内蒙古自治区急性胰腺炎4 168例病因分析

Etiological analysis of 4 168 cases of acute pancreatitis in Inner Mongolia Autonomous Region, China

目的探讨内蒙古地区急性胰腺炎(AP)的病因,以及与性别、年龄、疾病严重程度的关系。方法回顾性收集2015年1月至2018年12月内蒙古自治区6家大型三级综合医院收治的4168例AP住院患者的临床资料,归纳AP病因,并对不同性别、年龄、AP严重程度的病因进行分析。统计学方法采用卡方检验和校正卡方检验。结果4168例AP患者病因包括胆源性2060例(49.4%),高三酰甘油血症608例(14.6%),特发性579例(13.9%),酒精性399例(9.6%),过度进食256例(6.1%)和其他病因266例(6.4%)。男性患者胆源性AP的发生率低于女性[39.2%(917/2340)比62.5%(1143/1828)],高三酰甘油血症性AP、酒精性AP、过度进食性AP和其他病因AP的发生率均高于女性[17.4%(406/2340)比11.1%(202/1828),14.9%(349/2340)比2.7%(50/1828),7.6%(178/2340)比4.3%(78/1828),7.1%(165/2340)比5.5%(101/1828)],差异均有统计学意义(χ^2=223.645、32.693、175.859、19.858、4.001,P均<0.05)。19~59岁患者中胆源性AP占比低于≤18岁和≥60岁患者[42.4%(1100/2593)比55.1%(54/98)、61.3%(906/1477)],差异均有统计学意义(χ^2=6.199、134.746,P均<0.016);≥60岁患者中高三酰甘油血症性AP占比低于19~59岁和≤18岁患者[6.9%(102/1477)比18.9%(491/2593)、15.3%(15/98)],差异均有统计学意义(χ^2=109.403、9.430,P均<0.016);19~59岁患者中特发性AP占比高于≤18岁患者[14.8%(384/2593)比6.1%(6/98)],差异有统计学意义(χ^2=5.750,P<0.016);19~59岁患者中酒精性AP占比高于≤18岁和≥60岁患者[11.7%(303/2593)比1.0%(1/98)、6.4%(95/1477)],差异均有统计学意义(χ^2=10.718、29.435,P均<0.016);≤18岁患者中其他病因AP占比高于19~59岁和≥60岁患者[14.3%(14/98)比5.9%(152/2593)、6.8%(100/1477)],差异均有统计学意义(χ^2=0.559、0.959,P均<0.016)。胆源性AP在中度重症急性胰腺炎(MSAP)患者中的占比高于轻症急性胰腺炎(MAP)和重症急性胰腺炎(SAP)患者[59.6%(336/564)比47.5%(1522/3204)、50.5%(202/400)],差异均有统计学意义(χ^2=27.959、7.814,P均<0.016);高三酰甘油血症AP和其他AP在MAP患者中的占比均最低[12.7%(407/3204)、4.0%(127/3204)],与MSAP、SAP患者[23.0%(130/564)、12.2%(69/564)和17.8%(71/400)、17.5%(70/400)]相比差异均有统计学意义(χ^2=42.013、7.874、66.520、126.094,P均<0.016);特发性AP在MSAP患者中的占比最低[0.7%(4/564)],与MAP、SAP患者[16.6%(533/3204)、10.5%(42/400)]相比差异均有统计学意义(χ^2=99.540、49.369,P均<0.016),且SAP患者中特发性AP占比低于MAP患者,差异有统计学意义(χ^2=9.983,P<0.016);酒精性AP和过度进食AP在MAP患者中的占比均最高[11.4%(365/3204)、7.8%(250/3204)],与MSAP、SAP患者[3.5%(20/564)、0.9%(5/564)和3.5%(14/400)、0.2%(1/400)]相比差异均有统计学意义(χ^2=32.182、23.537、36.358、31.307,P均<0.016)。结论内蒙古地区AP的病因以胆源性和高三酰甘油血症为主。胆源性AP多为女性,好发于≥60岁患者,且多表现为MSAP;高三酰甘油血症性和酒精性AP多见于中青年男性患者,多表现为MSAP、SAP;而酒精性AP则多表现为MAP。

Objective To investigate the etiology of acute pancreatitis(AP)in Inner Mongolia and its correlation with gender,age and severity of the disease.Methods From January 2015 to December 2018,the clinical data of 4168 patients with AP admitted to six large tertiary general hospitals in Inner Mongolia were retrospectively collected and the etiology of AP was summarized.The etiology of different gender,age and severity of AP was analyzed.Chi-square test and adjusted chi-square test were used for statistical analysis.Results The etiology of 4168 patients with AP included 2060 cases(49.4%)of biliary diseases,608 cases(14.6%)of hypertriglyceridemia,579 cases(13.9%)of idiopathic causes,399 cases(9.6%)of alcohol intake,256 cases(6.1%)of overeating and 266 cases(6.4%)of other causes.The proporation of biliary AP in male patients was lower than that in female patients(39.2%,917/2340 vs.62.5%,1143/1828),however the proporations of hypertriglyceridemic AP,alcoholic AP,overeating AP and AP caused by other causes were all higher than those of female patients(17.4%,406/2340 vs.11.1%,202/1828;14.9%,349/2340 vs.2.7%,50/1828;7.6%,178/2340 vs.4.3%,78/1828 and 7.1%,165/2340 vs.5.5%,101/1828),and the differences were statistically significant(χ^2=223.645,32.693,175.859,19.858,and 4.001,all P<0.05).The proporation of biliary AP in patients aged between 19 and 59 years was lower than that in patients aged less than 18 years and over 60 years(42.4%,1100/2593 vs.55.1%,54/98 and 61.3%,906/1477),and the differences were statistically significant(χ^2=6.199 and 134.746,both P<0.016).The proporation of hypertriglyceridemic AP in patients aged over 60 years was lower than that in patients aged between 19 and 59 years and less than 18 years(6.9%,102/1477 vs.18.9%,491/2593 and 15.3%,15/98),and the differences were statistically significant(χ^2=109.403 and 9.430,both P<0.016).The proporation of idiopathic AP in patients aged between 19 and 59 years was higher than that of patients aged over 18 years(14.8%,384/2593 vs.6.1%,6/98),and the difference was statistically significant(χ^2=5.750,P<0.016).The proporation of alcoholic AP in patients aged between 19 and 59 years was higher than that of patients aged less than 18 years and over 60 years(11.7%,303/2593 vs.1.0%,1/98 and 6.4%,95/1477),the differences were statistically significant(χ^2=10.718 and 29.435,both P<0.016).And the proporation of other causes of AP of the patients aged less than 18 years was higher than those of patients aged between 19 and 59 years and over 60 years(14.3%,14/98 vs.5.9%,152/2593 and 6.8%,100/1477),and the differences were statistically significant(χ^2=0.559 and 0.959,P<0.016).Among the biliary causes,the proporation of moderate severe acute pancreatitis(MSAP)was higher than those of mild acute pancreatitis(MAP)and severe acute pancreatitis(SAP)(59.6%,336/564 vs.47.5%,1522/3204 and 50.5%,202/400),and the differences were statistically significant(χ^2=27.959 and 7.814,both P<0.016).In terms of hypertriglyceridemia and other causes,the proporation of MAP was the lowest(12.7%,407/3204 and 4.0%,127/3204),and the proporations were statistically significant compared with the proporation of MSAP and SAP(23.0%,130/564;12.2%,69/564 and 17.8%,71/400;17.5%,70/400;χ^2=42.013,7.874,66.520 and 126.094,all P<0.016).The proporation of MSAP was the lowest among the idiopathic causes(0.7%,4/564),and the difference was statistically significant compared with the proporation of MAP and SAP(16.6%,533/3204 and 10.5%,42/400;χ^2=99.540 and 49.369,both P<0.016).The proporation of SAP was lower than that of MAP,and the difference was statistically significant(χ^2=9.983,P<0.016).In alcoholic and overeating causes,the proporation of MAP was the highest(11.4%,365/3204,7.8%,250/3204),and the differences were statistically significant compared with MSAP and SAP(3.5%,20/564;0.9%,5/564;3.5%,14/400 and 0.2%,1/400;χ^2=32.182,23.537,36.358 and 31.307,all P<0.016).Conclusions Consistent with reports in most areas of China,the etiology of AP in Inner Mongolia area is mainly biliary diseases and hypertriglyceridemia.Most of the patients with biliary acute pancreatitis are female,mostly in patients more than 60 years old and most of them are MSAP.Hyperlipidemic and alcoholic AP are more common in middle-aged and young male patients,and are mostly MSAP and SAP;while most of alcoholic AP is MAP.