Department of Pathophysiology, University of Szeged, Szeged, Hungary.
Institute for Translational Medicine and Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
Sci Rep. 2020 Oct 21;10(1):17936. doi: 10.1038/s41598-020-74943-8.
The main causes of acute pancreatitis (AP) are biliary disease, alcohol consumption, hypertriglyceridaemia (HTG) and endoscopic retrograde cholangiopancreatography (ERCP). The aim of this meta-analysis was to evaluate the effects of these aetiological factors on the severity and outcome of AP. Pubmed and Embase were searched between 01/01/2012 and 31/05/2020. Included articles involved adult alcoholic, biliary, HTG- or post-ERCP AP (PAP) patients. Primary outcome was severity, secondary outcomes were organ failures, intensive care unit admission, recurrence rate, pancreatic necrosis, mortality, length of hospital stay, pseudocyst, fluid collection and systematic inflammatory response syndrome. Data were analysed from 127 eligible studies. The risk for non-mild (moderately severe and severe) condition was the highest in HTG-induced AP (HTG-AP) followed by alcoholic AP (AAP), biliary AP (BAP) and PAP. Recurrence rate was significantly lower among BAP vs. HTG-AP or AAP patients (OR = 2.69 and 2.98, 95% CI 1.55-4.65 and 2.22-4.01, respectively). Mortality rate was significantly greater in HTG-AP vs. AAP or BAP (OR = 1.72 and 1.50, 95% CI 1.04-2.84 and 0.96-2.35, respectively), pancreatic necrosis occurred more frequently in AAP than BAP patients (OR = 1.58, 95% CI 1.08-2.30). Overall, there is a potential association between aetiology and the development and course of AP. HTG-AP is associated with the highest number of complications. Furthermore, AAP is likely to be more severe than BAP or PAP. Greater emphasis should be placed on determining aetiology on admission.
急性胰腺炎（AP）的主要病因包括胆源性疾病、酒精摄入、高甘油三酯血症（HTG）和内镜逆行胰胆管造影术（ERCP）。本荟萃分析的目的是评估这些病因因素对 AP 的严重程度和预后的影响。我们于 2012 年 1 月 1 日至 2020 年 5 月 31 日在 Pubmed 和 Embase 上进行了检索。纳入的文章涉及成人酒精性、胆源性、HTG 或 ERCP 后 AP（PAP）患者。主要结局为严重程度，次要结局为器官衰竭、入住重症监护病房、复发率、胰腺坏死、死亡率、住院时间、假性囊肿、液体积聚和全身炎症反应综合征。我们从 127 项符合条件的研究中分析了数据。HTG 诱导的 AP（HTG-AP）后发生非轻度（中度和重度）疾病的风险最高，其次是酒精性 AP（AAP）、胆源性 AP（BAP）和 PAP。BAP 患者的复发率明显低于 HTG-AP 或 AAP 患者（OR=2.69 和 2.98，95%CI 1.55-4.65 和 2.22-4.01）。HTG-AP 患者的死亡率明显高于 AAP 或 BAP 患者（OR=1.72 和 1.50，95%CI 1.04-2.84 和 0.96-2.35），AAP 患者的胰腺坏死发生率高于 BAP 患者（OR=1.58，95%CI 1.08-2.30）。总的来说，病因与 AP 的发生和病程之间存在潜在关联。HTG-AP 与更多并发症相关。此外，AAP 比 BAP 或 PAP 更严重。入院时应更加强调确定病因。
