Yang Dan-Dan, Gao Jin, Liu Jian, Liu Chuan, Liang Yong
Department of Radiology, Chengdu Third People's Hospital, Chengdu, China.
Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2022 Aug;12(8):4109-4119. doi: 10.21037/qims-21-1157.
Currently, the concept of "a single cause results in acute pancreatitis (AP)" has been deeply incorporated into clinical practice, whereas the concept of "compound-etiology" has not attract considerable attention. This study aimed to explore the impact of the category of etiology on AP clinical outcomes.
Patients with AP hospitalized within 72 h of symptom onset were retrospectively enrolled in this study from January 2014 to October 2019. AP etiology was classified into two main categories: single-etiology and compound-etiology category. The single-etiology category mainly includes biliary, hypertriglyceridemia (HTG), and alcohol. The compound-etiology category refers to AP with two or more causes, which mainly include dual-etiology and triple-etiology category, that is the biliary-HTG type, HTG-alcoholic type, and biliary-HTG-alcoholic type. The general information and clinical outcomes were reviewed and compared in AP patients with different etiologies.
Two hundred sixty-eight out of a total of 904 AP patients belonged to the compound-etiology category. Compared with the single-etiology category, the patients in the compound-etiology category were younger, more predominantly male, more likely to be obese (body mass index ≥30 kg/m) and more likely to have pre-existing diabetes. The clinical outcomes were worse for patients with increasing complexity of etiology type, as shown by comparison of the incidence of any organ failure (P<0.001); persistent organ failure (POF) (P<0.001); intensive care unit need (P<0.001); local complications (P<0.001). AP with HTG had a higher rate of POF (P=0.032) and acute necrotic collection (P=0.013) than AP with biliary or alcohol involvement. When other etiologies simultaneously accompanied HTG-AP, the clinical outcomes were significantly worse than those in HTG-AP without other etiologies, particularly the biliary-HTG-alcoholic type. The compound-etiology category was independently associated with POF [odds ratio (OR): 2.47, 95% confidence interval (CI): 1.65-3.72, P<0.001].
These results highlight the importance of determining AP etiology and the prevalence of the "compound-type" etiology. The compound-etiology category should be recognized as a separate concept in AP etiology and deserve higher priority.
目前，“单一病因导致急性胰腺炎（AP）”的概念已深深融入临床实践，而“复合病因”的概念尚未引起足够重视。本研究旨在探讨病因类别对AP临床结局的影响。
回顾性纳入2014年1月至2019年10月症状发作72小时内住院的AP患者。AP病因分为两大类：单一病因类和复合病因类。单一病因类主要包括胆源性、高甘油三酯血症（HTG）和酒精性。复合病因类指有两种或更多病因的AP，主要包括双病因和三病因类型，即胆源性-HTG型、HTG-酒精性型和胆源性-HTG-酒精性型。对不同病因的AP患者的一般信息和临床结局进行回顾和比较。
904例AP患者中，268例属于复合病因类。与单一病因类相比，复合病因类患者更年轻，男性居多，更易肥胖（体重指数≥30kg/m²），且更易有既往糖尿病史。病因类型复杂性增加的患者临床结局更差，如比较任何器官衰竭发生率（P<0.001）；持续性器官衰竭（POF）（P<0.001）；入住重症监护病房需求（P<0.001）；局部并发症（P<0.001）时所示。与有胆源性或酒精性因素的AP相比，HTG相关性AP的POF发生率（P=0.032）和急性坏死性积液发生率（P=0.013）更高。当其他病因同时伴有HTG相关性AP时，临床结局明显比无其他病因的HTG相关性AP更差，尤其是胆源性-HTG-酒精性型。复合病因类与POF独立相关[比值比（OR）：2.47，95%置信区间（CI）：1.65-3.72，P<0.001]。
这些结果凸显了确定AP病因的重要性以及“复合类型”病因的普遍性。复合病因类应被视为AP病因中的一个独立概念，值得更高的关注。
