidemia AP （ OR =0. 51, 95% CI ：0. 33 -0. 79, P 〈0. 05）. However, there was no significant dif ference between alcoholic AP with hyperlipidemia AP （ OR =0. 70, OR =0. 70, 95% CI ：0.46 - 1.05, P 〉 0. 05 ）. Conclusions There is difference in the severity of AP caused by different reasons in China. There is more likely that hyperlipidemia AP and alcohol AP easily developed into ANP than biliary AP. However, further investigation and large-scale clinical trials will be needed to confirm this conclusion.