| Research background and purpose: Acute pancreatitis(acute pancreatitis,AP)is a common clinical acute abdomen,having high incidence and mortality.Severe acute pancreatitis(severe acute pancreatitis,SAP)makes the mortality rate was as high as 36-50%.Predicting the severity of AP earlily and taking preventive measures are the key to reduce the mortality of AP.Recurrent acute pancreatitis(Recurrent Acute Pancreatitis,RAP.)may eventually develop into chronic pancreatitis or pancreatic cancer,bringing enormous physical and mental harm and economic pressure to patients.To study the risk factors and clinical features of RAP to take preventive measures to effectively reduce the recurrence of AP.The purpose of this research is to establish a large sample AP database,to find the risk factors of early prediction of AP severity,to establish risk assessment model,and to find the risk factors of RAP.Methods :(First).Establishment of acute pancreatitis database 1.According to the latest domestic and international consensus and guidelines for the diagnosis and treatment of acute pancreatitis,establish the database of acute pancreatitis after the discussion of digestive medicine experts in our hospital.2.Using Epi Data software to establish acute pancreatitis database template.3.To collect the clinical data of 1400 inpatients with AP in digestive department of our hospital from January 2015 to December 2016.(Second).Studying for risk factors and risk assessment model of AP severity 1.A total of 1082 patients with AP were selected from the AP database collected from AP patients of 1400 to as the object of this study,who were admitted to hospital within 3 days of onset and with basic information and inspection data within 24 hours.2.According to the latest diagnostic criteria for the severity of AP,1082 patients with AP were divided into MAP,MSAP and SAP groups.3.Comparing the otherness between the MAP and SAP groups among the various indexes.There were statistically otherness risk factors,and multivariate logistic regression was used to analyze the independent risk factors of SAP.Establish a risk assessment model,and verify the accuracy of the model.(Third).Clinical features and risk factors of recurrent acute pancreatitis 1.A total of 1076 patients with AP over 18 years old were selected from the AP database collected from AP patients of 1400 to as the object of this study,who were admitted to hospital within 3 days of onset and with basic information and inspection data within 24 hours.2.According to the diagnostic criteria of AP and rap,796 patients with AP in the primary group and 280 patients with AP in the recurrence group.3.Comparing the otherness between the MAP and SAP groups among the various indexes,studying clinical features of RAP.There were statistically otherness risk factors,and multivariate logistic regression was used to analyze the independent risk factors of SAP.Result(First).Establishment of acute pancreatitis database Database was entered clinical data of 1400 inpatients with AP in digestive department of our hospital from January 2015 to December 2016,including the basic clinical information of patients with AP,laboratory tests,and other indicators of the impact of information collection.At the same time,the basic treatment,special treatment,nutritional risk assessment,nutritional support treatment,prognosis and follow-up of AP patients were recorded in detail.1.Basic information Of 1400 inpatients with AP,with an average age of 49.62±15.183(years old);There were 747 male patients(53.33%),with an average age of 49.29±15.037(years old);There were 653 female patients(46.67%),with an average age of 50.00±15.355(years old);There was no statistically significant in average age between male and female patients;Of 1400 patients with AP,Luzhou accounted for 67.38% of the local,other provinces and cities accounted for 32.62%,the average age in the provinces and cities AP patients were no statistically significant.2.History of past illness Of 1400 patients with AP,there was a history of hypertension 300 patients(21.44%),diabetes 193 patients(13.77%),gallstones 88 patients(6.28%),hyperlipoidemia in 46 patients(3.32%).Hypertension,diabetes,gallstones are the most common history of past illness.3.Operation history Of 1400 patients with AP,gallbladder or biliary tract surgery 139 patients(9.98%),ERCP 4 patients(0.28%),stomach surgery 4 patients(0.28%).Gallbladder or biliary tract surgery is the most common.4.Incentive Of 1400 patients with AP,about clear oneset factors,high fat diet 435 patients(31.05%),drinking 193 patients(13.77%),gluttony 25 patients(1.76%).High fat diet and drinking are the most common.5.Cause of disease Etiological analysis of 1400 patients with AP,biliary origin 472 patients(33.71%),fat origin 437 patients(31.21%),alcohol origin 203 patients(14.50%),tumor 8 patients(0.58%),other or unknown etiology 280 patients(20%).In patients with AP,the cause of the disease was in the order of biliary origin,fat origin and alcohol origin.In patients with biliary origin AP,the number of female patients(52.6%)was significantly higher than that of male patients(47.4%),the difference has statistically significant;In patients with fat origin and alcohol origin AP,the number of male patients(61.5%,97.0%)was significantly higher than that of female patients(38.5%?3.0%),the difference has statistically significant.6.Classification Of 1400 patients with AP,MAP 785 patients(56.10%),MSAP 193 patients(13.77%),SAP 422 patients(30.13%).7.Complication Of 1400 patients with AP,acute peripancreatic fluid aggregation was the most common local complication in 573 patients(28.35%).SIRS 120 was the most common general complication(8.6%),followed by respiratory failure in 111 cases(7.95%).8.Clinical efficacy Of 1400 patients with AP,1236 patients were cured(88.26%),81 patients were improved(5.82%),8 patients were converted to surgery(0.55%),Automatic discharge in 60 patients(4.26%)and 15 patients died(1.11%).The average length of being in hospital was 14 ±8.771(days).(Second).Studying for risk factors and risk assessment model of AP severity Gender,Age Of 607 patients with MAP,the average age was 48.94±15.046(years).Of 326 patients with SAP,the average age was 50.63±15.614(years).There was no statistically significant in average age between the two groups.There were 342 males patients and 265 females patients in MAP.There were 163 males patients and 163 females patients in SAP.There was no statistically difference in gender between the two groups.2.Incentive 185 patients(30.48%)were induced by high fat diet of 607 patients with MAP,drinking 89 patients(14.67%),gluttony 19 patients(2.14%),and there were no obvious causes in 320 patients(52.71%).100 patients(30.67%)were induced by high fat diet of 326 patients with SAP,drinking 50 patients(15.34%),gluttony 55 patients(1.53%),and there were no obvious causes in 171 patients(52.46%).High fat diet was the most common incentive in patients with MAP and SAP.There was no statistically difference in different incentive constituent ratio between the MAP group and the SAP group(P>0.05)).3.Cause of disease There were 191 cases of MAP group due to biliary origin,173 cases of fat source,83 cases of alcohol source,5 cases of tumou,other or unknown etiology 155 cases.There were 113 cases of SAP group due to biliary origin,81 cases of fat source,41 cases of alcohol source,1 cases of tumou,other or unknown etiology 90 cases.Biliary factor was the most common cause of disease in patients with MAP and SAP.There was no statistically difference in cause of disease between the MAP group and the SAP group(P>0.05)).4.History of past illness There were129 cases had a history of hypertension of 607 cases with MAP,82 cases of diabetes,53 cases of disease of biliary tract,20 cases of hyperlipoidemia,12 cases of coronary disease,11 cases of hepatic adipose infiltration.There were 82 cases had a history of hypertension of 326 cases with SAP,47 cases of diabetes,25 cases of disease of biliary tract,6cases of hyperlipoidemia,5 cases of coronary disease,5 cases of hepatic adipose infiltration.Hypertension,diabetes and disease of biliary tract were the most common history of past illness in patients with MAP and SAP.There was no statistically difference in history of past illness between the MAP group and the SAP group(P>0.05)).5.Vital signs and laboratory tests Between group MAP and group SAP,the difference statistically significant about vital signs and 24 hour laboratory test were as follows: temperature,breathe,heart rate,leucocyte count,neutrophil ratio,blood platelet,total protein,albumin,usea nitrogen,Creatinine,cholesterol total,fasting blood-glucose,K+,Ca2+,CRP,PTR,partial thromboplastin time.Between group MAP and group SAP,no statistically significant about vital signs and 24 hour laboratory test were as follows: systolic pressure,diastolic pressure,prothrombin time,lithic acid,hemoglobin,GOT,hematocrit,GPT,BRD,IBIL,ALP,TG,high density cholesterol,LDL-c,amylase.6.Protective factors and risk factors Multivariate logistic regression analysis showed that albumin(P value 0.000,OR value 0.884)was the only protective factor of SAP.White blood cells(P value 0.000,OR value 1.132),creatinine(P value 0.019,OR value 1.006),fasting blood-glucose(P value 0.000,OR value 1.094),CRP(P value 0.000,OR value 1.008)were the reliable risk factors for early prediction of the disease.7.Evaluation of risk model.Logistic regression risk assessment model was established based on logistic regression analysis: Logit PMAP/SAP=1.0773+0.124* white blood cells-0.123*ALB+0.006* serum creatinine +0.089* fasting blood-glucose +0.008*CRP.The accuracy of SPSS model is 78.88%,which shows that the model has a high predictive value.(Third).Clinical features and risk factors of recurrent acute pancreatitis 1.Recurrence frequency and severity 280 cases of RAP patients,147(52%)cases recurred 1 times,47(17%)cases recurred 2 times,34(12%)cases recurred 3 times,52(19%)cases of recurrence over 4 times.Although the majority of patients relapse 1 times,but the number of relapse is greater than or equal to the 4 patients still account for a higher proportion.280 RAP patients,in which 98 cases of MAP,19 cases of MSAP,30 cases of SAP recurrence 1 times;in which 31 cases of MAP,4 cases of MSAP,12 cases of SAP recurrence 2 times;in which 19 cases of MAP,2 cases of MSAP,13 cases of SAP recurrence 3 times;in which 36 cases of MAP,7 cases of MSAP,9 cases of SAP recurrence More than 4 times;the severity of the disease which have no significant differences in recurrence times(P=0.331<0.05),shows that there is no obvious relationship between AP severity and recurrence times.2.Severity of illness 726 cases of the initial onset group,there were SAP 260(32.7%)cases,280 cases of the recurrence group,there were SAP 64(22.9%)cases.The incidence rate of SAP in the primary group was significantly higher than that in the recurrence group,and the difference was statistically significant.(P<0.05)3.Complication The primary group AP 726 patients with local complications 395 cases(49.6%),the recurrence group AP 280 patientsin with local complications 102 cases(36.4%),the incidence of the primary group of AP patients was significantly higher than that of local complications of relapsed patients,the difference was statistically significant(P<0.05).The primary group of 726 AP patients with 110(13.8%)cases complicated with systemic complications,the recurrence group of 280 AP patients with systemic complications32(11.4%),the primary group of AP patients with systemic complications were higher in recurrence group,but the difference was not statistically significant.4.Gender,Age 796 cases of primary AP,there were 411(51.6%)males and 385(48.4%)females,280 cases of RAP patients,including 165(58.9%)cases of male,115(41.1%)cases were female,there was significant difference in sex composition ratio between primary and recurrent group(P<0.05)?There were 796 patients with primary AP,with an average age of 49.24±15.071(year of age),with an average age of 50.66±15.265(year of age)in the RAPpatients with.There was no significant difference in mean age between the primary and recurrent groups(P>0.05).5.Past medical history The primary group of AP patients with 796 cases,16(2%)cases of hyperlipidemia disease,91(11.4%)cases of diabetes,280 cases of AP in recurrence group,15(5.4%)patients with hyperlipidemia disease,56(20%)cases with diabetes,the AP patients a history of diabetes mellitus and hyperlipidemia in the primary group were significantly higher than that in the recurrence group,the difference have statistically significant(P<0.05).6.Operation history The primary group of AP patients with 796 cases,68(8.5%)cases of patients undergoing cholecystectomy or biliary tract surgery,3(0.4%)cases of ERCP,3(0.4%)cases of stomach surgery;the recurrence group of AP patients with 280 cases,35(12.5%)patients underwent cholecystectomy or biliary surgery,0(0%)cases of ERCP,0(0%)cases of stomach surgery.There was no significant difference between the two groups.7.Incentive The primary group have 796 AP patients,about clear oneset factors,high fat diet 235 patients(29.5%),drinking 103 patients(12.9%),gluttony 15 patients(1.9%).,0 cases of drugs(0%),443 cases had no obvious causes(56.6%);280 AP patients in the recurrence group,.about clear oneset factors,high fat diet 100 patients(35.7%),drinking 47 patients(16.8%),gluttony 4 patients(1.4%).,2 cases of drugs(0.7%),127 cases had no obvious causes(45.4%).There was no statistical difference between the two groups.8.Personal history In the primary group,796 cases of AP,smoking patients 184 cases,alcohol consumption patients 227 cases;in the recurrence group of 280 AP patients,smoking patients 76 cases,alcohol consumption patients 92 cases.There was no significant difference in smoking and alcohol consumption between the two groups? 9.Cause of disease Etiological analysis of 796 AP patients in the primary group,biliary origin 291 patients(36.6%),fat origin 225 patients(28.3%),alcohol origin 110 patients(13.8%),drugs 0 patients(0.0%),280 AP patients in the recurrent group,biliary origin 71 patients(25.3%),fat origin112 patients(40%),alcohol origin 45 patients(16.1%),drugs 1 patients(0.4%).In the primary group,the cause of the disease was in the order of biliary origin,fat origin and alcohol origin;the order of the patients with AP in the recurrent group was hyperlipidemia biliary tract diseas and alcohol..The primary group of AP patients is significantly higher than that of recurrent etiology of biliary tract disease in patients with AP group,the difference was statistically significant;but the recurrence group AP patients is the cause of hyperlipidemia was significantly higher than the primary group of AP patients,the difference was statistically significant.10.Independent risk factors for RAP Multivariate Logistic regression analysis showed that there was a history of hyperlipidemia,diabetes mellitus,hyperlipidemia,and the three were independent risk factors for RAP.(First).Establishment of acute pancreatitis database Common cause of AP is high fat diet,the order of the common causes of AP is bile,fat,alcohol;female patients with a common etiology of biliary disease,male patients with alcoholic and fat source of common.(Second).Studying for risk factors and risk assessment model of AP severity 1.Multivariate Logistic regression analysis showed that plasma albumin level was the only protective factor of SAP,and white blood cell count,serum creatinine concentration,blood glucose concentration and serum CRP were independent risk factors for early prediction of SAP.2.Logit PMAP/SAP=1.0773+0.124* white blood cells-0.123*ALB+0.006* serum creatinine +0.089* fasting blood-glucose +0.008*CRP,can accurately predict the severity of AP(Third).Clinical features and risk factors of recurrent acute pancreatitis1.The incidence of SAP in the recurrence group AP patients was lower than that in the primary group 2.In this study,we found that the etiology of patients with AP in the initial stage primary group was biliary disease,hyperlipidemia,alcohol,and the causes of RAP were hyperlipidemia,biliary tract disease and alcohol.3.There was a history of hyperlipidemia,a history of diabetes mellitus,and hyperlipidemia,which were independent risk factors for in patients with RAP. |
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