發(fā)布時間：2018-02-28 08:22

  本文關(guān)鍵詞： 急性胰腺炎 復(fù)發(fā) 初發(fā) Meta分析　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:復(fù)發(fā)性急性胰腺炎(RAP)是急性胰腺炎(AP)中的一種特殊臨床類型,如何有效預(yù)防AP復(fù)發(fā)成為臨床研究的重要課題。本文旨在探討我國復(fù)發(fā)性急性胰腺炎(RAP)的臨床特點及發(fā)病的高危因素,為今后RAP防治工作提供一定的參考依據(jù)。方法:以急性胰腺炎(AP)、復(fù)發(fā)、病因的中英文為檢索詞,計算機檢索Pubmed、Medline、EMBASE、Science Direct、Cochrane Library、CBM、中國知網(wǎng)、萬方數(shù)據(jù)庫及維普數(shù)據(jù)庫,收集2001年1月至2016年12月公開發(fā)表的有關(guān)RAP發(fā)病因素及臨床特征的臨床對照研究。由2名研究者按照預(yù)先制定的納入和排除標準,獨立的篩選文獻、提取研究資料,根據(jù)NOS評分對納入文獻方法學質(zhì)量進行評價,采用Rev Man 5.3軟件進行文獻數(shù)據(jù)整合及發(fā)表偏倚檢測。固定或隨機效應(yīng)模型的選擇由各研究間異質(zhì)性大小決定,二分類變量采用比值比(OR)及其95%可信區(qū)間(95%CI)表示。結(jié)果:共納入16篇文獻,病例總數(shù)3980例(復(fù)發(fā)組1231例,初發(fā)組2749例),其中11篇研究詳細報道AP復(fù)發(fā)率的情況,本文統(tǒng)計結(jié)果顯示AP治愈后復(fù)發(fā)率為24.25%。將復(fù)發(fā)組(RAP)與初發(fā)組(AP)的發(fā)病原因進行比較,高脂血癥是AP復(fù)發(fā)的危險因素(OR=2.16,95%CI 1.34~3.49,P=0.002)。研究發(fā)現(xiàn),我國近10余年AP病因構(gòu)成仍以膽系疾病為主,膽源性因素與AP的發(fā)作密切相關(guān),但不是AP復(fù)發(fā)的高危因素,AP組與RAP組膽源性因素所占比重無統(tǒng)計學差異(OR=1.19,95%CI 0.77~1.85,P=0.44)。分別合并兩組人群酒精、飲食等因素的臨床數(shù)據(jù),均未見統(tǒng)計學差異(OR=1.24,95%CI 0.89~1.72,P=0.21)、(OR=0.69,95%CI 0.45~1.05,P=0.08),上述因素并非導致AP復(fù)發(fā)的高危風險因素。研究發(fā)現(xiàn)膽囊切除術(shù)后仍存在AP復(fù)發(fā)的情況,兩組差異無統(tǒng)計學意義(OR=1.74,95%CI 0.95~3.18,P=0.07)。合并數(shù)據(jù)分析,復(fù)發(fā)組較初發(fā)組出現(xiàn)黃疸、局部并發(fā)癥的情況多,復(fù)發(fā)組重癥患者比例相對較高,差異有統(tǒng)計學意義(OR=1.61,95%CI 1.16~2.23,P=0.005)、(OR=1.60,95%CI 1.15~2.22,P=0.005)、(OR=1.42,95%CI 1.14~1.76,P=0.001)。AP復(fù)發(fā)與年齡、性別無明顯相關(guān)性,高齡不是導致AP復(fù)發(fā)的高危因素(OR=0.73,95%CI 0.34~1.57,P=0.42)、(OR=0.97,95%CI 0.83~1.13,P=0.68)。RAP組中特發(fā)性因素所占比重小于AP組,差異有統(tǒng)計學意義(OR=0.57,95%CI 0.44~0.72,P0.05)。結(jié)論:高脂血癥為AP復(fù)發(fā)的重要危險因素,膽源性因素在RAP病因中仍占較高比例,但并非導致復(fù)發(fā)的高危因素。復(fù)發(fā)組患者病情相對重,較易發(fā)生重癥急性胰腺炎(SAP)的情況,行膽囊切除術(shù)后AP仍可復(fù)發(fā),RAP組中特發(fā)性因素所占比重相對小。積極尋找病因及針對病因進行早期治療是治療及預(yù)防胰腺炎復(fù)發(fā)的關(guān)鍵所在。
[Abstract]:Objective: recurrent acute pancreatitis (rapp) is a special clinical type of acute pancreatitis. How to effectively prevent the recurrence of AP has become an important subject in clinical research. This article aims to explore the clinical characteristics and high risk factors of recurrent acute pancreatitis in China. Methods: according to the Chinese and English key words of acute pancreatitis, recurrence and etiology, we searched PubmedMedline EMBASE Direct Science Direct Cochrane Library CBM, China knowledge Network, Wanfang Database and Weip Database. From January 2001 to December 2016, a clinical controlled study on the pathogenesis and clinical characteristics of RAP was published. According to the pre-established criteria of inclusion and exclusion, two researchers extracted the data from the independent screening literature. According to the NOS score, the quality of the included literature methodology was evaluated, and the data integration and publication bias detection were performed with Rev Man 5.3 software. The choice of fixed or random effect models was determined by the heterogeneity of each study. Results: a total of 16 literatures were included, with a total of 3 980 cases (1231 cases of recurrence and 2 749 cases of initial onset). Among them, 11 studies reported the recurrence rate of AP in detail. The statistical results show that the recurrence rate of AP after cure is 24.25.The etiology of AP in relapsing group was compared with that in primary group. Hyperlipidemia was the risk factor of AP recurrence. The risk factor of AP recurrence was 2.1695 CI 1.34 ~ 3.49% PX 0.002. It was found that the etiology of AP in China was still mainly caused by biliary diseases in recent 10 years. Biliary factors were closely related to AP attack, but there was no significant difference in the proportion of biliary factors between AP group and RAP group. There was no statistical difference in OR1.2495CI 0.891.72P0. 21. There was no high risk factor for AP recurrence. These factors were not high risk factors for AP recurrence. The study found that there was still AP recurrence after cholecystectomy, and there was no significant difference between the two groups in terms of OR1.7495 CI 0.95C3.18P0.070.Combined data analysis was performed. The results showed that there was no significant difference between the two groups in AP recurrence after cholecystectomy, and there was no significant difference between the two groups. The results were as follows: (1) there was no significant difference between the two groups in terms of AP recurrence after cholecystectomy. The incidence of jaundice and local complications in the recurrent group was higher than that in the initial group, and the proportion of severe patients in the relapsing group was relatively high. The difference was statistically significant. There was no significant correlation between the recurrence and age and sex. Old age is not a high risk factor for AP recurrence. The proportion of idiopathic factors in the OR0.7395CI 0.341.57 CI 0.831.13P0.68P0.68. rap group is lower than that in the AP group, and the difference is statistically significant. Conclusion: hyperlipidemia is an important risk factor for AP recurrence. Choledochogenic factors still account for a high proportion in the etiology of RAP, but they are not high risk factors for recurrence. After cholecystectomy, the proportion of idiopathic factors in AP can still recur rap group is relatively small. It is the key to treat and prevent the recurrence of pancreatitis by actively seeking the etiology and early treatment.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R576

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