| ObjectivesTo explore and analyze the high risk factors of recurrent acute pancreatitis in The Second Affiliated Hospital of Fujian Medical University in Quanzhou,so as to provide a basis for diagnosis,treatment and prevention of recurrent pancreatitis in quanzhou area.MethodsIn this paper,clinical data were collected from 422 patients diagnosed with acute pancreatitis with the first onset and complete data from the second affiliated hospital of fujian medical university from October 2015 to October 2018.Patients were divided into relapsed group(RG)and single-episode group(PG)according to the presence or absence of recurrence.The general characteristics,etiology,laboratory indicators and clinical characteristics of the two groups of patients were analyzed and compared to explore the risk factors of RAP.ResultsA total of 422 patients with AP were collected in this study.There were 101 patients with RAP,and the recurrent rate was 23.9%.1.Single factor analysis:(1)general characteristics:There was no significant statistical difference in gender,age and alcohol consumption between the RG and the PG(P>0.05).There were significant statistical differences in Smoking and diabetes between the RG and the PG.(2)Etiology: There were 101 patients in RG,including 29(28.71 %)patients with biliary causes,55(54.46%)patients with hyperlipidemia,7(6.93%)patients with alcohol,3(2.97%)patients with other causes and 7(6.93%)patients with idiopathic diseases.There were 321 patients in PG,including 151(47.04%)patients with biliary causes,86(26.79%)patients with hyperlipidemia,37(11.53%)patients with alcohol,10(3.12%)patients with other causes and 37(11.53%)patients with idiopathic diseases.There were statistically significant differences in the proportion of biliary cause and hyperlipidemia cause between the RG and PG(P < 0.05).There was no statistically significant difference in the proportion of alcohol cause,other causes and idiopathic cause between the RG and PG(P>0.05).(3)Complications: there was no statistically significant difference in the complications of Acute peripancreatic fluid exudation(APFC),pancreatic pseudocyst,pleural effusion,peritoneal effusion,Acute respiratory distress syndrome(ARDS),Acute renal insufficiency,and paralytic ileus between the RG and the PG(P > 0.05).(4)There was no significant difference in blood amylase(BAM),Calcium ions(Ca)and White blood cells(WBC)between RG group and PG group(P>0.05).There were statistically significant differences in Alanine transaminase(ALT),Aspertate aminotransferase(AST)and Total bilirubin(TBi L)between the RG and the PG(P<0.05)Through the above single factor risk analysis,There were statistically significant differences in smoking,diabetes,biliary cause,hyperlipidemia cause,ALT,AST and TBIL between the RG and PG.2.Multiple risk factors binary Logistic regression analysis:Logistic regression analysis was used to analyze the risk factors of RAP.The results showed that diabetes history,causes due to hyperlipidemia and smoking were independent risk factors of RAP(P﹤0.05,OR>1).3.There were statistically significant differences in the mean age of onset of each etiology group(P < 0.05),among which,the average age of onset was older in the biliary group than in the other four etiology groups(P<0.05),and there were no statistically significant differences in the mean age of onset in the other four etiology groups(P > 0.05)4.Severity : There was no significant statistical difference in severity between the RG and PG(P>0.05).5.Etiology and severity:There were statistically significant differences in severity between the cause of hyperlipidemia and the cause of non-hyperlipidemia(P< 0.05).6.(1)Frequency and interval of recurrence in relapse group: there were 59(58.42%)patients with 1 recurrence,25(24.75%)patients with 2 recurrences,17(16.83%)patients with more than 2 recurrences in RG..There were 59 patients with the frequency of recurrence < 2 times,among which 36 cases were males and 23 cases were females.There were 42 patients with the frequency of recurrence ≥ 2times,among which 26 patients were males and 16 patients were females.There was no significant statistical difference between the two groups(P>0.05).(2)There were42(41.58%)patients with recurrence interval of 3 to 6 months,36(35.64%)patients with recurrence interval of 7 to 12 months.There were 42 patients with the recurrence of interval ≤6 months,among which 26 patients were males and 16 patients were females.There were 59 patients with the recurrence of interval 6 >months,among which 36 patients were males and 23 patients were females.There was no significant statistical difference between the two groups(P>0.05).7.The effect of cholelithiasis on AP recurrence: There were statistically significant differences in the proportion of patients with RG and PG after gallstone extraction of AP compared with the untreated group(P < 0.05).8.The effect of different treatment strategies on the recurrence of AP caused by cholelithiasis:There were 180 AP patients with biliary causes and 159 patients with cholelithiasis.(1)There was no significant statistical difference in the proportion of PG and RG patients in the group undergoing laparoscopic cholecystectomy and the group without laparoscopic cholecystectomy(P > 0.05)(2)There was no significant statistical difference in the proportion of PG and RG patients in the group undergoing Endoscopic retrograde cholangiopancreatography(ERCP)and the group without ERCP.(P > 0.05).(3)There were significant statistical differences in the proportion of PG and RG patients in the group undergoing LC+ERCP/LCBDE and the group without it(P﹤0.05).Conclusions1.The incidence of RAP was 23.9% in our hospital,One recurrence was more common than others in RAP and the interval time was usually within 12 months.2.The top three causes of RAP were hyperlipidemia,biliary and alcoholic(idiopathic).Diabetes,hyperlipidemia causes,and smoking were independent risk factors for AP recurrence3.Hyperlipidemic cause of RAP was more severe,the TG level should be controlled.Neither LC nor ERCP could significantly reduce the recurrence of AP,and LC+ERCP or LC+LCBDE could reduce the risk of recurrence of pancreatitis。... |
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