复发性急性胰腺炎危险因素的Meta分析

Meta-analysis of risk factors for recurrent acute pancreatitis

背景随着生活水平的不断提高,复发性急性胰腺炎的发病率也逐年攀升,近年来成为研究的热点.寻找复发性急性胰腺炎的病因成为临床上亟待解决的问题.目的用系统评价方式探讨复发性急性胰腺炎(recurrent acute pancreatitis,RAP)危险因素,为更好地预防胰腺炎复发提供循证依据.方法计算机检索中国知网、中国生物医学文献数据库(CBM)、万方数据库、维普数据库、The Cochrane Library、PubMed、Embase、Web of science数据库,检索时限为建库至2020-12,经2名研究者筛选文献、提取信息与质量评价后,并采用RevMan 5.3软件进行Meta分析.结果15篇文献符合纳入标准,累计病例数和对照数分别为2258例和8482例,经Meta分析结果显示,复发性急性胰腺炎的危险因素为:饮酒[OR=1.83,95%CI(1.30,2.59),P=0.0006]、吸烟[OR=2.09,95%CI(1.61,2.73),P<0.00001]、胆源性AP[OR=1.82,95%CI(1.28,2.57),P=0.0008]、高三酰甘油血症性AP[OR=2.24,95%CI(1.76,2.85),P<0.00001]、酒精性AP[OR=2.68,95%CI(2.03,3.55),P<0.00001]、糖尿病[OR=1.57,95%CI(1.48,1.66),P<0.00001]、脂肪肝[OR=2.05,95%CI(1.22,3.47),P=0.007]、CT评分[OR=3.52,95%CI(2.28,5.43),P<0.00001].结论当前证据显示,疾病因素(胆源性AP、高三酰甘油血症性AP、酒精性AP、脂肪肝、糖尿病)、行为危害因素(吸烟、饮酒)、相关指标(CT评分)均与复发性急性胰腺炎相关.受纳入研究数量和质量限制,仍需前瞻性大样本的高质量临床研究予以验证.

BACKGROUND With the continuous improvement of living standards,the incidence of recurrent acute pancreatitis is also increasing year by year,and this disease has become a hot research topic in recent years.Understanding the etiology of recurrent acute pancreatitis has become an urgent problem to be solved in clinical practice.AIM To explore the risk factors for recurrent acute pancreatitis(RAP)by means of systematic evaluation,and provide evidence for better prevention of RAP.METHODS We searched CNKI,CBM,VIP,Wanfang,The Cochrane Library,PubMed,Embase,and Web of Science databases to collect case-control and cohort studies on the risk factors associated with RAP from January 1,2000 to February 29,2020.“Pancreatitis”,“recurrence”,“risk factors”,and their free words were selected as keywords.The retrieved articles were evaluated and filtrated using the Newcastle-Ottawa Scale(NOS).Meta-analysis was performed based on the articles scored above 6 by using Revman5.3 software.RESULTS A total of 15 articles were included,with the cumulative number of cases and controls reaching 2258 and 8482,respectively.The results of meta-analysis showed that alcohol consumption[odds ratio[OR]=1.83,95%CI(1.30,2.59),P=0.0006],smoking[OR=2.09,95%CI(1.61,2.73),P<0.00001],biliary AP[OR=1.82,95%CI(1.28,2.57),P=0.0008],hypertriacylglyceremic AP[OR=2.24,95%CI(1.76,2.85),P<0.00001],alcoholic AP[OR=2.68,95%CI(2.03,3.55),P<0.00001],diabetes[OR=1.57,95%CI(1.48,1.66),P<0.00001],fatty liver[OR=2.05,95%CI(1.22,3.47),P=0.007],and CT score[OR=3.52,95%CI(2.28,5.43),P<0.00001]were statistically significant risk factors for RAP.CONCLUSION Current evidence shows that the risk factors for RAP include disease factors(biliary,alcoholic,and hypertriacylglyceremic AP,fatty liver,and diabetes),behavioral factors(alcohol consumption and smoking),and related indicators(CT score).Due to the limited quantity and quality of included studies,more prospective high-quality clinical studies are needed to verify the above conclusion.