“假定的”特发性急性胰腺炎的诊断检查和结果:对多中心观察队列的事后多重比较分析

时间:2020-05-23 作者:admin 点击:129次
“假定的”特发性急性胰腺炎的诊断检查和结果:对多中心观察队列的事后多重比较分析
The diagnostic work-up and outcomes of‘presumed’ idiopathic acute pancreatitis: A post-hoc analysis of a multicentre observational cohort
Nora D Hallensleben1,2, Devica S Umans2,3, Stefan AW Bouwense4,Robert C Verdonk5, Tessa EH Romkens6, Ben J Witteman7,Matthijs P Schwartz8, Marcel B Spanier9, Robert Laheij10,Hjalmar C van Santvoort11,12, Marc G Besselink13, Jeanin E van Hooft3andMarco J Bruno1; for the Dutch Pancreatitis Study Group

翻译:王浩 审校:张立超 侯森林

摘要
引言:在经过标准的诊断检查后仍有16-27%的急性胰腺炎病例不能明确病因,这种情况一般被称为特发性急性胰腺炎(IAP)。确定胰腺炎的病因是很有必要的,因为这直接影响急性阶段的治疗以及对预防胰腺炎的复发提供一些干预措施。
注:IAP/APA循证指南总结了首次急性胰腺炎急性发作时推荐的最低限度的诊断检查,至少应包括五项内容:(1)详细的个人病史;(2)家族史;(3)体检;(4)实验室检查(即肝酶、钙、甘油三酯);和(5)经腹部超声(TUS)。如果用这项检查不能确定病因,急性胰腺炎被归类为“假定的”特发性急性胰腺炎(IAP)。
方法:在2008-2015年之间,荷兰的19家医院前瞻性的登记记录了一些急性胰腺炎的患者。这些患者胰腺炎的潜在病因不能根据首要的诊断检查而确定,从而被贴上“假定的”IAP标签。本研究的目的是评估诊断模式的使用以及确定“假定的” IAP的病因,并评估这些患者接受治疗和不接受治疗后的复发率。
结果:在1632名登记的患者中,有191名患者第一次胰腺炎发作诊断为“假定的”IAP,其中有176(92%)名又接受了额外的诊断检查:CT (n=124, 诊断率8%), EUS (n=62, 诊断率 35%), MRI/MRCP (n=56, 诊断率 33%), 再次超声检查(n=97, 诊断率 21%), IgG4 (n=54, 诊断率 9%) and ERCP (n=15, 诊断率47%)。在176位患者中有64位(36%)确定了病因,最多的是胆系疾病(n=39)。在176位患者中有13位(7%)诊断为肿瘤。如果经过额外的检查确定了病因,那么相比于没有确切病因的患者来说,其复发率在接受治疗的病人中较低 (15% VS 43%, p=0.014)。
结论:额外的诊断检查确定了三分之一的“假定的”IAP患者的病因。病因大部分是是胆系疾病,但偶尔也会发现肿瘤。确定病因并进行后续治疗可降低复发率。
 
Abstract
Introduction: After standard diagnostic work-up, the aetiology of acute pancreatitis remains unknown in 16–27% of cases, a condition referred to as idiopathic acute pancreatitis (IAP). Determining the aetiology of pancreatitis is essential, as it may direct treatment in the acute phase and guides interventions to prevent recurrent pancreatitis.
Methods: Between 2008 and 2015, patients with acute pancreatitis were registered prospectively in 19 Dutch hospitals. Patients who had a negative initial diagnostic work-up with regard to the underlying aetiology of their pancreatitis were labelled ‘presumed’ IAP . The aim of this study was to assess the use of diagnostic modalities and their yield to establish an aetiology in ‘presumed’ IAP , and to assess recurrence rates both with and without treatment.
 Results: Out of the 1632 registered patients, 191 patients had a first episode of ‘presumed’ IAP , of whom 176 (92%) underwent additional diagnostic testing: CT (n=124, diagnostic yield 8%), EUS (n=62, yield 35%), MRI/MRCP (n=56,yield 33%), repeat ultrasound (n=97, yield 21%), IgG4 (n=54, yield 9%) and ERCP (n=15, yield 47%). In 64 of 176 patients (36%) an aetiological diagnosis was established, mostly biliary (n=39). In 13 out of 176 of patients (7%) a neoplasm was diagnosed. If additional diagnostic work-up revealed an aetiology, the recurrence rate was lower in the treated patients than in the patients without a definite aetiology (15% versus 43%, p=0.014).
 Conclusion: Additional diagnostic testing revealed an aetiology in one-third of ‘presumed’ IAP patients. The aetiology found was mostly biliary, but occasionally neoplasms were found. Identification of an aetiology with subsequent treatment reduced the rate of recurrence.