| Objective:Explore the clinical features and distribution of etiology of recurrent acute pancreatitis(RAP)in our hospital to raise the awareness of clinicians on this disease and improve the diagnosis and treatment of RAP.Methods:Collect medical record data of 546 patients with AP from the First Affiliated Hospital of Kunming Medical University from January 2014 to December 2017 and divided them into the early-onset AP group and RAP group according to the number of acute pancreatitis.Analyze and compare the etiology and clinical indicators of the two groups.Results:1 General clinical data1.1 AgeAmong the 164 patients with RAP,the average age was 43.16± 12.64 years old;382 patients with early-onset AP,the average age was 44.12±14.83 years old.There was no significant difference in mean age between the two groups(P>0.05).1.2 GenderOf 164 RAP patients,116 were males(70.7%),and 48 were females(29.3%),the male to female ratio was 2.4:1;Of the 382 patients with early-onset AP,241 were male(63.1%)and 141 were female(36.9%),with a male to female ratio of 1.7:1,and the gender between the two groups had no significant difference(P>0.05).2 Etiological analysis2.1 Comparison of the etiology of the RAP and early-onset groupsThe etiology of 164 RAP patients were as follows:67 cases(40.9%)of biliary,34 cases(20.7%)of hyperlipidemia,24 cases(14.6%)of alcohol,23 cases(14.0%)of dietary,13 cases(8.0%)of idiopathic,other factors in 3 cases(1.8%),including 1 case of pancreas divisum,lease of annluar pancreas,1 case of juxta-papilary duodenal diverticulum;The causes of 382 patients with early-onset AP were as follows:158 cases(41.4%)of biliary,84 cases(22.0%)of alcoholic,47 cases(12.3%)of hyperlipidemia,47 cases(12.3%)of dietetic,36 cases(9.4%)of idiopathic,other factors in 10 cases(2.6%),including 1 case of pancreas divisum,4 cases of duodenal papillary tumor,1 case of common bile duct cyst,1 case of juxta-papilary duodenal diverticulum,2 cases of autoimmune distress,1 case of trauma.Alcohol and hyperlipidemia were statistically significant between the two groups(P<0.05).There were no significant difference in biliary,dietary,other factors and idiopathic factor between the two groups(P>0.05).2.2 Independent risk factors for recurrence of APLogistic multivariate regression analysis suggested that hyperlipidemia was an independent risk factor for AP recurrence(OR=2.14,95%CI=1.83-2.49,P<0.001).2.3 Relationship between etiology and gender in RAP groupThere was a statistically significant difference between men and women in alcoholic factors(P<0.05),while there was no significant difference between men and women in biliary,hyperlipidemia,dietary,other factors and idiopathic factors(P>0.05).3 Clinical features3.1 Recurrence period and peak age groupAmong the 546 patients with AP,164 cases of recurrent acute pancreatitis,the recurrence rate is 30%.The peak of recurrence age ranges from 30 to 49 years old,accounting for 62.2%,and the recurrence cycle was mainly concentrated within 1 year,accounting for 70.1%.3.2 Number of relapsesThe number of relapses fluctuates 1-10 times with an average of 2.36 times,And the greatest proportion of recurrences occurred in 1 time,accounting for 48.2%.3.3 Compare the severity between the RAP group and early-onset groupsIn the RAP group,there were 83 cases(50.6%)of MAP,48 cases(29.3%)of MSAP,and 33 cases(20.1%)of SAP;In the early-onset AP group,there were 149 cases(39.0%)of MAP,110 cases(28.8%)of MSAP,and 123 cases(32.2%)of SAP,the proportion of severe RAP was lower than that of early-onset AP,and there was a statistically significant difference between the two groups(P<0.05).3.4 Hospital stayThe average number of days of hospitalization in the RAP group was 8.57±4.65 days;the average number of days of hospitalization in the early-onset group was 10.72±6.23.days,there was a statistically significant difference between the two groups(P<0.05).3.5 The relationship between pancreatitis and diabetes,fatty liver and smokingIn the RAP group,there were 77 cases of smoking(47.0%),71 cases of fatty liver(43.3%),and 42 cases of diabetes(25.6%);In the early-onset group,there were 144 cases(37.7%)of smoking,118 cases(30.9%)of fatty liver,and 38 cases(10%)of diabetes.there was a statistically significant difference between the two groups in diabetes,fatty liver and smoking(P<0.05).3.6 Analysis of risk factors for recurrence of hyperlipidemia pancreatitisLogistic multivariate regression analysis of recurrent hyperlipidemia pancreatitis revealed fatty liver(OR=1.89,95%CI=1.13-3.43,P<0.001),diabetes(OR=2.95,95%CI=1.82-6.69,P = 0.002),triglycerides(OR = 2.65,95%CI=1.42-3.57,P<0.001),BMI(OR = 2.16,95%CI = 1.86-7.32,P = 0.002)were independent causes of their recurrence factor.3.7 Laboratory index comparisonAlbumin,blood glucose,TG,CRP were statistically significant between the two groups(P<0.05);while there was no significant difference in WBC,serum calcium,PCT(P>0.05).3.8 Comparison of complicationsThe two groups had statistically significant differences in hypoproteinemia,ascites,and pulmonary infection(P<0.05);but in hyperlipidemia,abnormal liver function,pleural effusions,hypoxemia,acute peripancreatic effusion,pancreatic pseudocyst had no statistically significant(P>0.05).3.9 Treatment and prognosis of RAPOf the 164 patients in the RAP group,162 were given conservative medical treatment,2 were treated with ERCP+ conservative medical treatment,and 0 were treated with surgery.163 were improved and discharged,1 was discharged automatically,and 0 died.A total of 16 patients in the RAP group underwent cholecystectomy,of which 7 were biliary,4 were hyperlipidemia,and 5 were idiopathic.Conclusion:1.RAP occurs in young and middle-aged men,with the highest proportion of men drinking.2.The main pathogenic factors of RAP were biliary,hyperlipidemia and alcoholic factors,among which hyperlipidemia was an independent risk factor for AP recurrence.3.Previously suffering from diabetes,fatty liver and smoking are risk factors for recur rence of AP.4.The peak of AP recurrence is mainly within one year after the cure,and the number of relapses is mainly one.5.Fatty liver,diabetes,triglycerides,and BMI are independent risk factors for the recurrence of hyperlipidemic pancreatitis.6.RAP was significantly lower than that of early-onset AP in terms of albumin and CRP,but significantly higher in TG and blood glucose than in early-onset AP.7.The proportion of severe RAP and the proportion of complications was lower than that of early-onset AP,and the length of stay in hospital was shorter than that of early-onset AP.8.The treatment of RAP was based on conservative medical treatment,and the outcome was better after treatment.There were still patients with pancreatitis after cholecystectomy. |
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