| Background and purpose:Chronic pancreatitis(CP)is a chronic inflammatory and fibrotic disease of the pancreas,which often leads to irreversible damage of pancreatic parenchyma and exocrine dysfunction.A series of complications caused by CP do great harm to the quality of life and prognosis of patients.In recent years,the incidence of CP has gradually increased.In the face of the rapid growth of cases,there is an urgent need for standardized and efficient storage and utilization of case data.This can provide great help for clinical and scientific research work.Autoimmune pancreatitis(AIP)is a special type of CP,which is rare in clinic.To analyze the clinical characteristics of AIP can provide reference for clinical diagnosis and treatment.Therefore,the purpose of this study is to establish a CP database using Access,a common database management system in China,and to analyze the clinical characteristics of CP patients in our hospital,as well as the differences in clinical characteristics and course of disease of CP patients with different causes,which will help us to choose appropriate treatment methods according to different causes.Methods:1.Establishment of chronic pancreatitis database(1)According to the latest guidelines at home and abroad,the collection standard of CP data was set,and the content to be collected was formulated after consulting relevant literature,combining with the experience of our hospital in the diagnosis and treatment of CP,and discussed by gastroenterology experts of our hospital.(2)Use Access2019 software to create CP database,design login interface,data input interface,data query and export interface.(3)Data of 380 CP patients with complete clinical data admitted to our hospital from January 2000 to December 2022 were collected.2.Clinical analysis of chronic pancreatitis(1)The epidemiological characteristics,etiology distribution,clinical manifestations,imaging features,complications and treatment methods of 380 CP patients were analyzed.(2)Analyze the influence of alcohol causes and idiopathic causes on the course of CP,and the influence of smoking and drinking on the clinical features of CP.3.Clinical features of autoimmune pancreatitis(1)Data of 36 patients with complete data and AIP diagnosis were selected from the CP database.(2)The demographic characteristics,clinical characteristics,serology,imaging,histopathology,treatment and prognosis of AIP patients were analyzed.Results:1.Establishment of chronic pancreatitis database(1)The CP database was composed of six data tables,namely:basic information table,admission situation table,test table,examination/drug treatment table,intervention table and follow-up table.A one-to-many relationship between tables was established.The basic information table of patients was set as the parent table,and the other tables were set as the child tables.The database covered all aspects of CP demographics,clinical symptoms,clinical signs,laboratory tests,imaging examinations,treatment options,prognosis,and follow-up data.(2)Realized the login interface,data input interface,query function,data import and export function.(3)the data of eligible CP patients were entered into the database.2.Analysis of clinical features of chronic pancreatitisA total of 380 patients with CP admitted to our hospital from January 2000 to December 2022 were analyzed,including 265 males and 115 females,with a male to female ratio of 2.30:1.The age of the first admission was normal distribution,with an average age of(49.24±16.00)years old,ranging from 7 to 89 years old,and 16 cases were 18 years old or below,accounting for 4.2%.In this group of CP patients,idiopathic CP was the most common etiology(180 cases,47.37%),followed by alcoholic CP(113cases,29.74%).Among the CP patients in this group,151(39.74%)had a history of smoking and 141(37.37%)had a history of drinking.During the course of the disease,abdominal pain was the most common clinical symptom in 311 cases(81.84%),followed by weight loss(37.89%)and radiating pain(30%).Thirteen patients(3.42%)had no symptoms.Imaging examination,abdominal CT detection of pancreatic calcification(55.4%),and atrophy of the pancreas(49.2%),the highest rate,Magnetic Resonance imaging of pancreatic(Magnetic Resonance Cholangio Pancrea-tography,MRCP)check out the expansion of the main pancreatic duct(79.6%),the highest positive rate,endoscopic ultrasound(EUS)had the highest positive detection rate of pancreatic duct stones(47.3%).The positive rates of CP detected by abdominal CT,EUS,MRCP and abdominal ultrasound were calculated.Chi-square test showed that the positive rates of the four tests were statistically significant(?~2=75.7,P<0.001).The positive rate of abdominal CT(94.1%)was not significantly different from that of EUS(91.0%),but was significantly higher than that of abdominal MR(82.3%)and abdominal ultrasound(60.6%).The incidence of complications in this group of CP patients was as follows:There were 102 cases(26.84%)of diabetes,96 cases(25.26%)of common bile duct stenosis,69 cases(18.16%)of pancreatic pseudocyst,23 cases(6.05%)of pancreatic portal hypertension,5 cases(1.32%)of pancreatic fistula,4 cases(1.05%)of pancreatic duct interruption,4 cases(1.05%)of pancreatic cancer,and 2cases(0.53)of pseudoaneurysm%).A total of 113 patients with Alcoholic chronic pancreatitis(ACP)and Idiopathic chronic pancreatitis(IPF)were enrolled in our hospital.The different characteristics of ACP and ICP patients in our hospital were analyzed.In terms of gender classification,all ACP patients were male,which was significantly higher than the male proportion of ICP patients(53.9%)(P<0.001).The average onset age of ICP patients was(46.4±17.6)years,which was earlier than that of ACP patients(51.3±10.2)years(P=0.003).Previous AP history and smoking history were more common in ACP patients(P<0.001)and abdominal pain(P=0.007).ICP patients were more likely to have diabetes mellitus(P=0.016),pancreatic atrophy(P=0.003)and pancreatic duct stones(P=0.001)at the first admission.ACP patients were more likely to develop pancreatic pseudocysts(P<0.001)and bile duct stenosis(P=0.001).The correlation between smoking history,drinking history and clinical characteristics of CP was analyzed.The results of statistical differences were as follows:the incidence of pancreatic pseudocysts in patients with smoking history was higher than that in patients without smoking history(P=0.014).The incidence of abdominal pain(P=0.032),weight loss(P=0.026),pancreatic calcification(P=0.016)and pancreatic pseudocyst(P=0.001)in patients with drinking history were higher than those in patients without drinking history.The incidence of pancreatic duct stones in patients without drinking history was higher than that in patients with drinking history(P=0.014).Binary Logistic regression analysis showed that alcohol as a cause was an independent risk factor for pancreatic pseudocyst(OR,7.006,95%CI,1.399-35.090)(P=0.018).A total of 380 patients were admitted to our hospital for 536 times,including471 times(87.9%)in gastroenterology department,60 times(11.2%)in general surgery department(including 12 cases transferred from gastroenterology department during hospitalization),2 times in endocrinology department,1 time in traditional Chinese medicine department,1 time in urology department and 1 time in emergency department.One hundred and eighty-three patients(48.2%)were treated conservatively with drugs during hospitalization.ERCP was performed 268 times in157 patients(41.3%),with an average of 1.7 times per patient.Surgical treatment was performed in 52 cases,including 12 cases after ERCP.3.analysis of clinical features of autoimmune pancreatitisIn the study group,there were 28 males and 8 females,with a male to female ratio of 3.5:1.There were 35 cases of type 1 AIP.The average age of males was 62.4±10.5years,and the average age of females was 62±7.3 years.One case of type 2 AIP was an11-year-old female patient.The three most common clinical manifestations of type 1AIP were weight loss(28 cases,80%),obstructive jaundice(17 cases,48.6%),and abdominal pain(15 cases,42.9%).Among the 35 patients with type 1 AIP,15(42.9%)had increased TBIL,26(74.3%)had increased DBIL,23(65.7%)had increased ALT,and 25(71.4%)had increased AST.Twenty-eight patients underwent Ig G4 detection,and 23 patients(82.1%)had elevated Ig G4.Abdominal CT/MRI is the main imaging method for the diagnosis of AIP in our hospital,which is characterized by focal or diffuse enlargement of the pancreatic parenchyma in the lesion area,typical"saussure-like"changes in some patients,enhanced examination with delayed enhancement,showing"frame sign"or"sheath sign",irregular sclerosis and stenosis of the pancreatic duct in the lesion area.endoscopic ultrasound guidedfine needle aspiration(EUS-FNA)was performed in 10 patients(13.1%),and the pathological results in 6 patients were as follows:Pancreatic acinar atrophy,interstitial fibrosis,scattered lymphocytes and plasma cells distribution.Immunohistochemical staining showed that there were more than 10 Ig G4(+)cells in the focal area per high power field,indicating type 1 AIP.The pathological results of 1 case showed acinar atrophy,significant interstitial fibrosis,a few lymphocytes and plasma cells infiltration.Immunohistochemistry showed Ig G4(-)and interstitial smooth muscle(+).Combined with imaging and serology,the final diagnosis of type 2 AIP was made.The pathological results were negative in 3 cases.One case was misdiagnosed as pancreatic tumor and underwent pancreaticoduode-nectomy,and the postoperative pathological diagnosis was type 1 AIP.Eighteen patients were treated with glucocorticoids during induction remission,of which 5patients were treated with ursodeoxycholic acid,and 1 patient was treated with immunosuppressive agents.One case was misdiagnosed as a tumor and underwent surgery.17 cases did not receive hormone therapy.Among 18 patients treated with glucocorticoid,13 patients were followed up successfully,and 1 patient relapsed after5 years of glucocorticoid withdrawal during maintenance treatment,and was relieved after retreatment with glucocorticoid.There was no recurrence in the remaining 12patients treated with hormone maintenance therapy.Conclusion:1.This study successfully established a CP clinical case database based on Microsoft Access 2019 database management system.This database has the characteristics of low development cost,simple interface,convenient operation,easy maintenance and management,etc.2.The number of CP patients admitted has been increasing in the past 20 years.The main causes of CP are idiopathic,alcohol and biliary.Abdominal pain and weight loss are the most common clinical manifestations of CP.3.Smoking and alcohol can aggravate pancreatic injury in CP patients.4.CT,MRCP and EUS are commonly used imaging methods for the diagnosis of CP in our hospital,among which CT can be used as the first choice.5.The patients with CP were mainly treated with endoscopic interventional therapy and drug conservative treatment.6.AIP is relatively rare in clinical practice,and most patients are type 1 AIP with weight loss and jaundice as the main clinical manifestations.7.The diagnosis of AIP is difficult,and there is a possibility of missed diagnosis and misdiagnosis.The diagnosis should be based on clinical symptoms,serology,imaging,histopathology and so on.8.Glucocorticoid has a significant effect on inducing remission of AIP,but there is a possibility of recurrence,so the follow-up of AIP patients needs to be strengthened. |
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