671例复发性急性胰腺炎临床特点及危险因素分析

Analyses of clinical characteristics and risk factors of 671 cases of recurrent acute pancreatitis

目的探讨复发性急性胰腺炎(recurrent acute pancreatitis,RAP)的临床特征,分析与复发相关的危险因素,为RAP的预防及诊治提供依据。方法回顾性分析2013年1月至2018年8月我院消化科急性胰腺炎(acute pancreatitis,AP)数据库的3 605例AP患者的资料,根据纳入及排除标准分为初发组与复发组。收集两组患者的资料,采用统计学方法进行分析。结果(1)复发组男性比例高于初发组(P <0.005)。(2)初发组主要病因依次为胆道疾病、高脂血症、酒精性,复发组依次为高脂血症、胆道疾病、酒精性;复发组病因为高脂血症显著高于初发组(P <0.005)。(3)初发组重型胰腺炎(severe acute pancreatitis,SAP)发生率高于复发组(P <0.05)。复发组区域性门脉高压(regional portal hypertension,RPH)发生率明显高于初发组(P <0.005)。初发组急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发生率明显高于复发组(P <0.005)。(4)既往有高脂血症、糖尿病病史,病因为高脂血症,三者为RAP的独立危险因素。结论 RAP好发于中年男性;高脂血症是RAP主要病因;既往有高脂血症、糖尿病病史,是RAP的危险因素;RAP较初次发生AP更易发生RPH;初次发生AP更易并发ARDS,更易发展为SAP。

Objective To investigate the clinical features of recurrent acute pancreatitis(RAP),and analyze the risk factors related to recurrence,which can provide useful information for the prevention,diagnosis and treatment of RAP. Method We analyzed the data of 3 605 patients with acute pancreatitis(AP)from January 2013 to August 2018 in the database of acute pancreatitis in our hospital. According to the inclusion and exclusion criteria,the patients were divided into the primary group and the recurrence group. The clinical data in the two groups were collected and analyzed using a statistical method. Result(1)The proportion of male in the recurrent group was higher than that in the primary group(P < 0.005).(2)The main causes in the primary group were bile duct disease,hyperlipidemia and alcohol,however,the main causes in the recurrence group were hyperlipidemia,bile duct disease and alcohol. The hyperlipidemia in the recurrent group was significantly higher than that in the primary group(P < 0.005).(3)The incidence of severe pancreatitis in the primary group was higher than that in the recurrent group(P < 0.05). The incidence of regional portal hypertension in the recurrent group was significantly higher than that in the primary group(P < 0.005). The incidence of ARDS in the primary group was significantly higher than that in the recurrent group(P < 0.005).(4)The previous suffering from hyperlipidemia or diabetes,and the etiology of hyperlipidemia was an independent risk factor for RAP. Conclusion RAP is more common in the middle-aged men. Hyperlipidemia is a main cause of RAP. The previous suffering from hyperlipidemia or diabetes is a risk factor for RAP. RAP is more likely to occur RPH. The first occurrence of AP is more likely to be complicated with ARDS,and more likely to develop into SAP.