中国人群复发性急性胰腺炎风险因素的meta分析

Risk factors for recurrent acute pancreatitis in Chinese population:a meta-analysis

目的系统评价中国人群复发性急性胰腺炎(RAP)的危重程度、危险因素及病因的相关特征。方法计算机检索PubMed、Web of Science、Embase、中国知网、万方医学网、维普资讯中文期刊服务平台、中国生物医学文献服务系统等数据库中关于RAP风险因素的病例对照研究和队列研究,检索时限为建库至2022年4月1日,采用RevMan5.3软件进行meta分析。结果共纳入21篇文献,其中病例对照研究20篇,队列研究1篇。RAP患者重症比例较急性胰腺炎患者明显升高,差异有统计学意义[优势比(OR)=1.70,95%可信区间(95%CI):1.09~2.66,P=0.02000]。吸烟、糖尿病是RAP的重要危险因素,高血压不是RAP的危险因素,差异均有统计学意义(OR=2.10、2.45、0.72,95%CI:1.11~4.00、1.50~4.01、0.59~0.88,P=0.02000、0.00040、0.00100);高脂性、酒精性、复合性急性胰腺炎患者复发的风险比例均较高,胆源性、特发性病因是RAP的保护性因素,差异均有统计学意义(OR=2.27、1.31、1.46、0.71、0.65,95%CI:1.80~2.88、1.04~1.67、1.06~2.02、0.51~0.98、0.44~0.98,P<0.00010、0.02000、0.02000、0.04000、0.04000)。结论中国人群中吸烟、糖尿病仍为RAP的危险因素,酒精性、高脂性、复合性急性胰腺炎是RAP病因的主要类型。

Objective To systematically evaluate the characteristics of the severity,risk factors,and etiology of recurrent acute pancreatitis(RAP)in the Chinese population.Methods The PubMed,Web of Science,Embase,China national knowledge internet(CNKI),Wanfang Data,VIP and other databases were searched computationally for case-control studies and cohort studies on risk factors for RAP.The retrieval time was from the establishment of the database to April 1,2022,and meta-analysis was conducted by using RevMan5.3 software.Results A total of 21 studies were included,including 20 case-control and one cohort study.The proportion of severe RAP patients was significantly higher than that of acute pancreatitis patients,and the difference was statistically significant(OR=1.70,95%CI:1.09-2.66,P=0.02000).Smoking(OR=2.10,95%CI:1.11-4.00,P=0.02000)and diabetes mellitus(OR=2.45,95%CI:1.50-4.01,P=0.00040)were significant risk factors for RAP,while hypertension(OR=0.72,95%CI:0.59-0.88,P=0.00100)was not a risk factor of RAP,and the differences were statistically significant.Hyperlipidemic AP(OR=2.27,95%CI:1.80-2.88,P<0.00010),alcoholic AP(OR=1.31,95%CI:1.04-1.67,P<0.02000),combined AP(OR=1.46,95%CI:1.06-2.02,P<0.02000)had higher hazard ratios for recurrence,while biliary(OR=0.71,95%CI:0.51-0.98,P<0.04000)and idiopathic(OR=0.65,95%CI:0.44-0.98,P<0.04000)were the protective factors of RAP,and the differences were statistically significant.Conclusion Smoking and diabetes are still risk factors for RAP in the Chinese population,whereas alcoholic AP,hyperlipidemic AP,and combined AP are the major types of the etiology of RAP.