慢性胰腺炎患者内镜逆行胰胆管造影术后胰腺炎的发生率及危险因素。
Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis.
机构信息
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China; Department of Gastroenterology, Jining NO. 1 People's Hospital, Jining, Shandong, China.
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, the Second Military Medical University, Shanghai Institute of Pancreatic Diseases, National Clinical Research Center of Digestive Diseases, Shanghai, China.
出版信息
Gastrointest Endosc. 2017 Sep;86(3):519-524.e1. doi: 10.1016/j.gie.2016.12.020. Epub 2017 Jan 4.
BACKGROUND AND AIMS
Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort.
METHODS
In this observational cohort study, medical records of patients with CP (CP group) and biliary diseases (BD group) in a tertiary hospital from January 2011 to May 2015 were examined. The difference in the incidence of PEP between CP group and BD group and the risk of PEP at different clinical stages of CP were calculated by the χ test or the Fisher exact test. The predictive and protective factors for PEP were investigated by univariate and multivariate analysis.
RESULTS
In total, 2028 ERCP procedures were performed in 1301 patients with CP and 2000 procedures in 1655 patients with BD. The overall incidence of PEP in CP group (4.5%) was similar to that in the BD group (4.8%; P = .747). However, CP patients had significantly lower rates of moderate and severe attacks (0% vs 1.3%, P < .01). According to the M-ANNHEIM classification, the PEP incidences of CP at stages 0, I, II, III, and IV were 4.4%, 5.1%, 3.8%, 2.0%, and 2.0%, respectively. CP patients at stage Ia had the highest PEP incidence (8.0%) among all CP patients, significantly higher than that at stages Ib + Ic (3.9%) and II (3.8%). Female gender, history of acute pancreatitis, and prior PEP were independent risk factors of PEP, whereas extracorporeal shock wave lithotripsy was a protective factor.
CONCLUSIONS
Compared with BD patients, CP patients had similar incidence of PEP overall but lower grades of severity. The incidence of PEP in CP patients decreased significantly with disease progression. (Clinical trial registration number: NCT02781987.).
背景与目的
几乎所有关于内镜逆行胰胆管造影术后胰腺炎（PEP）的研究主要涉及胆道疾病患者，而不是慢性胰腺炎（CP）患者，CP 似乎是 PEP 的保护因素这一概念尚未得到详细研究。本研究旨在确定不同临床阶段 CP 患者 PEP 的发生率，并在大样本中确定 PEP 的预测和保护因素。
方法
在这项观察性队列研究中，检查了 2011 年 1 月至 2015 年 5 月在一家三级医院接受 CP（CP 组）和胆道疾病（BD 组）治疗的患者的病历。通过卡方检验或 Fisher 确切检验计算 CP 组和 BD 组之间 PEP 发生率的差异，以及 CP 不同临床阶段 PEP 的风险。通过单因素和多因素分析研究 PEP 的预测和保护因素。
结果
共对 1301 例 CP 患者和 1655 例 BD 患者进行了 2028 次 ERCP 操作，CP 组（4.5%）的总体 PEP 发生率与 BD 组（4.8%）相似（P=0.747）。然而，CP 患者中中度和重度发作的发生率明显较低（0% vs 1.3%，P<0.01）。根据 M-ANNHEIM 分类，CP 在 0 期、I 期、II 期、III 期和 IV 期的 PEP 发生率分别为 4.4%、5.1%、3.8%、2.0%和 2.0%。CP 患者的 I 期 a 期的 PEP 发生率最高（8.0%），明显高于 I 期 b+c 期（3.9%）和 II 期（3.8%）。女性、急性胰腺炎史和既往 PEP 是 PEP 的独立危险因素，而体外冲击波碎石术是保护因素。
结论
与 BD 患者相比，CP 患者总体上 PEP 发生率相似，但严重程度较低。CP 患者的 PEP 发生率随着疾病的进展显著下降。（临床试验注册号：NCT02781987）。
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