| Part One Analysis of Risk Factors of Recurrent Acute PancreatitisObjective To analyze clinical features and risk factors of recurrence after the first attack of acute pancreatitis.Methods We performed a study of 489 patients with a first episode of acute pancreatitis from September 2012 to September 2015.We collected relevant information of disease course and followed up until June 2016.We classified these patients according to etiology,explored the relevant characteristics of recurrence episode and performed univariate and multivariate regression of possible risk factors.Results During a median follow-up duration of 30.4 months,411 cases were followed up completely.The total recurrence rate was 27.5%(113/411),with a median recurrence interval of 6.5(IQR 2.61-10.33)months.The recurrence rate and median recurrence interval of biliary group,hyperlipidemic group,alcoholic group,other known etiology group and idiopathic group were 21.5%(57/265),5.78(IQR 2.52-9.92)months;49.2%(30/61),8.28(IQR 5.35-16.30)months;42.1%(8/19),7.90(IQR 4.15-10.60)months;28.6%(6/21),4.45(IQR 2.50-7.90)months;26.7%(12/45),5.55(IQR 3.45-12.85)months,respectively.To biliary AP,the recurrence rate of patients who underwent cholecystectomy within two weeks after AP attack was lower than patients without cholecystectomy,and the difference was statistically significant(P<0.001).Logistic regression suggested that hyperlipidemic pancreatitis(OR=2.247;95% CI,1.077-4.688;P=0.023),pancreatic necrosis(OR=3.312;95% CI,1.675-6.546;P=0.001),smoking(OR=4.023;95% CI,2.377-6.809;P<0.001),complicated with diabetes(OR=3.417;95%CI,1.979-5.900;P<0.001)were independent risk factors of RAP.Conclusions Hypertriglyceridemia,smoking,complicated with pancreatic necrosisand diabetes are independent risk factors of RAP.Timely cholecystectomy can prevent biliary AP from recurring.Part Two Risk Factors of Abnormal Glucose Metabolism after The First Attack of Acute PancreaitisAim To analyze the clinical features and related risk factors of abnormal glucose metabolism after the first attack of acute pancreatitis.Methods We collected relevant information of patients diagnosed as first attack of AP admitted to First Affiliated Hospital of Soochow University from September 2012 to September 2013,and made a follow-up of these patients through out-patient visit,measured fasting and 2 hours after OGTT blood glucose.These patients were classified according to etiology,we compared the clinical features of different groups and made Logistic regression of possible risk factors.Results Finally,154 patients were completely followed up,the incidence rate of biliary group,hyperlipidemic group and other etiology group were 14.7%,46.2% and26.9%.The interval between the occurrence of abnormal glucose metabolism and the first attack of AP were 19.31±9.44,9.88±4.25,20.54±7.71 months,respectively.Risks for abnormal glucose metabolism were higher in patients with younger age(OR=0.837;95%CI,0.739-0.948;P=0.005),hyperlipidemic pancreatitis(OR=4.971;95% CI,1.931-12.802;P=0.001),complicated with pancreatic necrosis(OR=6.696;95% CI,2.426-18.480;P<0.001),whose BMI≥25(OR=5.042;95% CI,2.240-11.350;P < 0.001)and in patients suffered recurrent acute pancreatitis(OR=4.783;95% CI,2.046-11.185;P<0.001).Conclusion Abnormal glucose metabolism is more common and attacks earlier among hyperlipidemic pancreatitis.Younger age,hyperlipidemic pancreatitis,pancreatic necrosis,BMI≥25,recurrent acute pancreatitis are risk factors of abnormal glucose metabolism. |
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