Natural History Following the First Attack of Acute Pancreatitis
Natural History Following the First Attack of Acute Pancreatitis
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DOI：
10.1038/ajg.2012.126
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发表时间：
2012-07-01
影响因子：
9.8
通讯作者：
Papachristou, Georgios I.
中科院分区：
文献类型：
--
作者：
Yadav, Dhiraj;O'Connell, Michael;Papachristou, Georgios I.
目的：关于急性胰腺炎(AP)哨兵发作后自然病史的数据有限。这项研究的目的是确定急性胰腺炎(AP)首次发作后复发和随后诊断为慢性胰腺炎(CP)的风险。方法：使用宾夕法尼亚州卫生保健成本控制委员会(PHC4)的数据集，我们确定了1996年至2005年首次首次住院诊断为AP的阿勒格尼县唯一的白人和黑人居民。使用相关的诊断代码来确定AP的病因。我们还检查了这些患者中是否有任何患者在2007年第三季度之前再次入院和/或接受CP住院诊断。结果：总共有7,456名独特的居民(平均年龄58+/-20岁，45%男性，80%白人)入院。常见病因包括胆汁(28%)、酒精(19%)和特发性(36%)。与其他原因相比，酒精性AP患者明显年轻，更有可能是男性和黑人。在幸存者(98.1%)和未患胰腺癌的患者中，84%的患者可获得随访(中位数40个月，四分位数范围18，69)。再次入院的原发或任何急性胰腺炎分别为22%和29%；随后的原发或任何慢性胰腺炎诊断分别为6%和12.8%。RAP的显著独立预测因素是酒精病因和烟草滥用，CP的独立预测因素是RAP和烟草滥用。胆源性AP的RAP风险随着AP与胆囊切除术之间持续时间的延长而增加。结论：AP哨兵发作后再入院是常见的。进展到CP的情况很少见，通常发生在说唱、酗酒和吸烟的背景下。胆源性急性胰腺炎发作后，应尽快考虑行胆囊切除术。早期行为干预可改变脑性瘫痪的自然病程。
OBJECTIVES: Data on natural history following a sentinel attack of acute pancreatitis (AP) are limited. The objective of this study was to determine the risk of recurrent AP (RAP) and subsequent chronic pancreatitis (CP) diagnosis after the first attack of AP.METHODS: Using the Pennsylvania Health Care Cost Containment Council (PHC4) data set, we identified all unique White and Black Allegheny County residents who received a first-time primary inpatient discharge diagnosis of AP from 1996 through 2005. AP etiology was determined using associated diagnoses codes. We also checked whether any of these patients were readmitted for AP and/or received inpatient CP diagnosis until third quarter of 2007.RESULTS: In all, 7,456 unique residents (mean age 58 +/- 20 years, 45% male, 80% White) with incident AP admission were identified. Common etiologies included biliary (28%), alcohol (19%), and idiopathic (36%). Compared with other causes, alcoholic AP patients were significantly younger and more likely to be male and Black. Among survivors (98.1%) and those without pancreatic cancer, follow-up (median 40 months, interquartile range 18, 69) was available for 84% of patients. Readmission for primary or any AP was recorded for 22 and 29%; subsequent primary or any CP diagnosis was assigned to 6 and 12.8%, respectively. Significant independent predictors for RAP were alcohol etiology and tobacco abuse and for CP were RAP and tobacco abuse. RAP risk in biliary AP increased with the duration between AP and cholecystectomy.CONCLUSIONS: Readmissions following a sentinel attack of AP are common. Progression to CP is infrequent and usually occurs in the setting of RAP, alcohol, and smoking. Cholectstectomy should be considered as soon as feasible after an attack of biliary AP. Natural history of CP may be altered through early behavioral intervention.