Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pancreatology. 2022 Dec;22(8):1091-1098. doi: 10.1016/j.pan.2022.10.004. Epub 2022 Oct 31.
The mechanistic definition of chronic pancreatitis (CP) identifies acute pancreatitis (AP) as a precursor stage. We hypothesized that clinical AP frequently precedes the diagnosis of CP and is associated with patient- and disease-related factors. We describe the prevalence, temporal relationship and associations of AP in a well-defined North American cohort.
We evaluated data from 883 patients with CP prospectively enrolled in the North American Pancreatitis Studies across 27 US centers between 2000 and 2014. We determined how often patients had one or more episodes of AP and its occurrence in relationship to the diagnosis of CP. We used multivariable logistic regression to determine associations for prior AP.
There were 624/883 (70.7%) patients with prior AP, among whom 161 (25.8%) had AP within 2 years, 115 (18.4%) within 3-5 years, and 348 (55.8%) >5 years prior to CP diagnosis. Among 504 AP patients with available information, 436 (86.5%) had >1 episode. On multivariable analyses, factors associated with increased odds of having prior AP were a younger age at CP diagnosis, white race, abdominal pain, pseudocyst(s) and pancreatic duct dilatation/stricture, while factors associated with a lower odds of having prior AP were exocrine insufficiency and pancreatic atrophy. When compared with patients with 1 episode, those with >1 AP episode were diagnosed with CP an average of 5 years earlier.
Nearly three-quarters of patients were diagnosed with AP prior to CP diagnosis. Identifying which AP patients are at-risk for future progression to CP may provide opportunities for primary and secondary prevention.
慢性胰腺炎（CP）的发病机制定义将急性胰腺炎（AP）确定为前驱阶段。我们假设临床 AP 常发生在 CP 之前，并与患者和疾病相关因素有关。我们描述了在一个明确的北美队列中，AP 的流行率、时间关系和相关性。
我们评估了 2000 年至 2014 年间在 27 个美国中心进行的北美胰腺炎研究中前瞻性纳入的 883 例 CP 患者的数据。我们确定了患者发生一次或多次 AP 的频率及其与 CP 诊断的关系。我们使用多变量逻辑回归来确定 AP 发生的相关因素。
在 883 例 CP 患者中，有 624 例（70.7%）有 AP 病史，其中 161 例（25.8%）在 CP 诊断前 2 年内发生 AP，115 例（18.4%）在 3-5 年内发生，348 例（55.8%）在 CP 诊断前>5 年发生。在 504 例有 AP 相关信息的患者中，436 例（86.5%）有>1 次发作。多变量分析表明，CP 诊断时年龄较小、白种人、腹痛、假性囊肿和胰管扩张/狭窄是 AP 发生几率增加的相关因素，而外分泌功能不全和胰腺萎缩是 AP 发生几率降低的相关因素。与发生 1 次 AP 发作的患者相比，发生>1 次 AP 发作的患者平均提前 5 年被诊断为 CP。
近四分之三的患者在 CP 诊断前被诊断为 AP。确定哪些 AP 患者有发展为 CP 的风险，可能为一级和二级预防提供机会。
