大麻吸食对急性胰腺炎是否有影响？
Is There an Effect of Cannabis Consumption on Acute Pancreatitis?
机构信息
Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
出版信息
Dig Dis Sci. 2018 Oct;63(10):2786-2791. doi: 10.1007/s10620-018-5169-2. Epub 2018 Jun 20.
BACKGROUND AND AIM
Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this study was to identify the prevalence of cannabis use among all patients with a first episode of AP, particularly in those labeled as idiopathic etiology, and determine any effect on AP severity.
METHODS
Retrospective cohort of all consecutive patients admitted with a first episode of AP at a large tertiary referral hospital from 01/2013 through 12/2014. AP was identified by ICD9 code, or lipase ≥ 3 times the upper limit of normal and abdominal pain consistent with AP. Cannabis users (CU) were identified via history or urine toxicology.
RESULTS
Four hundred and sixty patients were included. 54% were men, with a mean age of 48 years (range 17-89 years). Forty-eight patients (10%) were identified as CU. After adjusting for admission SIRS, age, and gender, cannabis use was not found to be an independent risk factor for persistent SIRS, AKI, ARDS, pancreatic necrosis, mortality, ICU admission, length of stay, in-hospital infections, nor recurrent AP. Of note, AKI was least common among non-CU compared to CU (OR 0.4; p = 0.02; CI 0.2-0.9) and non-CU had a higher admission BISAP score (≥ 2) compared to CU (OR 2.5; p = 0.009; CI 1.2-4.9).
CONCLUSION
This is the largest study to date examining cannabis use in AP. Cannabis use was found across almost all etiologies of AP with a prevalence of 10% (48 cases), and in 9% (9 cases) of so-called idiopathic AP cases in this cohort, which could account as an association for approximately 2% of all AP cases. Cannabis use did not independently impact AP severity or mortality.
背景与目的
20%的急性胰腺炎（AP）病例被标记为特发性。大麻仍然是世界上使用最广泛的非法药物。本研究的目的是确定首次发作 AP 的所有患者中大麻使用的流行率，特别是在那些被标记为特发性病因的患者中，并确定其对 AP 严重程度的任何影响。
方法
这是一项回顾性队列研究，纳入了 2013 年 1 月至 2014 年 12 月期间在一家大型三级转诊医院因首次发作 AP 而住院的所有连续患者。AP 通过 ICD9 编码、或脂肪酶≥正常上限的 3 倍和与 AP 一致的腹痛来确定。通过病史或尿液毒物检测确定大麻使用者（CU）。
结果
共纳入 460 例患者。54%为男性，平均年龄为 48 岁（范围 17-89 岁）。48 例（10%）被确定为 CU。在校正入院时 SIRS、年龄和性别后，大麻使用未被发现是持续性 SIRS、AKI、ARDS、胰腺坏死、死亡率、入住 ICU、住院时间、院内感染或复发性 AP 的独立危险因素。值得注意的是，非 CU 患者的 AKI 发生率明显低于 CU（OR 0.4；p=0.02；CI 0.2-0.9），而非 CU 的入院 BISAP 评分（≥2）高于 CU（OR 2.5；p=0.009；CI 1.2-4.9）。
结论
这是迄今为止研究 AP 中大麻使用情况的最大研究。大麻使用几乎存在于 AP 的所有病因中，流行率为 10%（48 例），在该队列中，约 9%（9 例）的所谓特发性 AP 病例中存在大麻使用，这可能占所有 AP 病例的约 2%。大麻使用并未独立影响 AP 的严重程度或死亡率。
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