基于M-ANNHEIM分类系统的307例慢性胰腺炎临床特征分析

目的 以M-ANNHEIM分类系统为指导,研究慢性胰腺炎(CP)的临床表现、病因、危险因素,探讨M-ANNHEIM分类系统对CP的有效性及临床指导意义.方法 收集2007年12月到2009年12月在长海医院住院的CP患者的临床资料,按M-ANNHEIM分类系统进行分类.结果 307例CP患者入组,其中男性214例,女性93例,男∶女=2.3∶1,成人256例,青少年(＜18岁)51例.有饮酒史129例(42.0%),吸烟110例(35.8%),血脂升高31例(10.1%),12例有胰腺分裂、胰腺创伤后胰管瘢痕形成等胰腺导管因素.胰腺钙化231例(75.2%),外分泌功能不全(脂肪泻)45例(14.7%),内分泌功能不全(糖尿病)58例(18.9%),曾行胰腺外科手术者32例(10.4%),伴有胰腺假性囊肿、胆管梗阻、胰腺癌等严重的器质性并发症者39例(12.7%).M-ANNHEIM临床分期:0期患者为0,Ⅰ期患者220例(71.7%),Ⅱ期69例(22.5%),Ⅲ期12例(3.9%),Ⅳ期6例.M-ANNHEIM临床特征及严重性评分平均为7.78分.轻度69例(22.5%),中度174例(56.7%),进展62例(20.2%).结论 M-ANNHEIM 分类系统是临床实践的一个简单的、客观的、精确的、有效的和相对非侵害性的分类系统,有助于研究各危险因素对疾病的影响及其交互作用.

Clinical features of 307 cases of chronic pancreatitis in China based on the M-ANNHEIM classification system

Objective To investigate the clinical manifestations, etiology and risk factors of chronic pancreatitis guided by the M-ANNHEIM classification of chronic pancreatitis and to evaluate the validity and clinical significance of this classification. Methods A review of clinical data of inpatients in our hospital from December 2007 to December 2009 was conducted. The classification was carried out according to the pancreatitis were enrolled. There were 256 adult patients and 51 children and adolescent patients (age of onset<18 yr). Among these cases, 129(42%) reported a drinking history. 110 cases (35.8%) had a smoking history, 31 cases (10.1%) presented with hyperlipoidemia. 12 cases had some factors related to pancreatic duct such as pancreas divisum, pancreas trauma. There were 231 (75.2%) cases with calcification of pancreas, 45 (14.7%) with exocrine insufficiency (steatorrhea), 58 (18.9%) with endocrine dysfunction (diabetes mellitus), 32 (10.4%) underwent pancreatic surgeries, and 39 (12.7%) with pancreatic pseudocysts, biliary obstruction, pancreatic cancer and other severe complications. The M-ANNHEIM clinical staging of chronic pancreatitis was: no case in stage 0, 220(71.7%) cases in stage Ⅰ , 69(22.5%) cases in stage Ⅱ ,12(3.9%) cases in stage Ⅲ and 6 cases in stage Ⅳ. The mean value of the M-ANNHEIM score and severity index was 7.78,69 (22.5%) cases were in the minor level, 174 (56.7%) were in the increased level,62(20.2%) cases were in the advanced level. Conclusions The M-ANNHEIM classification of chronic pancreatitis is a simple, objective, accurate and noninvasive tool in clinical practice. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease.