慢性胰腺炎。一项对来自印度的1086名受试者进行的全国性前瞻性研究。
Chronic pancreatitis. A prospective nationwide study of 1,086 subjects from India.
作者信息
Balakrishnan Vallath, Unnikrishnan Ambika Gopalakrishnan, Thomas Varghese, Choudhuri Gourdas, Veeraraju Peda, Singh Shivram Prasad, Garg Pramod, Pai Cannore Ganesh, Devi Raveendranathan Nair Sobhana, Bhasin Deepak, Jayanthi Venkataraman, Premalatha Narayanan, Chacko Ashok, Kar Premashish, Rai Ramesh Roop, Rajan Ramesh, Subhalal Narayanan, Mehta Rajiv, Mishra Sri Prakash, Dwivedi Manisha, Vinayakumar Kattoor Ramakrishnan Nair, Jain Ashok Kumar, Biswas Kalidas, Mathai Sunil, Varghese Jaison, Ramesh Hariharan, Alexander Thomas, Philip Jacob, Raj Vigna Venugopal, Vinodkumar Ankarath, Mukevar Srikanth, Sawant Prabha, Nair Prem, Kumar Harish, Sudhindran Surendran, Dhar Puneet, Sudheer Othayil Vayoth, Sundaram Karimassery Ramaiyer, Tantri Bailuru Vishwanath, Singh Devinder, Nath Thekkayil Rajindra
机构信息
Amrita Institute of Medical Sciences, Cochin, India.
出版信息
JOP. 2008 Sep 2;9(5):593-600.
CONTEXT
Chronic pancreatitis is common in India. However, its risk factors are not clear. There is sparse data on the current prevalence of tropical pancreatitis in India.
OBJECTIVE
To undertake a prospective nationwide study of the risk factors and clinical profile of chronic pancreatitis.
SETTING
Thirty-two major centers from different regions of India contributed data on 1,086 patients to a common online website (www.ipans.org).
MAIN OUTCOME MEASURES
Risk factors, clinical features complications and treatment of chronic pancreatitis.
RESULTS
Of the 1,086 subjects, complete data on risk factors were available for 1,033 subjects. Idiopathic pancreatitis was the most common form of pancreatitis (n=622; 60.2%) and alcoholic chronic pancreatitis accounted for about a third of the cases (n=400; 38.7%); the rest (n=11; 1.1%) had rare risk factors. Smoking and cassava intake were documented in 292 (28.3%) and 189 (18.3%) subjects, respectively. Using well-defined criteria, only 39 (3.8%)cases could be labeled as 'tropical pancreatitis'. Pain occurred in 971 patients (94.0%). Four hundred and eighteen (40.5%) subjects had diabetes mellitus. Of alcohol consumers, alcoholism and female gender were independent risk factors for diabetes in subjects with chronic pancreatitis (OR=1.48, P=0.003; and OR=1.75, P<0.001, respectively). The most common complications were pseudocysts (15.8%) and biliary obstruction (8.2%). Pancreatic cancer occurred in 42 subjects (4.1%). Ultrasound detected calculi in 69.7%, ductal dilatation in 63.4% and atrophy in 27.3%. The majority of patients were on medical therapy (n=849; 82.2%); endotherapy and surgery accounted for the rest. About 50% percent of the patients with diabetes required insulin (198/418).
CONCLUSIONS
In this first nationwide prospective survey of chronic pancreatitis in India, idiopathic pancreatitis was the most common form, followed by alcoholic pancreatitis. The classical form of tropical chronic pancreatitis is becoming less common.
背景
慢性胰腺炎在印度很常见。然而，其危险因素尚不清楚。关于印度热带胰腺炎当前患病率的数据稀少。
目的
对慢性胰腺炎的危险因素和临床特征进行一项全国性前瞻性研究。
设置
来自印度不同地区的32个主要中心向一个共同的在线网站（www.ipans.org）提供了1086例患者的数据。
主要观察指标
慢性胰腺炎的危险因素、临床特征、并发症及治疗。
结果
在1086名受试者中，1033名受试者有完整的危险因素数据。特发性胰腺炎是最常见的胰腺炎形式（n = 622；60.2%），酒精性慢性胰腺炎约占病例的三分之一（n = 400；38.7%）；其余（n = 11；1.1%）有罕见的危险因素。分别有292名（28.3%）和189名（18.3%）受试者记录有吸烟和木薯摄入情况。根据明确的标准，只有39例（3.8%）可被归类为“热带胰腺炎”。971例患者（94.0%）出现疼痛。418例（40.5%）受试者患有糖尿病。在饮酒者中，酗酒和女性是慢性胰腺炎患者患糖尿病的独立危险因素（OR = 1.48，P = 0.003；OR = 1.75，P < 0.001）。最常见的并发症是假性囊肿（15.8%）和胆道梗阻（8.2%）。42例受试者（4.1%）发生胰腺癌。超声检查发现结石的比例为69.7%，导管扩张的比例为63.4%，胰腺萎缩的比例为27.3%。大多数患者接受药物治疗（n = 849；82.2%）；其余接受内镜治疗和手术治疗。约50%的糖尿病患者需要胰岛素治疗（198/418）。
结论
在印度首次进行的这项全国性慢性胰腺炎前瞻性调查中，特发性胰腺炎是最常见的形式，其次是酒精性胰腺炎。经典形式的热带慢性胰腺炎正变得不那么常见。
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