Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis
Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis
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DOI：
10.1016/j.gie.2016.12.020
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发表时间：
2017-09-01
影响因子：
7.7
通讯作者：
Liao, Zhuan
中科院分区：
文献类型：
--
作者：
Zhao, Zhen-Hua;Hu, Liang-Hao;Liao, Zhuan
背景和目标：几乎所有关于ERCP术后胰腺炎（PEP）的研究主要涉及胆系疾病而不是慢性胰腺炎（CP）患者，CP似乎是PEP相关的保护因素的概念尚未详细研究。本研究的目的是确定PEP在不同临床阶段的CP患者中的发生率，并在一个大型队列中确定PEP的预测和保护因素。方法：在这项观察性队列研究中，检查了2011年1月至2015年5月在一家三级医院接受治疗的CP（CP组）和胆道疾病（BD组）患者的病历。采用卡方检验或Fisher精确检验计算CP组与BD组PEP发生率的差异及CP不同临床分期PEP发生的危险度。结果：1301例CP患者共行2028次ERCP，1655例BD患者共行2000次ERCP。CP组PEP的总体发生率（4.5%）与BD组相似（4.8%; P = 0.747）。然而，CP患者的中度和重度发作率显著较低（0%比1.3%，P <0.01）。根据M-ANNHEIM分类，0、I、II、III和IV期CP的PEP发生率分别为4.4%、5.1%、3.8%、2.0%和2.0%。在所有CP患者中，Ia期患者PEP发生率最高（8.0%），显著高于Ib + Ic期（3.9%）和II期（3.8%）。女性、急性胰腺炎病史、既往PEP是PEP的独立危险因素，而体外冲击波碎石术是PEP的保护因素。结论：与BD患者相比，CP患者PEP的总体发病率相似，但严重程度较低。CP患者PEP的发生率随疾病进展而显著降低。
Background and Aims: Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort.Methods: In this observational cohort study, medical records of patients with CP (CP group) and biliary diseases (BD group) in a tertiary hospital from January 2011 to May 2015 were examined. The difference in the incidence of PEP between CP group and BD group and the risk of PEP at different clinical stages of CP were calculated by the chi(2) test or the Fisher exact test. The predictive and protective factors for PEP were investigated by univariate and multivariate analysis.Results: In total, 2028 ERCP procedures were performed in 1301 patients with CP and 2000 procedures in 1655 patients with BD. The overall incidence of PEP in CP group (4.5%) was similar to that in the BD group (4.8%; P = .747). However, CP patients had significantly lower rates of moderate and severe attacks (0% vs 1.3%, P < .01). According to the M-ANNHEIM classification, the PEP incidences of CP at stages 0, I, II, III, and IV were 4.4%, 5.1%, 3.8%, 2.0%, and 2.0%, respectively. CP patients at stage Ia had the highest PEP incidence (8.0%) among all CP patients, significantly higher than that at stages Ib + Ic (3.9%) and II (3.8%). Female gender, history of acute pancreatitis, and prior PEP were independent risk factors of PEP, whereas extracorporeal shock wave lithotripsy was a protective factor.Conclusions: Compared with BD patients, CP patients had similar incidence of PEP overall but lower grades of severity. The incidence of PEP in CP patients decreased significantly with disease progression.