急性胰腺炎的自然病程

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急性胰腺炎的自然病程：一项长期人群研究
Natural history of acute pancreatitis: a long-term population-based study.
出处：Am J Gastroenterol   2009  Nov  104(11) :2797-805; quiz 2806
作者：Lankisch PG;Breuer N;Bruns A;Weber-Dany B;Lowenfels AB;Maisonneuve P
PMID：19603011

目的：在什么情况下，急性胰腺炎首次发作将完全痊愈或转变为慢性胰腺炎还不得而知。因此，本研究旨在探讨急性胰腺炎转变为慢性的病情进展情况。
方法：20年期间，532名因急性胰腺炎首次发作住院患者被纳入研究，平均随访时间为7.8年（范围：1天至 19.7年）。我们用Kaplan – Meier方法研究胰腺炎的复发率，随后转变为慢性胰腺炎的频率以及随访期间由不同原因造成的胰腺炎患者所有原因死亡率。
结果：随访期间，88名患者（16.5％）胰腺炎复发。每100名急性胰腺炎患者中，因酗酒，结石（胆囊）及其他已确认的不明原因（特发性原因）引起的年复发率分别为 5.3，1.5，0.6及1.9/100。慢性胰腺炎仅发生于酗酒的患者，与急性胰腺炎首次发作的严重程度及患者是否戒烟戒酒无关。慢性胰腺炎的10年累积发病率为13％，20年累积发病率为16％。急性胰腺炎第二次发作后，仅随访2年，慢性胰腺炎的发病率显著上升至38％。吸烟使急性胰腺炎转变为慢性酒精性胰腺炎的风险大大升高。
结论：急性胰腺炎转变为慢性胰腺炎仅发生于酗酒患者。在这项研究中，有不少病人在急性胰腺炎第二次发作后很快转变为慢性。酗酒及吸烟是急性胰腺炎转变为慢性胰腺炎的危险因素。

OBJECTIVES: It is unknown whether after an initial attack of acute pancreatitis, the inflamed gland heals completely, or whether and under what circumstances the disease progresses to chronic pancreatitis. Therefore, the aim of this study was to investigate the progression of disease from acute to chronic pancreatitis. METHODS: During a 20-year period, 532 patients who were hospitalized after an initial attack of acute pancreatitis were followed up for an average of 7.8 years (range: 1 day to 19.7 years). We used the Kaplan-Meier method to study the frequency of recurrent attacks of pancreatitis, subsequent development of chronic pancreatitis, and all-cause mortality during the follow-up period in patients with pancreatitis due to different causes. RESULTS: During the follow-up period, recurrent pancreatitis developed in 88 (16.5%) patients. The annual relapse rates were 5.3, 1.5, 0.6, and 1.9/100 per year in patients with acute pancreatitis due to alcohol, gallstones (biliary), and other identified causes of unknown origin (idiopathic), respectively. Chronic pancreatitis developed only in alcoholics, independent of the severity of the first attack and also of discontinuation of alcohol and nicotine consumption. The cumulative incidence of chronic pancreatitis was 13% in 10 years and 16% in 20 years. After surviving a second attack, the incidence of chronic pancreatitis increased distinctly to 38% after only 2 years of follow-up. Smoking significantly enhanced the risk of progression from acute to chronic alcoholic pancreatitis. CONCLUSIONS: The progression from acute to chronic pancreatitis occurred only in alcoholics. In this group, a substantial number of patients developed chronic pancreatitis in a short period of time after surviving a second attack of acute pancreatitis. Both alcohol consumption and smoking at this time are risk factors for the transition from acute to chronic pancreatitis.

专家评价：
Kofi Clarke and
Dhiraj Yadav
University of Pittsburg, United States of America
Gastroenterology & Hepatology
This study offers data on the natural history of acute pancreatitis and its progression. Knowledge of the natural history of a disease is important in several ways -- it provides the following: i) an understanding of the initial presentation; ii) insights into the probability of disease progression and the associated factors; and iii) information on long-term outcomes. Such knowledge may be useful for the development of strategies to prevent disease progression or devise better treatment options. In the context of acute pancreatitis, this is specifically important since data on its natural history and its relationship to the eventual development of chronic pancreatitis remain poorly understood. In this single-center, population-based prospective study from Lüneburg, Germany, the investigators report on the natural history after the first episode of acute pancreatitis in 532 patients followed for an average of 7.8 years. The most common etiologies at the time of the initial presentation were gallstones (42%) and alcohol abuse (30%) while, in 20% cases, no etiology could be discerned (idiopathic). The absolute risk of relapse was higher in patients with alcohol-induced pancreatitis (33%) compared to biliary (12%) or idiopathic (14%) pancreatitis. The recurrence rate was also highest in the subgroup with alcohol-induced pancreatitis. Overall, only 4% of patients progressed to chronic pancreatitis during the follow-up period -- all of whom had alcohol as the etiologic factor. The cumulative risk of developing chronic pancreatitis in this group was ~15% at 10 years but increased dramatically after suffering the second episode to 38% at 2 and 42% at 10 years. Patients who reported heavy smoking (>30 cigarettes a day) were 4.3 times more likely to progress to chronic pancreatitis after controlling for demographic factors and alcohol consumption. Interestingly, discontinuation of alcohol consumption and smoking did not influence disease progression. This study reports several important observations; it confirms the following: i) acute pancreatitis progresses to chronic pancreatitis, albeit only in a small proportion of cases. This is consistent with the low prevalence of chronic pancreatitis in the general population; ii) the risk of chronic pancreatitis is high among patients with recurrent acute pancreatitis; and iii) in addition to alcohol, smoking is a strong risk factor for the recurrence and development of chronic pancreatitis. Future studies need to consider evaluating how often acute pancreatitis is the presenting feature or occurs during the course of chronic pancreatitis, and they also need to consider elucidating the mechanisms behind the progression from acute to chronic pancreatitis.

hbv30year

谢谢411. 急性胰腺炎是我完全忽略的一种病. 根据你的介绍, 我查了下, 这病的死亡率还很高, 非常容易误诊, 是我们患者的心腹大患. 由于它有可能是中毒引起, 战友们要非常小心, 小心!