与重症急性胰腺炎相关的包裹性坏死的危险因素：一项多中心回顾性观察研究。
Risk factors for walled-off necrosis associated with severe acute pancreatitis: A multicenter retrospective observational study.
机构信息
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata, Japan.
出版信息
J Hepatobiliary Pancreat Sci. 2020 Nov;27(11):887-895. doi: 10.1002/jhbp.787. Epub 2020 Jul 30.
BACKGROUND
This study aimed to identify the risk factors for walled-off necrosis (WON) associated with severe acute pancreatitis (SAP).
METHODS
This retrospective study was conducted in eight institutions in Japan between 2014 and 2017. We analyzed WON incidence, patient characteristics, and risk factors for WON in patients with SAP who were observed for >28 days.
RESULTS
Of 134 patients with SAP, WON occurred in 40 (29.9%). Male sex (P = .045), body mass index (BMI) ≥25 (P < .001), post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (P = .020), and disseminated intravascular coagulation (DIC) (P = .001) were more frequent in the WON group than in the non-WON group. On admission, the frequency of white blood cell counts ≥ 12 000/µL (P = .037) and hypoenhanced pancreatic lesion on computed tomography (P = .047) were significantly higher in the WON group. In multivariate analysis, BMI ≥ 25 (odds ratio [OR] 5.73, 95% confidence interval [CI] 1.95-16.8; P = .002), post-ERCP (OR 8.08, 95% CI 1.57-41.7; P = .013), and DIC (OR 3.52, 95% CI 1.20-10.4; P = .022) were independent risk factors for WON.
CONCLUSIONS
High BMI, post-ERCP pancreatitis, and DIC are risk factors for the development of WON associated with SAP.
背景
本研究旨在确定与重症急性胰腺炎（SAP）相关的包裹性坏死（WON）的危险因素。
方法
本回顾性研究于 2014 年至 2017 年在日本的 8 家机构进行。我们分析了观察时间超过 28 天的 SAP 患者中 WON 的发生率、患者特征以及 WON 的危险因素。
结果
在 134 例 SAP 患者中，40 例（29.9%）发生了 WON。与非 WON 组相比，WON 组中男性（P =.045）、体质量指数（BMI）≥25（P <.001）、内镜逆行胰胆管造影术（ERCP）后胰腺炎（P =.020）和弥散性血管内凝血（DIC）（P =.001）更为常见。入院时，WON 组白细胞计数≥12000/μL（P =.037）和 CT 显示低增强胰腺病变的频率（P =.047）明显更高。多变量分析显示，BMI≥25（比值比 [OR] 5.73，95%置信区间 [CI] 1.95-16.8；P =.002）、ERCP 后（OR 8.08，95% CI 1.57-41.7；P =.013）和 DIC（OR 3.52，95% CI 1.20-10.4；P =.022）是 WON 的独立危险因素。
结论
高 BMI、ERCP 后胰腺炎和 DIC 是 SAP 相关 WON 发生的危险因素。
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