Bermejo F, Lopez-Sanroman A, Taxonera C, Gisbert J P, Pérez-Calle J L, Vera I, Menchén L, Martín-Arranz M D, Opio V, Carneros J A, Van-Domselaar M, Mendoza J L, Luna M, López P, Calvo M, Algaba A
Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Community of Madrid, Madrid, Spain.
Aliment Pharmacol Ther. 2008 Sep 1;28(5):623-8. doi: 10.1111/j.1365-2036.2008.03746.x. Epub 2008 May 30.
Pancreatitis is a potentially severe condition. Patients with inflammatory bowel disease (IBD) seem to be at increased risk for acute pancreatitis.
To describe the incidence, main causes and possible predictive factors of acute pancreatitis in inflammatory bowel disease.
Information was retrospectively extracted from the clinical records of patients followed in the IBD Units of nine hospitals in Madrid (n = 5073).
A total of 82 acute pancreatitis episodes were diagnosed (cumulative incidence, 1.6%); 98% of them were mild. Recurrent acute pancreatitis developed in 13% of patients. Most cases of acute pancreatitis (63.4%) were attributed to drug exposure [azathioprine/mercaptopurine (AZA/MP) n = 46, mesalazine (mesalamine) n = 6]; 20.7% were idiopathic, and 12.2% were biliary. Incidence of acute pancreatitis in patients treated with AZA/MP was 3.1%. In patients with acute pancreatitis, female gender (OR 3.4 95% CI: 1.3-9.3; P = 0.012) and Crohn's disease (CD) (OR 5.8 95% CI: 1.6-20.6; P = 0.007) were risk factors for AZA/MP-associated acute pancreatitis, the latter also when analysed only in patients treated with AZA/MP (n = 1477) (OR 5.2 95% CI: 1.8-14; P = 0.002).
The incidence of acute pancreatitis in our IBD patients (1.6%) is similar to that previously described. Drugs, mainly AZA/MP, are the leading cause. AZA-induced acute pancreatitis is always mild. Patients with CD are at a higher risk for AZA/MP-associated acute pancreatitis. The frequency of idiopathic acute pancreatitis is higher than expected, suggesting that part of these cases could be extraintestinal manifestations of IBD.
胰腺炎是一种潜在的严重疾病。炎症性肠病（IBD）患者似乎患急性胰腺炎的风险增加。
描述炎症性肠病中急性胰腺炎的发病率、主要病因及可能的预测因素。
回顾性提取马德里九家医院IBD科室随访患者的临床记录信息（n = 5073）。
共诊断出82例急性胰腺炎发作（累积发病率为1.6%）；其中98%为轻症。13%的患者出现复发性急性胰腺炎。大多数急性胰腺炎病例（63.4%）归因于药物暴露[硫唑嘌呤/巯嘌呤（AZA/MP）n = 46，美沙拉嗪（柳氮磺胺吡啶）n = 6]；20.7%为特发性，12.2%为胆源性。接受AZA/MP治疗的患者中急性胰腺炎的发病率为3.1%。在急性胰腺炎患者中，女性（比值比3.4，95%置信区间：1.3 - 9.3；P = 0.012）和克罗恩病（CD）（比值比5.8，95%置信区间：1.6 - 20.6；P = 0.007）是与AZA/MP相关的急性胰腺炎的危险因素，仅在接受AZA/MP治疗的患者（n = 1477）中分析时，后者也是危险因素（比值比5.2，95%置信区间：1.8 - 14；P = 0.002）。
我们的IBD患者中急性胰腺炎的发病率（1.6%）与先前描述的相似。药物，主要是AZA/MP，是主要病因。AZA诱发的急性胰腺炎总是轻症。CD患者发生与AZA/MP相关的急性胰腺炎的风险更高。特发性急性胰腺炎的发生率高于预期，提示这些病例部分可能是IBD的肠外表现。
