Madzak Adnan, Olesen Søren Schou, Lykke Poulsen Jakob, Bolvig Mark Esben, Mohr Drewes Asbjørn, Frøkjær Jens Brøndum
aDepartment of Radiology, Imaging Research Unit & Mech-Sense bDepartment of Gastroenterology & Hepatology, Centre for Pancreatic Diseases & Mech-Sense, Aalborg University Hospital cDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Eur J Gastroenterol Hepatol. 2017 Nov;29(11):1269-1275. doi: 10.1097/MEG.0000000000000955.
The aim of this study was to explore the association between morphological and functional secretin-stimulated MRI parameters with hospitalization, quality of life (QOL), and pain in patients with chronic pancreatitis (CP).
This prospective cohort study included 82 patients with CP. Data were obtained from clinical information, QOL, and pain as assessed by questionnaires (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and modified Brief Pain Inventory short form). Secretin-stimulated MRI morphological parameters included pancreatic gland volume, main pancreatic duct diameter, the modified Cambridge Classification of Duct Abnormality, apparent diffusion coefficient, fat signal fraction, and the pancreatic secretion volume as a functional parameter. The primary outcomes were time to first hospitalization related to the CP, as well as annual hospitalization frequency and duration. The secondary outcomes were pain severity, QOL, and pain interference scores.
A main pancreatic duct diameter below 5 mm was associated with reduced time to first hospitalization (hazard ratio=2.06; 95% confidence interval: 1.02-4.17; P=0.043). Pancreatic secretion volume was correlated with QOL (r=0.31; P=0.0072) and pain interference score (r=-0.27; P=0.032), and fecal elastase was also correlated with QOL (r=0.28; P=0.017). However, functional and morphological findings were not related to pain intensity.
Advanced pancreatic imaging techniques may be a highly sensitive tool for prognostication and monitoring of disease activity and its consequences.
本研究旨在探讨慢性胰腺炎（CP）患者中，形态学和功能学促胰液素刺激磁共振成像（MRI）参数与住院情况、生活质量（QOL）及疼痛之间的关联。
这项前瞻性队列研究纳入了82例CP患者。数据来源于临床信息、生活质量及通过问卷评估的疼痛情况（欧洲癌症研究与治疗组织生活质量问卷及改良简明疼痛问卷简表）。促胰液素刺激MRI形态学参数包括胰腺体积、主胰管直径、改良的剑桥导管异常分类、表观扩散系数、脂肪信号分数，以及作为功能参数的胰液分泌量。主要结局指标为与CP相关的首次住院时间，以及年度住院频率和住院时长。次要结局指标为疼痛严重程度、生活质量及疼痛干扰评分。
主胰管直径小于5mm与首次住院时间缩短相关（风险比=2.06；95%置信区间：1.02 - 4.17；P = 0.043）。胰液分泌量与生活质量（r = 0.31；P = 0.0072）及疼痛干扰评分（r = -0.27；P = 0.032）相关，粪便弹性蛋白酶也与生活质量相关（r = 0.28；P = 0.017）。然而，功能学和形态学检查结果与疼痛强度无关。
先进的胰腺成像技术可能是用于疾病活动及其后果的预后评估和监测的高度敏感工具。
