A population-based evaluation of the natural history of chronic pancreatitis.
A population-based evaluation of the natural history of chronic pancreatitis.
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DOI：
10.1016/j.pan.2017.11.012
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Yadav D
中科院分区：
文献类型：
--
作者：
Machicado JD;Chari ST;Timmons L;Tang G;Yadav D
根据三级保健中心的报告，慢性胰腺炎（CP）被认为是一种痛苦和衰弱的疾病，经常需要侵入性干预。我们的主要目的是在以人群为基础的队列中评估CP的自然病程，使用内窥镜和手术干预作为疾病侵袭性的替代。我们从1977年至2006年间，从明尼苏达州奥姆斯特德县（Olmsted County）找到所有新诊断为明确CP的患者（n=89，酗酒者[ACP=46]，非酗酒者[NACP]=43）。患者被跟踪到死亡或切除。在诊断时和每次随访期间审查了医疗记录。估计和比较自CP初始表现以来的终生比例和累积发病率。用Kaplan-Meier方法估计生存率。CP诊断的中位年龄为56岁（IQR， 48-67岁），56%为男性。在中位随访10年期间，68例（76%）患者出现胰腺疼痛，但只有27例（30%）患者需要任何侵入性治疗干预：23%接受了胰腺内治疗，11%接受了胰腺手术。在临床过程中，与NACP相比，ACP患者明显有更多的疼痛（均p<0.05）（87%比65%）、复发性急性胰腺炎（44%比23%）、假性囊肿（41%比16%）、外分泌功能不全的累积发生率（60比21%）和CP诊断后的年度住院率（0.79比0.25）。糖尿病、钙化、手术和总生存的累积风险在ACP和NACP中相似。我们的研究表明，人群水平的CP可能比三级中心报告的病程更温和。我们证实ACP具有比NACP更严重的表型。
Based on reports from tertiary care centers, chronic pancreatitis (CP) is considered to be a painful and debilitating disease frequently requiring invasive interventions. Our primary aim was to assess the natural course of CP in a population-based cohort using endoscopic and surgical interventions as surrogates for disease aggressiveness. We identified all patients (n=89, alcoholic [ACP=46], non-alcoholic [NACP]=43) with newly diagnosed definite CP from Olmsted County, Minnesota between 1977 and 2006. Patients were followed until death or censoring. Medical records were reviewed at time of diagnosis and during each follow-up. Both lifetime proportions and cumulative incidence since the initial manifestation of CP were estimated and compared. Survival was estimated with Kaplan-Meier methodology. Median age at CP diagnosis was 56 years (IQR, 48–67) and 56% were male. During median follow-up of 10 years, 68 (76%) experienced pancreatic pain, but only 27 (30%) needed any invasive therapeutic intervention: 23% had endotherapy and 11% had pancreatic surgery. During the clinical course, when compared with NACP, ACP patients had significantly more (all p<0.05) pain (87 vs. 65%), recurrent acute pancreatitis (44 vs. 23%), pseudocysts (41 vs. 16%), cumulative incidence of exocrine insufficiency (60 vs. 21%), and annual hospitalizations after CP diagnosis (0.79 vs. 0.25). The cumulative risk of diabetes, calcifications, surgery and overall survival was similar in ACP and NACP. Our study suggests that CP at a population level may have a milder course than that reported from tertiary centers. We confirm that ACP has a more severe phenotype than NACP.
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影响因子：
3.6
作者：
Yadav, Dhiraj;Muddana, Venkata;O'Connell, Michael
通讯作者：
O'Connell, Michael
DOI：
10.1016/j.pan.2015.10.015
发表时间：
2016-01
期刊：
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
影响因子：
--
作者：
Anderson MA;Akshintala V;Albers KM;Amann ST;Belfer I;Brand R;Chari S;Cote G;Davis BM;Frulloni L;Gelrud A;Guda N;Humar A;Liddle RA;Slivka A;Gupta RS;Szigethy E;Talluri J;Wassef W;Wilcox CM;Windsor J;Yadav D;Whitcomb DC
通讯作者：
Whitcomb DC
影响因子：
12.6
作者：
Nojgaard, Camilla;Bendtsen, Flemming;Matzen, Peter
通讯作者：
Matzen, Peter
影响因子：
2.9
作者：
Anand, Gobind;Hutfless, Susan M.;Singh, Vikesh K.
通讯作者：
Singh, Vikesh K.
影响因子：
9.3
作者：
Dumonceau, J-M.;Delhaye, M.;Bruno, M.
通讯作者：
Bruno, M.