| Background: Acute pancreatitis(AP) is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. It is well-known that AP is the common cause of diabetes mellitus(DM), which is classified as type-3C DM. The persistent impaired insulin secretion may contribute to type-3C DM. DM is a worldwide public health issues which threatens human health, the prevalence and the number of patients is increasing sharply, if DM is not promptly attended to,complications like ketoacidosis, lower extremities vascular lesions, diabetic retinopathy will happen as a result, thus making a research about the blood glucose metabolism and determining the optimal strategy for early management is utmost important. C-peptide is the secretory product of pancreaticβcell, which can be applied to distinguish the type of diabetes mellitus and know about the function of pancreatic βcell. Glycated serum protein can represent the average blood sugar in the past 1 or 2 weeks, and avoid the affect of blood-sugar level then.Pancreatic endocrine function and exocrine function connect with each other. Pancreatic exocrine dysfunction can not be ignored, and fecal elastase-1 is the the most common measurement. Whether the life quality of AP patients can be affected has aroused public’s attention.SF-36 short form is the most widely-used questionnaire which possesses high reliability and validity.After the release of revision of the Atlanta classification and definitions by international consensus, there is a lack of research about pancreas dysfunction and life quality in the long-term follow-up among MAP, MSAP and SAP in China.Objective: Make a research about pancreas function and life quality after AP.Methods: The 58 AP patients who discharged from the First Affiliated Hospital of Nanchang University during the year from 2005 to 2013 and paid visit at the gastroenterology outpatient clinic were enrolled. The mean time after the event was 3.2 years. Pancreatic endocrine function was evaluated by fasting C-Peptide,1 and 2 hour postprandial C-Peptide, fasting blood-glucose,1 and 2 hour postprandial blood glucose and glycated serum protein. Pancreatic exocrine function was evaluated by fecal elastase-1.Life quality was evaluated by SF-36 chart. We also collected clinical data which could influence pancreas function.Results: 58 cases were recruited, including 29 males(50%) and 29 females(50%) with an average age of 49.3±13.9 year. Among these cases, MAP occurred in 21 cases(36.2%),MSAP in 24 cases(41.4%), while the rest cases were SAP(13 cases, 22.4%).The etiology of AP was associated with biliary disease in 40 patients(69.0%), hyperlipidemia in 13(22.4%), alcohol abuse in 4 patients(6.9%), mix in 1 patients(1.7%).10 patients were diagnosed with pancreas necrosis(17.2%).13 cases(22.4%) were diagnosed with DM,14 with impaired glucose tolerance and 1 with impaired fasting glucose. Severity of AP appeared to have no effect on the risk of DM and pancreatic endocrine dysfunction(P=0.432 and 0.330, respectively).Blood glucose level on the first day of hospitalization(SAP vs. MSAP and SAP vs. MAP) was statistically significant(P<0.05).Patients who had longer follow-up interval were more likely to suffer from pancreatic endocrine dysfunction(P=0.042).Among the factors which may contribute to DM(age,obesity,hyperlipidemia history, pancreas necrosis and organ failure),pancreas necrosis is more important than the others(P=0.014). 22 subjects undertook the fecal elastase-1 test, 2 of them had abnormal presentations, with a ratio of 9%. no statistical difference was found in the FE-1 among subjects of different AP severity.45 subjects completed SF-36,there was no difference among MAP, MSAP and SAP in the 8 domain and Physical component summary(PCS) and Mental component summary(MCS)(P>0.05).There was also no statistically significant between SAP group and the control group(P >0.05).Additionally, no statistical difference was found in the life quality of subjects of different follow-up intervals(from 1 year to 4 year).Conclusions: Endocrine functional impairment was found in patients after AP. Severity of AP appears to have minimal effect on risk of pancreatic endocrine dysfunction. Pancreas necrosis increased the likelihood of developing DM after AP. In order to reduce DM complications, it is important to strengthen the blood glucose monitoring for subjects who had pancreas necrosis. The risk of endocrine functional impairment increases as follow-up intervals grow longer. While there is no obvious change in the exocrine function and quality of life in this group of patients. |
PDF Full Text Request