Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?
Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?
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DOI：
10.6092/1590-8577/2958
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发表时间：
2015-03-01
影响因子：
0.2
通讯作者：
De Campos, Tercio
中科院分区：
文献类型：
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作者：
Goebel Winter Gasparoto, Rafaela Cristina;Jorge Racy, Marcelo de Castro;De Campos, Tercio
急性胰腺炎的晚期后果很少受到关注。急性胰腺炎发作后胰腺是否完全恢复，特别是在坏死的情况下，仍有争议。因此，急性坏死性胰腺炎后晚期胰腺功能障碍的存在是不确定的，并且关于它如何影响长期生活质量存在争议。目的探讨急性坏死性胰腺炎患者胰腺功能和形态学的变化及生活质量。确定了10年内因急性坏死性胰腺炎入院的患者，并联系了38名幸存者参加研究，其中包括16名患者。方法采用定性排脂法研究外分泌功能。通过口服葡萄糖耐量试验、HOMA-β和C-肽评价内分泌功能。通过计算机断层扫描检查胰腺形态。生活质量采用36项简明健康调查表测量。在急性坏死性胰腺炎指数发作后至少12个月进行测试。结果胰腺外分泌功能不全的发生率为6.2%。内分泌功能障碍，观察了一半的情况下，没有发现与坏死的扩展。形态学变化是频繁的（62.5%），更普遍的那些面临广泛的坏死。生活质量被认为是良好的，其损害被发现专门在精神健康领域，特别是在酒精性胰腺炎患者。生活质量与预后指标之间无相关性。结论本组患者的外分泌功能和生活质量得到了保护。然而，急性坏死性胰腺炎后内分泌功能紊乱和形态学异常是常见的。这些发现证明了长期随访的合理性，以便及时启动特定治疗。
Context Late consequences of acute pancreatitis have received little attention. It is controversial whether the pancreas fully recovers after an episode of acute pancreatitis, especially in the presence of necrosis. Therefore, the presence of late pancreatic dysfunction following acute necrotizing pancreatitis is uncertain and there are controversies about how it may affect long-term quality of life. Objectives To evaluate pancreatic function and morphology, besides quality of life, in patients with prior acute necrotizing pancreatitis. Patients Patients who were admitted to our hospital with acute necrotizing pancreatitis in a ten-year interval were identified and thirty-eight survivors were contacted to enroll in the study out of which sixteen patients were included. Methods Exocrine function was studied by qualitative fecal fat excretion. Endocrine function was evaluated by oral glucose tolerance test, HOMA-beta and C-peptide. Pancreatic morphology was examined by computed tomography. Quality of life was measured by 36-item short-form health survey. Tests were performed at least twelve months after the index episode of acute necrotizing pancreatitis. Results The prevalence of pancreatic exocrine insufficiency was 6.2%. Endocrine dysfunction was observed in half the cases, and no association with the extension of necrosis was found. Morphological changes were frequent (62.5%) and more prevalent in those who faced extensive necrosis. Quality of life was considered good, and its impairment was found exclusively in mental health domain, markedly in patients who had alcoholic pancreatitis. There was no correlation between quality of life and prognostic indicators. Conclusions Exocrine function and quality of life were preserved in this group of patients. However, endocrine dysfunction and morphological abnormalities were frequent after acute necrotizing pancreatitis. These findings justify a long-term follow-up in order to initiate specific treatment promptly.