126例慢性胰腺炎病因学分析

目的 探讨我国慢性胰腺炎的病因。方法 回顾性分析1994～2002年我院共收治126例慢性胰腺炎病人病因。结果 126例慢性胰腺炎病人的病因中胆道系统疾病占32．5％。酒精中毒占28．6％。特发性占20．6％，其它病因包括自身免疫疾病、急性胰腺炎、外伤和遗传等。胆道系统疾病中以胆囊结石为最多见，其次为胆管结石和胆囊炎。结论 我国慢性胰腺疾病的病因，以胆道系统疾病为主，而酒精性因素有上升趋势。自身免疫系统疾病作为胰腺疾病的病因正渐受到重视。     

135例慢性胰腺炎临床病例分析

探讨慢性胰腺炎的不同病因和临床表现特点。回顾性分析本院135例慢性胰腺炎的住院患者的主要病因包括胆道系统疾病(31．85％)和酒精中毒(35．56％),其他病因包括特发性、自身免疫性疾病、外伤或遗传等。酒精性CP临床症状发生的比例较胆源性高,特别是腹痛、腹泻、糖尿病的发生率明显高于胆源性CP。酒精性与非酒精性CP组、对照组相比,TG、HDL-C、G／HDL-C差别显著。胆道系统疾病和酒精中毒为CP主要病因,近年来酒精性因素呈上升趋势。临床表现上,酒精性较胆源性CP的发生率高。TG／HDL-C比值可能有助于鉴别酒精性和非酒精性胰腺炎。     

慢性胰腺炎的病因

慢性胰腺炎的发病率地区间差别很大，欧美国家发病率较高，而我国发病率较低，但近年来有升高的趋势，目前尚无准确统计数字［１］。我国慢性胰腺炎的病因与两方国家有所不同。在西方国家的慢性胰腺炎病因中，酒精性高居首位，其他依次为遗传、热带性、损伤和自身免疫等因素。据我国文献及我院近１０年２１５例病例报道，我国慢性胰腺炎最常见的病因是胆道系统疾病，其次为酒精性，也有一部分患者无明显病因，称之为特发性。 胆源性疾病能否成为慢性胰腺炎的病因仍存在争议。我国学者与欧美，甚至亚洲的一些学者在这一问题上存在分歧。早在…     

酒精致胰腺炎的机制研究

慢性酒精中毒是西方发达国家慢性胰腺炎(CP)的首要原因,约占CP病因的40%~90%[1],男性多于女性,发病年龄多在40岁以上。急性胰腺炎(AP)约40%的病因是酒精。复发性胰腺炎患者57%的病因是酗酒。我国CP的病因中,急、慢性酒精中毒从10%~20%[2]上升到34.58%,从而取代慢性胆道系统疾病     

慢性胰腺炎196例的病因相关因素分析

目的 探讨慢性胰腺炎的病因构成。方法 回顾分析2001～2004年196例慢性胰腺炎患者的病因相关因素。结果 仅有12例（6．12％）病因不明确，184例（93．88％）患者具有两种或两种以上的病因相关因素存在。其中患有胆道系统疾病116例次（26．73％），吸烟92例次（21．20％），长期饮酒79例次（18．20％），胰腺疾病97例次（22．35％），高脂血症40例次（9．22％），自身免疫疾病4例次（0．92%），高钙血症2例次（0．46％），营养不良2例次（0．46％），胰周血管动脉瘤2例次（0．46％）。结论 在我国慢性胰腺炎的病因可能是多方面的，各种病因相关因素交织共同促使其发生。     

中国6223例急性胰腺炎病因及病死率分析

目的 调查我国急性胰腺炎（AP）的主要病因及病死率，为临床诊疗工作提供参考依据。方法 收集我国12所医院收治的AP患者，采用统一的软件记录患者的临床流行病学、实验室检查、影像学检查及相关的临床治疗经过，然后对所有患者的病因及病死率进行分析总结。结果 所收集的6223例患者中，重症急性胰腺炎（sAP）1743例，轻症急性胰腺炎（MAP）4480例。胆源性胰腺炎3385例，占54．4％；特发性胰腺炎1228例，占19．7％；高脂血症性胰腺炎782例，占12．6％；酒精性胰腺炎仅496例，占8．O％。284例患者病死，总病死率4．6％；SAP病死率15．6％，MAP为O．3％。结论 胆道疾病是我国AP的主要病因，SAP中以特发性胰腺炎的病死率最高，AP患者的病死率与高龄有关。     

酒精致胰腺炎的机制研究

慢性酒精中毒是西方发达国家慢性胰腺炎(CP)的首要原因,约占CP病因的40% ～ 90%[1],男性多于女性,发病年龄多在40岁以上.急性胰腺炎(AP)约40%的病因是酒精.复发性胰腺炎患者57%的病因是酗酒.我国CP的病因中,急、慢性酒精中毒从10% ～ 20%[2]上升到34.58%,从而取代慢性胆道系统疾病(31.15%)成为首要病因[3].     

胆源性和酒精性慢性胰腺炎临床特点分析

背景：慢性胰腺炎作为一种常见疾病已引起广泛关注．但对其病因分布以及不同类型慢性胰腺炎的临床特征尚不十分明了。目的：了解慢性胰腺炎的临床特征，分析胆源性与酒精性慢性胰腺炎的异同。方法：回顾性分析武汉协和医院1991年1月～2005年12月收治的119例慢性胰腺炎患者的病因构成、临床表现和常规实验室检查结果。结果：本组119例慢性胰腺炎中，最常见的病因为胆系疾病和长期饮酒，分别占37．0％和18．5％。临床表现多样化，常见的除腹痛外，还包括上腹不适、腹胀、消化不良等。除与胆道梗阻相关的黄疸和相应生化改变外，胆源性胰腺炎与酒精性胰腺炎的其他临床表现无明显差异。胆源性胰腺炎的中性粒细胞计数和天冬氨酸氨基转移酶（AST）水平更高。结论：胆系疾病和长期饮酒是本组慢性胰腺炎的主要病因。单从症状和体征难以直接判断慢性胰腺炎的病因，淤胆相关指标以及中性粒细胞计数和AST水平对鉴别胆源性与酒精性胰腺炎有一定临床价值。     

治疗性ERCP在胆胰疾病中的应用价值

目的探讨治疗性ERCP在胆胰系统疾病中的治疗价值。方法对1995年7月至2005年11月的2165例经ERCP治疗的病例资料进行回顾性分析，以评价治疗性ERCP在各种胆胰疾病中的应用价值。结果治疗性ERCP成功率98，7％，治疗病例中胆管结石最多，占51.6％，其次为恶性胆道梗阻，占18．6％，乳头良性狭窄占9.4％，急性胆源性胰腺炎占6．7％，急性梗阻性化脓性胆管炎占6．3％，医源性胆道损伤占3．2％，慢性胰腺炎占3．0％，胆道蛔虫占0．6％，其他0．6％。并发症发生率1．2％，其中穿孔死亡1例。结论治疗性ERCP对多种胆胰疾病疗效确实，是一种安全有效的胆胰疾病治疗手段。     

慢性胰腺炎294例的病因学及临床诊治

目的:研究我国慢性胰腺炎的相关因素及诊治特点方法:回顾分析长海医院近10 a确诊为慢性胰腺炎的294例住院患者,调查其相关病因、诊断方法及治疗措施. 结果:在294例患者中,胆源性89例(30.3%),酒精性84 例(28.6%),其他病因包括腹部手术后、胰腺外伤、胰管先天异常、自身免疫病、先天因素以及特发性等,均较少见.大部分患者表现为反复发作性腹痛,少数伴有脂肪泻及体重减轻等症状.49例患者通过组织学检查确诊,其他均通过影像学检查及BT-PABA试验诊断.大部分患者(81.0%)经非手术治疗症状缓解. 结论:慢性胆道系统疾病仍是我国慢性胰腺炎的主要致病因素,但其比例明显下降,而酒精性慢性胰腺炎明显增多.影像学检查在慢性胰腺炎诊断中具有重要作用,非手术治疗是目前治疗慢性胰腺炎的主要方法.     

Etiological analysis of chronic pancreatitis in 215 cases

OBJECTIVE: To investigate the etiology of chronic pancreatitis in China. METHODS: The causes of 215 cases of chronic pancreatitis treated at Peking Union Medical College Hospital between 1990 and 2000 were analyzed retrospectively. RESULTS: The causes of chronic pancreatitis were biliary diseases (36.7%), alcoholic (26.5%), idiopathic (30.2%), and other uncommon causes such as auto­immune disease, recurrent acute pancreatitis, trauma and heredity. Among biliary diseases, the most common cause was cholecystolithiasis, followed by bile duct stone and cholecystitis. CONCLUSIONS: The main cause of chronic pancreatitis in China is biliary disease. That caused by ethanol is increasing, and autoimmune disease is also receiving increasing attention.     

Epidemiology of pancreatic diseases in Lüneburg county: A study in a defined German population

Background/Aims: Worldwide, the incidence of pancreatic cancer is very well known, that of acute pancreatitis and chronic pancreatitis not. Our study sought to determine the incidence of all three pancreatic diseases in a well-defined population in Germany. Methods: Records of all patients treated for acute (first attacks only) and chronic pancreatitis as well as pancreatic cancer from 1988 to 1995 and who resided in the county of Lüneburg were evaluated. Results: The crude incidence rates for acute pancreatitis, chronic pancreatitis and pancreatic cancer per 100,000 inhabitants/year were 19.7, 6.4, and 7.8. In acute and chronic pancreatitis the male gender dominated, whereas in pancreatic carcinoma the gender ratio was almost even. Peak incidence for acute pancreatitis was in the age group of 35–44 years, for chronic pancreatitis 45–54, and for pancreatic cancer 6575. Etiology of acute pancreatitis was biliary in 40%, alcohol abuse in 32%, unknown in 20%, and other in 8% of the patients. In chronic pancreatitis alcohol abuse was the etiology in 72% and unknown (idiopathic) in 28%. Conclusion: For the first time, epidemiological data obtained in a well-defined German population are being published relating to all three pancreatic diseases: acute pancreatitis (incidence rate, etiology and severity), chronic pancreatitis (incidence rate and etiology), and pancreatic carcinoma (incidence rate). A peak incidence of chronic pancreatitis occurring in an age group 10 years older than the peak age group for acute pancreatitis suggests that chronic pancreatitis develops during this time-frame following first attacks of acute pancreatitis.     

Prevalence of pancreatitis in liver diseases of various etiologies: an analysis of 107,754 adult autopsies in Japan.

The frequency of acute and chronic pancreatitis is 3.3 and 2.1%, respectively, in 107,754 adult autopsies in Japan. Acute pancreatitis is highly associated with liver diseases of various etiologies such as subacute hepatitis (16.1%), fulminant hepatitis (13.5%), biliary cirrhosis (10.5%), cholangiocarcinoma (8.6%) and postnecrotic cirrhosis (7.1%). Chronic pancreatitis is also closely related to various liver diseases. It is suggested that the portal venous stasis in liver diseases may predispose the patients to develop pancreatitis regardless of the etiology of liver diseases.     

Causes of death and some etiologic aspects of acute and chronic pancreatitis

The study gives a survey of the causes of death of 106 patients suffering from acute pancreatitis and of 125 chronic pancreatitis cases. They account for 1.41% and 1.69% respectively of the autopsies performed by us. In 76.4% of the 106 cases of acute pancreatitis the disease was the main cause directly responsible for the death. Chronic pancreatitis was the main underlying disease or a significant secondary condition in the chronic group. The results of etiologic analysis are in acute pancreatitis: 67.9% biliary tract changes, 7.5% alcohol abuses and 20.8% postoperative damages. Alcoholism (44 cases) was important by patients with chronic pancreatitis.     

Etiology of acute pancreatitis--a multi-center study in Taiwan

BACKGROUND/AIMS: Little is known about the etiology of acute pancreatitis in Taiwan. The aim of this study was to evaluate the current etiology of acute pancreatitis in Taiwan by a multi-center cooperative study. METHODOLOGY: Patients with acute pancreatitis were collected from 8 major leading hospitals located at northern, southern, middle and eastern Taiwan from July 1, 1998 to June 30, 2000. The diagnosis of acute pancreatitis was based on characteristic clinical signs and symptoms and three-fold elevation of serum amylase/lipase level or positive evidence in imaging studies. The etiology was attributed to alcohol, gallstones, hypertriglyceridemia, miscellaneous causes, and idiopathic causes. RESULTS: In total 1,193 patients with acute pancreatitis were identified. There were 852 (71.4%) men and 341 (28.6%) women with a mean age of 52.5 years, ranging from 9 to 100 years. Etiology was identified as alcohol in 423 (33.6%), gallstones in 407 (34.1%), hypertriglyceridemia in 147 (12.3%), miscellaneous causes in 109 (9.1%), and idiopathic causes in 107 (9.0%). Patients with alcohol-related acute pancreatitis were the youngest (mean age: 41.5 years), while those with gallstone pancreatitis were the eldest (mean age: 64.1 years) (p < 0.001). The predominant cause of acute pancreatitis in women is gallstones, while alcohol is the leading cause of acute pancreatitis in Taiwanese males. In northern Taiwan, gallstone is the major cause of acute pancreatitis, while alcohol is the predominant etiology in middle, southern, and eastern Taiwan. CONCLUSIONS: Alcohol has become the predominant cause of acute pancreatitis in Taiwan recently. Ecological and gender differences play important roles in the etiology of acute pancreatitis in Taiwan.     

Analysis of the clinical features of recurrent acute pancreatitis in China

Background Since few systematic studies have focused on recurrent acute pancreatitis in China, we sought to investigate its clinical features, including etiological factors and relative frequency. Methods Patients were selected from a total 1471 patients with acute pancreatitis in ten cities of China. All had been admitted to a hospital with an attack of acute pancreatitis between January 1992 and December 2002. Data for each patient was recorded on a standardized form. Results Of the 1471 patients with acute pancreatitis, 157 (10.7%) had recurrent acute pancreatitis. The majority (63%) were male, with a mean age of 41 years (range, 13–82 years). Regarding the etiology, alcohol (20.4%) and cholelithiasis (20.4%) were the most frequent causes, followed by diet (13.4%), hypertriglyceridemia (8.3%), biliary tract infection (5.7%), other (5.1%), and idiopathic factors (26.8%). Alcohol was most frequent in male patients (30.3%), whereas cholelithiasis was most frequent (34.5%) in female patients. The majority of patients (79.6%) presented with their second attack of pancreatitis. Complications of recurrent acute pancreatitis in order of frequency were pancreatic pseudocyst, multiple organ failure, diabetes mellitus type 2, and shock. Conclusions Recurrent acute pancreatitis remains a frequent disease, with cholelithiasis and alcohol being the most usual etiological factors. Alcohol is the primary etiological factor in male patients. In about 26.8% of cases, the etiology remains unknown.     

Endocrine pancreatic function in patients after acute pancreatitis

BACKGROUND/AIMS: The incidence of carbohydrate tolerance disorders in patients after acute pancreatitis has not been clearly established yet. The aim of the study was to estimate the frequency of endocrine pancreatic function impairment in patients after acute pancreatitis and its correlation with acute pancreatitis etiology and clinical course. METHODOLOGY: 82 patients (27 women and 55 men), aged between 28-65 (mean: 47 +/- 8.3), 1-7 (mean: 4.7 +/- 3.6) years after acute pancreatitis were evaluated. Control group consisted of 15 healthy volunteers. Oral glucose tolerance test with RIA insulin level was performed in all examined patients. Patients with any sign of chronic pancreatitis, based on clinical, functional (stool chymotrypsin test) and imaging (US and CT) findings, were excluded from the study. RESULTS: Impaired glucose tolerance was found in 4 patients (4.9%) and overt diabetes in 13 patients (15.8%) recovered from acute pancreatitis, which was not significantly different from those values in the local general population. Mean insulin values fasting and 30, 60 and 90 min after administration of 75 g glucose were significantly lower in patients after acute pancreatitis than in controls (p < 0.001). Endocrine pancreatic function impairment was found significantly more often in patients after severe acute pancreatitis clinical course (p < 0.0001), than in patients after mild pancreatitis. The frequency of impaired glucose tolerance and diabetes after acute alcoholic pancreatitis was 13 (36%), which was significantly higher (p < 0.05), than in cases of gallstone etiology (14%) and other causes (0%). CONCLUSIONS: Pancreatic endocrine function impairment following acute pancreatitis is associated with the decreased plasma insulin levels fasting and after glucose stimulus. Overall, the incidence of diabetes mellitus in patients after acute pancreatitis is similar to the reported values for the general population in this area. Alcoholic pancreatitis is more often complicated with impaired glucose tolerance and diabetes mellitus as regards to other causes of pancreatitis. Endocrine pancreatic function impairment is significantly more common after severe than after mild acute pancreatitis.     

The pancreas and inflammatory bowel diseases

Summary This article reviews the literature and gives an overview on prevalence and possible explanations for pancreatic involvement in inflammatory bowel diseases (IBD). IBD patients have a markedly elevated risk for developing acute pancreatitis as well as pancreatic insuffiency. Multiple potential causes for pancreatitis in IBD patients exist. In the majority of cases acute pancreatitis appears to be related to drug side effects or local structural complications rather than a true extraintestinal manifestation of IBD. Nevertheless, some cases of acute pancreatitis remain unexplained. Prevalence of chronic pancreatitis in IBD patients also seems to be relatively high. However, etiology of pancreatic duct changes and/or the occurrence of exocrine insufficiency remain unclear. In most cases chronic pancreatitis is clinically unapparent, although in some patients it may be accompanied by clinically relevant exocrine insufficiency.     

The pancreas and inflammatory bowel diseases.

This article reviews the literature and gives an overview on prevalence and possible explanations for pancreatic involvement in inflammatory bowel diseases (IBD). IBD patients have a markedly elevated risk for developing acute pancreatitis as well as pancreatic insufficiency. Multiple potential causes for pancreatitis in IBD patients exist. In the majority of cases acute pancreatitis appears to be related to drug side effects or local structural complications rather than a true extraintestinal manifestation of IBD. Nevertheless, some cases of acute pancreatitis remain unexplained. Prevalence of chronic pancreatitis in IBD patients also seems to be relatively high. However, etiology of pancreatic duct changes and/or the occurrence of exocrine insufficiency remain unclear. In most cases chronic pancreatitis is clinically unapparent, although in some patients it may be accompanied by clinically relevant exocrine insufficiency.