Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai 200433, China; Shanghai Institute of Pancreatic Diseases, 168 Changhai Road, Shanghai 200433, China.
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai 200433, China.
Dig Liver Dis. 2021 Sep;53(9):1148-1153. doi: 10.1016/j.dld.2021.03.001. Epub 2021 Mar 20.
The relationship between chronic pancreatitis (CP) and acute pancreatitis (AP) is complex and not well understood. CP could be preceded by antecedent episodes of AP.
The aim of this study was to explore both genetic and environmental factors associated with AP episodes before the diagnosis of CP.
This was a cross-sectional study including 1022 patients. Detailed demographic, genetic, and clinical data were collected. Based on the presence of AP episode(s) before diagnosis of CP, patients were divided into AP group (further classified into single episode of AP group and recurrent AP group) and non-AP group. Related factors among these groups were assessed using multivariate logistic regression model.
Before diagnosis of CP, 737 patients (72.1%) had a history of AP. Smoking(P = 0.005) and heavy alcohol consumption(P = 0.002) were risk factors for AP while age at CP onset(P < 0.001), harboring the SPINK1 mutation(P < 0.001), diabetes(P < 0.001) and steatorrhea(P < 0.001) were protective factors. Further, alcoholic CP(P = 0.019) was the only independent risk factor for recurrent AP attacks while age at onset of CP(P < 0.001), pancreatic stones(P = 0.024). and pseudocysts(P = 0.018) served as protective factors.
SPINK1 mutations served as protective factor for AP episodes, suggesting SPINK1 mutation might play a pathogenic role in CP occurrence with occult clinical manifestations.
慢性胰腺炎（CP）和急性胰腺炎（AP）之间的关系复杂，尚未完全阐明。CP 可能发生在先前的 AP 发作之后。
本研究旨在探讨与 CP 诊断前 AP 发作相关的遗传和环境因素。
这是一项横断面研究，纳入了 1022 名患者。收集了详细的人口统计学、遗传和临床数据。根据 CP 诊断前 AP 发作的情况，将患者分为 AP 组（进一步分为单次 AP 发作组和复发性 AP 发作组）和非 AP 组。使用多变量逻辑回归模型评估这些组之间的相关因素。
在 CP 诊断之前，737 名患者（72.1%）有 AP 病史。吸烟（P=0.005）和大量饮酒（P=0.002）是 AP 的危险因素，而 CP 发病年龄（P<0.001）、携带 SPINK1 突变（P<0.001）、糖尿病（P<0.001）和脂肪泻（P<0.001）是保护因素。此外，酒精性 CP（P=0.019）是复发性 AP 发作的唯一独立危险因素，而 CP 发病年龄（P<0.001）、胰腺结石（P=0.024）和假性囊肿（P=0.018）是保护因素。
SPINK1 突变是 AP 发作的保护因素，提示 SPINK1 突变可能在 CP 发生中发挥致病作用，且临床表现隐匿。
