慢性胰腺炎残疾患者的长期随访：临床特征、结局及预测因素评估
Long-Term Follow-up of Disabled Patients With Chronic Pancreatitis: Evaluation of Clinical Characteristics, Outcomes, and Predictors.
作者信息
Liyen Cartelle Anabel, Shah Ishani, Bocchino Rachel, Ahmed Awais, Freedman Steven D, Kothari Darshan J, Sheth Sunil G
机构信息
Department of Medicine.
Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
出版信息
J Clin Gastroenterol. 2024 Jan 1;58(1):98-102. doi: 10.1097/MCG.0000000000001804.
BACKGROUND/AIMS: Patients with chronic pancreatitis (CP) often report a poor quality of life and may be disabled. Our study identifies clinical characteristics, predictors and outcomes in CP patients with disability.
METHODS
A review of established CP patients followed in our Pancreas Center between January 1, 2016 and April 30, 2021. Patients were divided into 2 groups based on disability. Univariate analysis was performed to identify differences in demographics, risk factors, comorbidities, complications, controlled medications, and resource utilization. Multivariate analysis was conducted to identify predictors for disability.
RESULTS
Out of 404 CP patients, 18% were disabled. These patients were younger (53.8 vs. 58.8, P =0.001), had alcoholic CP (54.1% vs. 30%; P <0.001), more recurrent pancreatitis (83.6% vs. 61.1%; P =0.001), chronic abdominal pain (96.7% vs. 78.2%; P =0.001), exocrine pancreatic insufficiency (83.6% vs. 55.5%; P <0.001), concurrent alcohol (39.3% vs. 23.3%; P =0.001) and tobacco abuse (42.6% vs. 26%; P =0.02), anxiety (23% vs. 18.2%; P <0.001), and depression (57.5% vs. 28.5%; P <0.001). A higher proportion was on opiates (68.9% vs. 43.6%; P <0.001), nonopiate controlled medications (47.5% vs. 23.9%; P <0.001), neuromodulators (73.3% vs. 44%; P <0.001), and recreational drugs (27.9% vs. 15.8%; P =0.036). Predictors of disability were chronic pain (OR 8.71, CI 2.61 to 12.9, P < 0.001), celiac block (OR 4.66, 2.49 to 8.41; P <0.001), neuromodulator use (OR 3.78, CI 2.09 to 6.66; P <0.001), opioid use (OR3.57, CI 2.06 to 6.31; P < 0.001), exocrine pancreatic insufficiency (OR3.56, CI 1.89 to 6.82; P <0.001), non-opioid controlled medications (OR 3.45, CI 2.01 to 5.99; P <0.001), history of recurrent acute pancreatitis (OR 2.49, CI 1.25 to 4.77; P <0.001), depression (OR 2.26, CI 1.79 to 3.01; P <0.001), and active smoking (OR1.8, CI 1.25 to 2.29; P <0.001).
CONCLUSION
CP patients with disability have unique characteristics and predictors, which can be targeted to reduce disease burden and health care expenditure in this population.
背景/目的：慢性胰腺炎（CP）患者常报告生活质量差，且可能致残。我们的研究确定了残疾CP患者的临床特征、预测因素和结局。
方法
回顾2016年1月1日至2021年4月30日在我们胰腺中心随访的确诊CP患者。根据是否残疾将患者分为两组。进行单因素分析以确定人口统计学、危险因素、合并症、并发症、控制性药物和资源利用方面的差异。进行多因素分析以确定残疾的预测因素。
结果
在404例CP患者中，18%为残疾患者。这些患者更年轻（53.8岁对58.8岁，P =0.001），患有酒精性CP（54.1%对30%；P <0.001），复发性胰腺炎更多（83.6%对61.1%；P =0.001），慢性腹痛（96.7%对78.2%；P =0.001），胰腺外分泌功能不全（83.6%对55.5%；P <0.001），同时存在酒精滥用（39.3%对23.3%；P =0.001）和烟草滥用（42.6%对26%；P =0.02），焦虑（23%对18.2%；P <0.001），以及抑郁（57.5%对28.5%；P <0.001）。使用阿片类药物（68.9%对43.6%；P <0.001）、非阿片类控制性药物（47.5%对23.9%；P <0.001）、神经调节剂（73.3%对44%；P <0.001）和消遣性药物（27.9%对15.8%；P =0.036）的比例更高。残疾的预测因素为慢性疼痛（OR 8.71，CI 2.61至12.9，P <0.001）、腹腔神经丛阻滞（OR 4.66，2.49至8.41；P <0.001）、神经调节剂使用（OR 3.78，CI 2.09至6.66；P <0.001）、阿片类药物使用（OR3.57，CI 2.06至6.31；P <0.001）、胰腺外分泌功能不全（OR3.56，CI 1.89至6.82；P <0.001）、非阿片类控制性药物（OR 3.45，CI 2.01至5.99；P <0.001）、复发性急性胰腺炎病史（OR 2.49，CI 1.25至4.77；P <0.001）、抑郁（OR 2.26，CI 1.79至3.01；P <0.001）和当前吸烟（OR1.8，CI 1.25至2.29；P <0.001）。
结论
残疾CP患者具有独特的特征和预测因素，可针对这些因素减轻该人群的疾病负担和医疗保健支出。
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