School of Medicine, University of Auckland, Auckland, New Zealand.
Auckland City Hospital, Room 12.085A, Level 12, Auckland, 1023, New Zealand.
Eur Radiol. 2019 Jul;29(7):3746-3756. doi: 10.1007/s00330-019-06126-7. Epub 2019 Apr 12.
Transition from the first attack of acute pancreatitis (AP) to chronic pancreatitis (CP) via recurrent AP is common. Total pancreas volume (TPV) and pancreas diameters are often reduced in advanced CP but have never been studied after AP. The objective of this study was to investigate pancreas size after clinical resolution of AP and its association with the number of AP attacks.
Individuals with a history of AP were grouped based on the number of attacks (1, 2, ≥ 3 attacks). Healthy individuals were also recruited. All participants underwent magnetic resonance imaging, from which TPV and pancreas diameters (across the head, body, and tail) were measured independently by two raters in a blinded fashion. Generalised additive models (including age, sex, body mass index, and glycated haemoglobin levels) were used.
A total of 123 participants were studied. Total pancreas volume and tail diameter were significantly reduced in both unadjusted (TPV (p = 0.036), tail diameter (p = 0.009)) and adjusted (TPV (p = 0.026), tail diameter (p = 0.034)) models in individuals with ≥ 3 attacks, but not with 1 or 2 attacks, compared with healthy individuals. Head and body diameters did not differ significantly.
Reduced TPV and tail diameter characterise individuals after ≥ 3 attacks of AP and may represent one of the earliest irreversible morphological changes in individuals after AP. A high-risk population for transition to CP might include individuals with at least 3 attacks of AP whereas those with less than 3 attacks might be at a low risk.
• A significant reduction in total pancreas volume was demonstrated in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis). • Pancreas tail diameter, but not head or body diameter, was reduced in individuals after 3 or more attacks of acute pancreatitis (without conventional signs of chronic pancreatitis). • The above findings were independent of age, sex, body mass index, and glycated haemoglobin levels.
急性胰腺炎（AP）首次发作后通过反复发作进展为慢性胰腺炎（CP）较为常见。在晚期 CP 中，总胰腺体积（TPV）和胰腺直径通常减小，但 AP 后从未进行过研究。本研究的目的是探讨 AP 临床缓解后胰腺大小及其与 AP 发作次数的关系。
根据发作次数（1、2、≥3 次）将有 AP 病史的个体分组。还招募了健康个体。所有参与者均接受磁共振成像检查，由两位盲法评估者独立测量 TPV 和胰腺直径（头、体和尾）。使用广义加性模型（包括年龄、性别、体重指数和糖化血红蛋白水平）。
共研究了 123 名参与者。与健康个体相比，发作次数≥3 次的个体，在未调整（TPV（p=0.036），尾径（p=0.009））和调整（TPV（p=0.026），尾径（p=0.034））模型中，TPV 和尾径均显著减小，但发作次数为 1 或 2 次的个体则没有显著差异。头径和体径无显著差异。
TPV 和尾径减小是 AP 发作次数≥3 次个体的特征，可能代表 AP 后个体最早出现的不可逆形态学变化之一。向 CP 转变的高危人群可能包括至少有 3 次 AP 发作的个体，而发作次数少于 3 次的个体风险较低。
有 3 次或更多次急性胰腺炎（无慢性胰腺炎的常规征象）发作的个体，其总胰腺体积明显减小。
有 3 次或更多次急性胰腺炎（无慢性胰腺炎的常规征象）发作的个体，胰腺尾部直径减小，而头部和体部直径无减小。
上述发现与年龄、性别、体重指数和糖化血红蛋白水平无关。
