复发性急性胰腺炎病因及临床特征的Meta分析

发布时间：2018-02-28 08:22

本文关键词： 急性胰腺炎复发初发 Meta分析　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:复发性急性胰腺炎(RAP)是急性胰腺炎(AP)中的一种特殊临床类型,如何有效预防AP复发成为临床研究的重要课题。本文旨在探讨我国复发性急性胰腺炎(RAP)的临床特点及发病的高危因素,为今后RAP防治工作提供一定的参考依据。方法:以急性胰腺炎(AP)、复发、病因的中英文为检索词,计算机检索Pubmed、Medline、EMBASE、Science Direct、Cochrane Library、CBM、中国知网、万方数据库及维普数据库,收集2001年1月至2016年12月公开发表的有关RAP发病因素及临床特征的临床对照研究。由2名研究者按照预先制定的纳入和排除标准,独立的筛选文献、提取研究资料,根据NOS评分对纳入文献方法学质量进行评价,采用Rev Man 5.3软件进行文献数据整合及发表偏倚检测。固定或随机效应模型的选择由各研究间异质性大小决定,二分类变量采用比值比(OR)及其95%可信区间(95%CI)表示。结果:共纳入16篇文献,病例总数3980例(复发组1231例,初发组2749例),其中11篇研究详细报道AP复发率的情况,本文统计结果显示AP治愈后复发率为24.25%。将复发组(RAP)与初发组(AP)的发病原因进行比较,高脂血症是AP复发的危险因素(OR=2.16,95%CI 1.34~3.49,P=0.002)。研究发现,我国近10余年AP病因构成仍以胆系疾病为主,胆源性因素与AP的发作密切相关,但不是AP复发的高危因素,AP组与RAP组胆源性因素所占比重无统计学差异(OR=1.19,95%CI 0.77~1.85,P=0.44)。分别合并两组人群酒精、饮食等因素的临床数据,均未见统计学差异(OR=1.24,95%CI 0.89~1.72,P=0.21)、(OR=0.69,95%CI 0.45~1.05,P=0.08),上述因素并非导致AP复发的高危风险因素。研究发现胆囊切除术后仍存在AP复发的情况,两组差异无统计学意义(OR=1.74,95%CI 0.95~3.18,P=0.07)。合并数据分析,复发组较初发组出现黄疸、局部并发症的情况多,复发组重症患者比例相对较高,差异有统计学意义(OR=1.61,95%CI 1.16~2.23,P=0.005)、(OR=1.60,95%CI 1.15~2.22,P=0.005)、(OR=1.42,95%CI 1.14~1.76,P=0.001)。AP复发与年龄、性别无明显相关性,高龄不是导致AP复发的高危因素(OR=0.73,95%CI 0.34~1.57,P=0.42)、(OR=0.97,95%CI 0.83~1.13,P=0.68)。RAP组中特发性因素所占比重小于AP组,差异有统计学意义(OR=0.57,95%CI 0.44~0.72,P0.05)。结论:高脂血症为AP复发的重要危险因素,胆源性因素在RAP病因中仍占较高比例,但并非导致复发的高危因素。复发组患者病情相对重,较易发生重症急性胰腺炎(SAP)的情况,行胆囊切除术后AP仍可复发,RAP组中特发性因素所占比重相对小。积极寻找病因及针对病因进行早期治疗是治疗及预防胰腺炎复发的关键所在。
[Abstract]:Objective: recurrent acute pancreatitis (rapp) is a special clinical type of acute pancreatitis. How to effectively prevent the recurrence of AP has become an important subject in clinical research. This article aims to explore the clinical characteristics and high risk factors of recurrent acute pancreatitis in China. Methods: according to the Chinese and English key words of acute pancreatitis, recurrence and etiology, we searched PubmedMedline EMBASE Direct Science Direct Cochrane Library CBM, China knowledge Network, Wanfang Database and Weip Database. From January 2001 to December 2016, a clinical controlled study on the pathogenesis and clinical characteristics of RAP was published. According to the pre-established criteria of inclusion and exclusion, two researchers extracted the data from the independent screening literature. According to the NOS score, the quality of the included literature methodology was evaluated, and the data integration and publication bias detection were performed with Rev Man 5.3 software. The choice of fixed or random effect models was determined by the heterogeneity of each study. Results: a total of 16 literatures were included, with a total of 3 980 cases (1231 cases of recurrence and 2 749 cases of initial onset). Among them, 11 studies reported the recurrence rate of AP in detail. The statistical results show that the recurrence rate of AP after cure is 24.25.The etiology of AP in relapsing group was compared with that in primary group. Hyperlipidemia was the risk factor of AP recurrence. The risk factor of AP recurrence was 2.1695 CI 1.34 ~ 3.49% PX 0.002. It was found that the etiology of AP in China was still mainly caused by biliary diseases in recent 10 years. Biliary factors were closely related to AP attack, but there was no significant difference in the proportion of biliary factors between AP group and RAP group. There was no statistical difference in OR1.2495CI 0.891.72P0. 21. There was no high risk factor for AP recurrence. These factors were not high risk factors for AP recurrence. The study found that there was still AP recurrence after cholecystectomy, and there was no significant difference between the two groups in terms of OR1.7495 CI 0.95C3.18P0.070.Combined data analysis was performed. The results showed that there was no significant difference between the two groups in AP recurrence after cholecystectomy, and there was no significant difference between the two groups. The results were as follows: (1) there was no significant difference between the two groups in terms of AP recurrence after cholecystectomy. The incidence of jaundice and local complications in the recurrent group was higher than that in the initial group, and the proportion of severe patients in the relapsing group was relatively high. The difference was statistically significant. There was no significant correlation between the recurrence and age and sex. Old age is not a high risk factor for AP recurrence. The proportion of idiopathic factors in the OR0.7395CI 0.341.57 CI 0.831.13P0.68P0.68. rap group is lower than that in the AP group, and the difference is statistically significant. Conclusion: hyperlipidemia is an important risk factor for AP recurrence. Choledochogenic factors still account for a high proportion in the etiology of RAP, but they are not high risk factors for recurrence. After cholecystectomy, the proportion of idiopathic factors in AP can still recur rap group is relatively small. It is the key to treat and prevent the recurrence of pancreatitis by actively seeking the etiology and early treatment.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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