急性胰腺炎进展为复发性急性胰腺炎及慢性胰腺炎的风险和影响因素。

Risk of and factors influencing the progression from acute to recurrent acute to chronic pancreatitis.

作者信息

Park Ji Young, Bang Seungmin, Jeon Tae Joo, Cho Jae Hee, Lee Kyong Joo

机构信息

Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, The Graduate School, Yonsei University College of Medicine, Republic of Korea.

Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Pancreatology. 2025 Aug;25(5):624-630. doi: 10.1016/j.pan.2025.04.004. Epub 2025 Apr 16.

DOI:10.1016/j.pan.2025.04.004

PMID:40280847

Abstract

OBJECTIVES & AIMS: Acute pancreatitis (AP) recurrence rates range from 11 to 36 % yet accurately predicting recurrent acute pancreatitis (RAP) and its progression to chronic pancreatitis (CP) after an initial episode remains challenging. Thus, this study explored the risk factors contributing to RAP and its progression to CP.

METHODS

This retrospective study included patients with AP from three tertiary medical centers between January 2010 and December 2017. The patients were followed up for up to 60 months. The primary endpoint was the incidence of RAP and CP; risk factors influencing these outcomes were also identified.

RESULTS

Overall, 501 patients were included, of which 164 (32.7 %) experienced RAP, and 71 (14.2 %) progressed to CP. The leading causes of AP were alcohol consumption (43.1 %), gallstones (41.5 %) and hypertriglyceridemia (4.4 %). Multivariate Cox regression analysis revealed that smoking (HR, 4.09; 95 % CI, 2.752-6.078, p < 0.001), and organ failure after 48 h of hospitalization (HR, 3.52; 95 % CI, 1.22-10.19, p < 0.02) were significant risk factors for RAP. Significant risk factors for progression to CP included age over 60 years (HR, 5.29; 95 % CI, 1.25-22.47, p = 0.024), smoking (HR, 2.50; 95 % CI, 1.04-6.01, p = 0.04), alcohol consumption (HR, 8.79; 95 % CI, 2.06-37.43, p = 0.003), computed tomography severity index (CTSI) (HR, 1.22; 95 % CI, 1.04-1.44, p = 0.015), and recurrence of AP (HR, 70.69; 95 % CI, 2.61-1914.86, p = 0.011). In alcohol-induced RAP patients, ≥3 recurrences (HR, 4.18; 95 % CI, 1.75-9.98, p = 0.001) was significant risk factor for progression to CP.

CONCLUSIONS

Alcohol consumption was the predominant cause of AP and RAP. The severity of the initial AP episode was the key determinant for RAP, and RAP was the most significant risk factor for the progression to CP. Therefore, smoking and alcohol cessation are important to prevent the development of recurrent AP and CP during long-term follow-up.

摘要

目的与目标

急性胰腺炎（AP）的复发率在11%至36%之间，但在初次发作后准确预测复发性急性胰腺炎（RAP）及其向慢性胰腺炎（CP）的进展仍然具有挑战性。因此，本研究探讨了导致RAP及其进展为CP的危险因素。

方法

这项回顾性研究纳入了2010年1月至2017年12月期间来自三个三级医疗中心的AP患者。对患者进行了长达60个月的随访。主要终点是RAP和CP的发生率；还确定了影响这些结果的危险因素。

结果

总体而言，共纳入501例患者，其中164例（32.7%）经历了RAP，71例（14.2%）进展为CP。AP的主要病因是饮酒（43.1%）、胆结石（41.5%）和高甘油三酯血症（4.4%）。多因素Cox回归分析显示，吸烟（HR，4.09；95%CI，2.752 - 6.078，p < 0.001）以及住院48小时后出现器官功能衰竭（HR，3.52；95%CI，1.22 - 10.19，p < 0.02）是RAP的显著危险因素。进展为CP的显著危险因素包括年龄超过60岁（HR，5.29；95%CI，1.25 - 22.47，p = 0.024）、吸烟（HR，2.50；95%CI，1.04 - 6.01，p = 0.04）、饮酒（HR，8.79；95%CI，2.06 - 37.43，p = 0.003）、计算机断层扫描严重程度指数（CTSI）（HR，1.22；95%CI，1.04 - 1.44，p = 0.015）以及AP复发（HR，70.69；95%CI，2.61 - 1914.86，p = 0.011）。在酒精性RAP患者中，≥3次复发（HR，4.18；95%CI，1.75 - 9.98，p = 0.001）是进展为CP的显著危险因素。