Clinical and pathological features of acute interstitial pancreatitis in the aged

Histological examination of the pancreas disclosed acute diffuse interstitial pancreatitis in nine cases (0.62%) out of 1457 autopsies performed in 3 yr at two general hospitals in Tokyo. In this series, there were 11 cases of necrotizing or hemorrhagic pancreatitis. In addition to diffuse phlegmonous inflammation, acute interstitial pancreatitis was characterized by rupture of the ducts and ductules associated with profuse intraluminal exudation of polymorphonuclear leukocytes and protein plugs formation. There was scarce parenchymal or fat necrosis. The interstitial type may represent characteristics of acute pancreatitis in the aged. In all nine cases, there were few clinical signs suggestive of acute pancreatitis, except for shock, that developed rapidly. Duration of the disease was rather short. Diagnosis of acute pancreatitis was not made before death. In five patients, acute pancreatitis was terminally superimposed on other serious ailments. But in the other four cases, acute pancreatitis was disclosed as the primary disease at autopsy. Although there was only one case that had a possibility of being secondary to biliary tract infection, ascending bacterial infection and impaired secretion by atrophic parenchyma seemed to be involved in its pathogenesis.     

药物致急性间质性肾炎的临床及病理特征

目的观察药物相关性急性间质性肾炎(DAIN)患者的临床及病理特征。方法选取2003年1月至2009年12月经我院肾活检诊断为急性间质性肾炎的患者72例。根据病程分为急性恢复组(肌酐在3个月之内即恢复至正常水平)和慢性化组(超过3个月肌酐未恢复至正常)。比较2组患者临床及病理特点。结果抗生素是DAIN最常见的因素,其次为非甾体类抗炎药。大多数患者以消化道症状为主诉。慢性化组和急性恢复组在起病时肌酐、病因及临床表现上差异无统计学意义,但慢性化组发病年龄较大(48.8岁对40.6岁,P=0.009),视黄醇结合蛋白(RBP)明显升高[(32.2±19.6)mg/L对(17.1±14.9)mg/L,P<0.01],开始就诊时间明显长于恢复组(34.7 d对14.5 d,P<0.001)。病理上小管病变未见明显差异,但慢性化组间质弥漫细胞浸润的发生率明显大于恢复组。结论抗生素是DAIN最常见病因。发病年龄越大、间质浸润细胞多,易演变为慢性化,预后相对越差。故对年龄较大的急性间质性肾炎患者应更早更积极进行干预治疗。     

老年急性胰腺炎临床特点和治疗分析

目的 探讨老年急性胰腺炎（AP）患者的临床特征和诊疗效果。方法 回顾性地分析南京医科大学第一附属医院胰腺中心2012年1月至2014年12月期间收治的164例老年AP患者（老年组,年龄≥60岁）临床特征和疗效,并与同期收治的309例非老年AP患者（对照组,年龄＜60岁）进行对比分析。结果 老年组AP的主要病因为胆道疾病,其次为高脂血症,老年组胆源性AP发生率明显高于对照组（84.15% vs 59.55%,P＜0.001）,高脂血症性AP发生率明显低于对照组（9.14% vs 31.07%,P＜0.001）。老年组和对照组主要全身并发症均为脏器功能衰竭（20.12% vs 18.77%,P＞0.05）,但老年组全身感染和持续性全身炎症反应综合征发生率明显高于对照组,两组间差异具有统计学意义（P＜0.05）,两组间局部并发症发生率无统计学差异（P＞0.05）。老年组重症急性胰腺炎（SAP）发生率与对照组相当（18.90% vs 18.77%）,但病死率明显高于对照组（7.93% vs 3.56%,P＜0.05）。结论 老年AP患者合并基础疾病多,易发生全身并发症,发展为SAP后病死率高,临床应予以早期诊断和有效治疗,可改善老年AP患者的预后。     

老年急性胰腺炎53例临床分析

目的探讨老年急性胰腺炎的临床特征及诊治方法。方法回顾性分析53例老年急性胰腺炎患者的临床资料。结果老年急性胰腺炎多合并有基础疾病,诱发因素主要为胆系疾病39例,占73.6%,临床主要表现为腹痛、腹胀、发热等。行急诊手术9例,术后6例发生并发症,经对症处理后均好转,死亡3例;行择期手术21例,术后发生并发症10例,经对症处理后均好转;其余23例经非手术保守治疗痊愈。结论老年急性胰腺炎主要病因为胆系疾病,临床表现多种多样,症状不典型,且合并症多,病情重,内科积极治疗有助于改善预后。     

年龄对急性胰腺炎的病理类型及预后的影响

目的：研究年龄同素对急性胰腺炎的病理类型及预后的影响。方法：采用Blamey多指标预测评分体系，对319例急性胰腺炎按年龄≤55和＞55岁分组，结合经外科、CT或腹穿证实的坏死型和水肿型胰腺炎统计分析．结果：＞55岁组的坏死型急性胰腺炎的比率与Blamey指标的积分均高于＜55岁组；计数相关及直线相关分析均示年龄与急性坏死性胰腺炎呈正相关（rn＝0．33，P＜0．005；r＝0．57，P＜0．001）；＞55岁组中与急性胰腺炎有关的9种发病因素中，胆石症及高脂血症多于≤55岁组；92例坏死型胰腺炎10种106次并发症中，88例次（83％）分布于＞55岁者；死亡32例中，27例（84％）年龄＞55岁；8种年龄界值的判别价值示＞55岁及＞60岁二者对坏死型的敏感性、特异性和预测准确性较高。结论：取值＞55岁作为急性胰腺炎的高危指标单独或列入一个预测体系较为合理。     

Clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis: Propensity score matching analysis from a prospective acute pancreatitis registry

BackgroundHypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis (AP) and elevation of serum triglycerides (TG) to ≥1000 mg/dl is strongly indicative of HTG-induced AP (HTG-AP). HTG-AP is potentially associated with persistent organ failure and poor prognosis. Here, we compared differences in clinical features and outcomes between patients with HTG-AP and patients with AP due to other causes.MethodsA prospective AP registry was constructed in Gil Medical Center between June 2014 and May 2018. In total, 499 patients with AP were included for whom serum TG data at admission were available.ResultsHTG-AP was present in 52 patients (10.4%); these patients were younger than patients with AP due to other causes (39.62 ± 10.12 vs. 51.62 ± 17.41, p < 0.001). After propensity score matching adjusted by age, the factors associated with severity were more common in the HTG-AP group; these factors included the presence of systemic inflammatory response syndrome, Ranson’s score ≥3, acute physiology, age, chronic health evaluation (APACHE) II score ≥8 at admission, and C-reactive protein level >10 mg/dl after 24 h of hospitalization. There were no significant differences in complications or severity based on the revised Atlanta classification 2012. In addition, recurrence was more frequent in the HTG-AP group (25.0% vs. 6.4%, p < 0.001).ConclusionHTG-AP occurred in younger patients and showed more frequent recurrences than AP with other causes. Although factors related to severe feature were more common in HTG-AP during early phase, overall severity and prognosis were not different between the two groups.     

高脂血症性急性胰腺炎与胆源性胰腺炎的临床对比分析

目的对比分析高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis,HLAP）与急性胆源性胰腺炎（acute biliary pancreatitis,ABP）的临床特点。方法回顾性对比分析我院2005年8月～2010年8月间收治的28例HLAP和64例ABP患者的临床资料。结果 HLAP组BMI、重症患者比例、Ranson评分≥3、CT分级为D、E及APACHEII≥8分者均较ABP组高（P〈0.05）。HLAP组血清TG、GLU、UA均显著高于ABP组,而ALT、AKP、TBIL、DBIL及血AMY均显著低于ABP组（P〈0.05）。两组患者平均住院时间无统计学差异（P〉0.05）。HLAP组患者死亡率为14.3%）,显著高于ABP组的1.5%（P〈0.05）。结论与ABP组相比,HLAP组通常病情较重,多为SAP且常不伴有血淀粉酶的显著升高,且死亡率高。     

Clinical outcomes of acute pancreatitis in patients with cirrhosis

BackgroundAP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis.MethodsThe National Inpatient Sample (NIS) database (2003–2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.ResultsOver 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001).ConclusionAP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.     

广东地区高脂血症性胰腺炎的临床特征分析

目的分析广东地区高脂血症性急性胰腺炎（HLAP）的临床特征。方法收集广州市第一人民医院、韶关市粤北人民医院、汕头市中心医院和梅州市人民医院1990年至2005年急性胰腺炎（AP）病例共1582例。根据病因分为HLAP（123例）和急性胆源性胰腺炎（ABP）（828例）两组,比较两组患者在诱因、临床表现、实验室指标、疾病严重程度和预后等方面的差异。结果两组的临床症状和体征无显著差异;HLAP组的TG水平显著高于ABP组;但血清淀粉酶仅有36%的患者升高3倍以上,显著低于ABP组的62%。HLAP组的SAP比例、脏器衰竭发生率、总体病死率和复发率均显著高于ABP组（P〈0.05）。结论HLAP具有显著的重症化和复发性趋势,预后较为凶险。     

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目的探讨系统性红斑狼疮(SLE)合并急性胰腺炎的临床特点、病因、发病机制和治疗方法。方法回顾性分析1983-01～2003-03北京协和医院住院治疗的SLE合并急性胰腺炎患者15例。结果急性轻型胰腺炎12例,重型胰腺炎3例。所有患者均给予中到大剂量糖皮质激素治疗,病情痊愈5例,好转5例,死亡5例。结论(1)急性胰腺炎是SLE病情活动的表现;(2)胰腺血管病变是导致胰腺炎的主要致病机制;(3)糖皮质激素可能不是导致胰腺炎的病因;(4)中到大剂量糖皮质激素治疗是安全有效的。     

The clinical outcome of elderly patients with acute pancreatitis is not different in spite of the different etiologies and severity

The aim of this study was to investigate the overall clinical characteristics of elderly patients with acute pancreatitis. We retrospectively evaluated 227 consecutively enrolled patients who were admitted with acute pancreatitis. The clinical features, the radiological and laboratory data and the clinical outcome were analyzed according to the age groups (≥65 years vs. <65 years). Among the 227 enrolled patients with acute pancreatitis, there were 85 elderly patients and 142 non-elderly. The mean age of the elderly patients was 72.3 ± 5.5 years and that of the non-elderly was 44.7 ± 11.7 (p < 0.001). For the elderly patients, biliary pancreatitis was the most common cause (56.5%), but alcoholic pancreatitis was most common in the non-elderly patients (45.8%). Although the computed tomography (CT) severity index was significantly higher for the non-elderly patients (p < 0.001), the acute physiology and chronic health evaluation (APACHE II) score was significantly higher for the elderly than that for the non-elderly (p < 0.001). However, the duration of the hospital stay (10.3 ± 9.6 days vs. 11.9 ± 10.1 days, p = 0.619) and mortality (3.5% vs. 0.7%, p = 0.148) were not different between the age-groups. In our study, chronological age had no significant influence on the clinical outcome in spite of the different etiologies and severity of acute pancreatitis.     

Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis

Background: The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine.

Aim: To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP).

Methods: Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI)?≤?3 on a CT obtained within 48?h of presentation were included.

Results: A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p?p?=?.01) and an AFC on initial CT (OR?=?3.5, 95% CI 1.4–9, p?=?.009) were independently associated with obtaining >1 CT.

Conclusion: An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.     

2012年亚特兰大急性胰腺炎严重程度分类的临床特征研究

目的 比较1992年和2012年亚特兰大急性胰腺炎（AP）严重程度分类的临床特征有无差异.方法 回顾性分析广西医科大学第一附属医院近3年的AP患者临床资料,分别按1992年和2012年AP分类标准将患者分为轻症组（MAP组）、重症组（SAP组）及轻度组（MAP1组）、中度组（MSAP组）、重度组（SAP1组）.比较两种分类方法的临床资料有无差异.结果 纳入的162例AP患者中,男115例,女47例,平均发病年龄（48.62 ±15.37）岁,女性发病年龄高于男性（P =0.006）,病因以胆源性、特发性及饱餐后为主,胆源性AP以女性为主（P＜0.001）.不同的性别、年龄段及病因的住院日、住院费用差异均无统计学意义（P均＞0.05）.MAP组及SAP组的性别、年龄、病因分布差异均无统计学意义（P均＞0.05）.MSAP组的女性比例、发病年龄及胆源性比例均低于MAP1组及SAP1组.各组的住院日及住院费用随AP严重程度升高而升高,且SAP1组＞SAP组（P均＜0.001）.结论 2012年AP严重程度分类标准下,不同AP严重程度的临床特征有一定的差异,较1992年分类标准更有临床指导意义.     

Hypertriglyceridemia and acute pancreatitis

Hypertriglyceridemia is the third most common cause of acute pancreatitis. It typically occurs in patients with an underlying disorder of lipoprotein metabolism and in the presence of a secondary condition such as uncontrolled diabetes, alcohol abuse, or medication use.The presentation of hypertriglyceridemia-induced pancreatitis is similar to that of acute pancreatitis due to other causes; however, patients with hypertriglyceridemia-induced pancreatitis are more likely to have severe disease courses and have a higher likelihood of persistent organ failure. The initial treatment of hypertriglyceridemia-induced pancreatitis is also similar to acute pancreatitis from other causes and consists of aggressive fluid resuscitation, pain control, and nutritional support. Hypertriglyceridemia is specifically treated with apheresis or insulin therapy when necessary.The prompt recognition of hypertriglyceridemia in the setting of acute pancreatitis is essential in both the initial and long-term management of this disease and are essential to prevent recurrent acute pancreatitis. The review seeks to highlight the etiology, pathogenesis, and clinical course of hypertriglyceridemia-induced acute pancreatitis.     

急性胰腺炎并发门静脉系统血栓152例临床特点和临床预测

目的:探讨急性胰腺炎(AP)伴发门静脉系统血栓(PVST)的临床特点和症状性PVST的临床预测。方法:回顾性分析2014年1月至2019年12月昆明医科大学第一附属医院和第二附属医院符合AP并发PVST诊断标准并有完整临床资料的住院患者152例,对其临床特点进行分析。按照是否发生PVST所致临床表现(食管-胃底静脉曲张...     

Clinical features of hypertriglyceridemia-induced acute pancreatitis in an international,multicenter, prospective cohort (APPRENTICE consortium)

BackgroundThe clinical features and outcomes of hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are not well-established.ObjectiveTo evaluate the clinical characteristics of HTG-AP in an international, multicenter prospective cohort.MethodsData collection was conducted prospectively through APPRENTICE between 2015 and 2018. HTG-AP was defined as serum TG levels >500 mg/dl in the absence of other common etiologies of AP. Three multivariate logistic regression models were performed to assess whether HTG-AP is associated with SIRS positive status, ICU admission and/or moderately-severe/severe AP.Results1,478 patients were included in the study; 69 subjects (4.7%) were diagnosed with HTG-AP. HTG-AP patients were more likely to be younger (mean 40 vs 50 years; p < 0.001), male (67% vs 52%; p = 0.018), and with a higher BMI (mean 30.4 vs 27.5 kg/m²; p = 0.0002). HTG-AP subjects reported more frequent active alcohol use (71% vs 49%; p < 0.001), and diabetes mellitus (59% vs 15%; p < 0.001). None of the above risk factors/variables was found to be independently associated with SIRS positive status, ICU admission, or severity in the multivariate logistic regression models. These results were similar when including only the 785 subjects with TG levels measured within 48 h from admission.ConclusionHTG-AP was found to be the 4th most common etiology of AP. HTG-AP patients had distinct baseline characteristics, but their clinical outcomes were similar compared to other etiologies of AP.     

Peritoneal lavage with aprotinin in patients with severe acute pancreatitis

Summary Conclusion Although high-dose aprotinin given intraperitoneally to patients with severe acute pancreatitis seems to inhibit activated trypsin in the peritoneal cavity, the treatment has little effect on the balance between proteases and antiproteases. Plasma levels of leukocyte proteases were high in all the patients, indicating leukocyte activation to be an important feature of the pathophysiology of severe acute pancreatitis. A surprise finding was that the patients had higher peritoneal levels of pancreatic secretory trypsin inhibitor (PSTI) after the lavage procedure. Background Although most studies have shown protease inhibitor therapy to have little or no effect on acute pancreatitis, in an earlier study we found that very high doses of the protease inhibitor aprotinin given intraperitoneally to patients with severe acute pancreatitis seemed to reduce the need of surgical treatment for pancreatic necrosis. In the present study we have further analyzed plasma and peritoneal samples from the same patients to ascertain whether the aprotinin treatment affects the balance between proteases and endogenous antiproteases. Methods In a prospective double-blind randomized multicenter trial, 48 patients with severe acute pancreatitis were treated with intraperitoneal lavage. One group (aprotinin group,n=22) was also treated with high doses (20 million KIU given over 30 h) of aprotinin intraperitoneally. The remaining 26 patients made up the control group. The protease-antiprotease balance was studied by measuring immunoreactive anionic trypsin (irAT), cationic trypsin (irCT), complexes between cationic trypsin and alpha 1-protease inhibitor (irCT-α1PI), leukocyte elastase and neutrophil proteinase 4 (NP4), as well as the endogenous protease inhibitors, pancreatic secretory trypsin inhibitor (PSTI), alpha 2-macroglobulin (α 2M), alpha 1-protease inhibitor (α 1PI), antichymotrypsin (ACHY), and secretory leukocyte protease inhibitor (SLPI). Intraperitoneal levels were studied before and after the lavage procedure, and plasma levels were followed for 21 d. Results The control group had lower plasma levels of SLPI and analysis of peritoneal fluid showed the reduction of irCT-α 1PI to be more pronounced in the aprotinin group. None of the other variables measured differed significantly between the two groups. All patients had very high levels of leukocyte elastase and NP4 both in peritoneal exudate and in plasma. Peritoneal levels of PSTI were higher after the lavage procedure in contrast to the other measured variables that all showed lower peritoneal levels after the lavage.     

胰腺腺泡细胞凋亡与急性胰腺炎及其治疗策略

细胞凋亡是由基因控制的细胞自主的有序的死亡,包含了复杂的调控机制,与细胞坏死有着本质区别,不引起炎症刺激.在实验性及临床急性胰腺炎中均观察到胰腺腺泡细胞的凋亡,研究表明其可能是机体有利的保护性反应,与病情严重程度呈负相关关系.本文总结了近年来对急性胰腺炎胰腺腺泡细胞凋亡机制的研究进展,并对治疗方面的相关研究和探索进行了归纳和阐述.