The Clinical Features Of 307 Cases Of Chronic Pancreatitis Based On The M-ANNHEIM Classification System

Objective:To study the clinical manifestations, etiology and risk factors of chronic pancreatitis guided by the M-ANNHEIM classification of chronic pancreatitis and to evaluate the validity and clinical significance of this classification.Methods:A review of clinical data of inpatients in our hospital from December 2007 to December 2009 was conducted. The classification was carried out according to the M-ANNHEIM system.Results:307 patents (Male 214, Female 93, M:F 2.3:1) with chronic pancreatitis were enrolled. There were 256 adult patients and 51 child and adolescent patients (age of onset<18yr). Among these cases,129(42%) had a drinking history and 90 cases >80g/d.110 cases (35.8%) had a smoking history. Both drinkers and smokers were adult patients.31 cases (10.1%) presented hyperlipoidemia.12 cases had the efferent duct factors such as pancreas divisum.192(62.5%) cases had the hereditary factors and 5 cases presented the immunological factors. We didn't find the miscellaneous and rare metabolic factors such as hypercalcemia and hyperparathyroidism, chronic renal failure, drugs and toxins. There were 231(75.2%) cases with calcification of pancreas,45(14.7%) with exocrine insufficiency (steatorrhea),58(18.9%) with endocrine dysfunction (diabetes mellitus),32(10.4%) with surgeries involving pancreas, and 39(12.7%) with pancreatic pseudocysts, biliary obstruction, pancreatic cancer and other severe complications. The M-ANNHEIM clinical staging of chronic pancreatitis:0 case were in stage 0,220(71.7%) cases were in stage I,69(22.5%) cases were in stage II,12(3.9%) cases were in stageⅢand 6 cases were in stageⅣ. Most cases were in stageⅠandⅡ。The M-ANNHEIM score and severity index:the mean point was 7.78,69(22.5%) cases were in the minor level, 174(56.7%) were in the increased level,62(20.2%) cases were in the advanced level. Most cases were in the minor and increased level and only a few belonged to the marked and exacerbated level. We found several clinical manifestations were significantly different between the adult chronic pancreatitis and the child and adolescent cases.Conclusions:The M-ANNHEIM classification of chronic pancreatitis is a simple, objective, accurate and noninvasive tool in clinical practice. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease.