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Clinical study of acute pancreatitis

Author: LuBo
Tutor: QianJiaMing
School: Beijing Union Medical College
Course: Internal Medicine
Keywords: acute pancreatitis clinical feature epidemiology mild acute pancreatitis severe acute pancreatitis elderly treatment prognosisacute pancreatitis severity organ failure BISAP score
CLC: R576
Type: Master's thesis
Year: 2011
Downloads: 103
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Abstract


1.Clinical features and epidemiological characteristics of acute pancreatitisAIM:To summarize the clinical features and epidemiological changes of acute pancreatitis.Methods:The data of747patients with AP, in Peking Union Medical College (PUMC) Hospital, from Jan2000to Dec2010were analyzed retrospectively. The epidemiological changes of681AP patients from Jan2000to Dec2009were analyzed retrospectively.Results:1)clinical features of AP①747patients with AP.Their gender ratio of male to female was1.56.The average age was53.08±7.41years old, with no difference between male and female patients.②Biliogenic factor (54.4%) was the most common etiology. Idiopathic(14.7%), hyperlipemic(7.9%) and alcoholic(6.4%) factor was the2nd,3rd and4th respectively in total cases.Alcoholic factor was the3rd etiology in male, which was significantly higher than female(10.1%vs0.7%, P=0.000).③Adominal pain was the main clinical manifestation,which appeared in96.1%patients.96.1%patients had obvious serum amylase and/or lypase increase.④A11of complications had been seen in SAP patients.In total AP cases pseudocyst(11.2%) still was the most common local complication.17.8%patients had organ dysfunction,and5.1%patients had multiple organs dysfunction.ALI/ARDS(14.6%) was the most common kind of organ dysfunction.⑤The hospital stay were28.43±24.30days.The overall mortality was5.0%,and all death patients were SAP.2) epidemiological changes of acute pancreatitis①In10years,there were681patients with AP. They divided two group by5years of each, which313patients in the former5years and368patients in the latter5years. It was no differences between the two groups in gender ratio and age.②Although time changed,biliogenic factor still was the most common etiology.There was an ascending trend in hyperlipemic AP (4.8%vs9.0%, P=0.034). It had a significantly descending trend in biliogenic AP in female groups (62.9%vs50.3%, P=0.039).③There were no differences between the two groups in hospital stay and mortality (P>0.05)Conclusions:Patients with AP were mainly in middle-age. Biliogenic and idiopathic factors were1st and2nd etiology respectively. Alcoholic factor was mainly in male.With time changed,there was an ascending trend in hyperlipemic AP. It had a descending trend in biliogenic AP in female. Abdominal pain was the main clinical manifestation. The overall mortality was5.0%.2.A comparative study of MAP and SAPAIM:To investigate the differences and similarities of clinical features between MAP and SAP.Methods:The clinical features of MAP and SAP in PUMC Hospital from Jan2000to Dec2010were analyzed retrospectively.Results:①442patients with MAP, their gender ratio of male(M) to female(F) was1.38.305patients with SAP,their gender ratio(M:F) was1.88.The proportion of male patients in SAP was higher than that in MAP (P=0.044).②Biliogenic factor was the most commom etiology in both MAP and SAP.The proportion of biliogenic factor in MAP was higher than that in SAP (58.8%vs47.9%,P=0.003),while the proportion of hyperlipemic and alcoholic factors in MAP were lower than that in SAP (P<0.05).③Abdominal pain was the main clinical manifestation in both groups.The incidence of fever and vomit in SAP were higher than that in MAP,while the incidence of jaundice, obvious serum amylase and/or lypase increase in SAP were lower than that in MAP.④The mortality was only seen in SAP patients.Their hospital stay was significantly longer.Conclusions:The proportion of male patients was higher in SAP.Biliogenic factor was the most commom etiology in both MAP and SAP. The proportion of biliogenic factor was higher in MAP than that in SAP,while the proportion of hyperlipemic and alcoholic factors were lower in MAP than that in SAP. Abdominal pain was the main clinical manifestation in both groups. Some SAP patients may not have obvious serum amylase and/or lypase increase. For SAP patients, their hospital stay was longer. The mortality was only occurred in SAP3.A comparative study of elderly and non-elderly acute pancreatitisAim:To investigate the differences and similarities of clinical features between elderly and non-elderly acute pancreatitis.Methods:The clinical data of292elderly patients with AP from Jan2000to Dec2010in PUMC hospital were analyzed retrospectively, and they compared with455cases of non-elderly patients with AP in the same period.Results:①292elderly patient,their gender ratio of male to female was1.26,455non-elderly patients their gender ratio was1.79. The proportion of male patients was higher in the elderly than that in the non-elderly (P=0.022).②The proportion of biliogenic factor in the elderly was higher than that in the non-elderly (75.7%vs40.7%,P=0.000). In the non-elderly the factors such as idiopathic,hyperlipemic,alcoholic and fatty diet, their proportion were higher than that in the elderly (P<0.05).③The proportion of abdominal pain in the non-elderly was obviously higher than that in the elderly (98.0%vs93.2%, P=0.001).④The incidence of pancreatic necrosis and organ dysfunction were higher in the non-elderly than that in the elderly (P<0.05).⑤There were no significant differences between the two groups in hospital stay and mortality.Conclusions:No matter SAP and MAP, the most common etiology was biliogenic factor. The proportion of biliogenic factor in the elderly was higher than that in non-elderly. The patients of alcoholic pancreatitis were mainly in the non-elderly. Some elderly patients may not have typical abdominal pain.4.Clinical study of treatment and prognosis of severe acute pancreatitis Aim:To analyse the treatment and prognosis of severe acute pancreatitis.Methods:305patients with SAP at PUMC Hospital from Jan2000to Dec2010were analyzed retrospectively. They were divided into death group and survival group.Results:①Among305patients,268patients lived and37patients died.There were no differences between the two groups in gender ratio and age.The mortality of SAP was12.1%.②Ranson score, APACHE Ⅱ(24h) score of death group were higher than of survival group.The proportion of idiopathic factor of death group was higher than of survival group, while the proportion of alcholic factor was lower than of survival group. At admission, the level of serum glucose and blood urea nitrogen in death group were higher than that in survival group,while the level of white blood cell,hematocrit and serum calcium were lower than that in survival group. The incidence of organ dysfunction and multiple organs dysfunction of death group were higher than survival group.③Logistic regression showed the independent death risk factors of SAP were blood urea nitrogen at admission and APACHE Ⅱ(24h) score.④The proportion of the patients being given conservative treatment,drug and operation treatment were76.7%and6.9%respectively.The proportion of the patients using somatostatin, antibiotics, enteral and/or parenteral nutrition were88.5%,99%and100%respectively.Conclusions:Blood urea nitrogen at admission and APACHE Ⅱ(24h) score were the independent death risk factors of SAP. Most patients could be cured by conservative treatment.The mortality of SAP was12.1%. Aim:To evaluate the value of BISAP in predicting severity and organ failure in acute pancreatitis.Methods:94patients with AP who admitted to the emergency of Peking Union Medical College Hospital between May2010and September2011were studied prospectively. The ROC curves of BISAP and CTSI scores were analyzed in assessing severity and organ failure.Results:Among94cases,49cases were classified as SAP and others were MAP.The mean scores of BISAP in SAP were significantly higher than MAP(P=0.000). Both BISAP and CTSI could predict the severity of AP.The AUC for severity by BISAP and CTSI were0.810(95%CI:0.724~0.895),0.907(95%CI:0.847~0.967) respectively(P=0.000).The cutoff values were both3.When the score was no less than3,the OR value of BISAP and CTSI were17.52(95%CI:3.81~80.54) and45.56(95%CI:12.98~159.92) respectively(P<0.01).BISAP could predict the organ failure of AP,while CTSI couldn’t(P≥0.01). The AUC for organ failure by BISAP was0.932(95%CI:0.866~0.999).A BISAP score>3was associated with an increased risk of developing organ failure(OR=49.29,95%CI:5.83~416.56,P<0.01).Conclusion:BISAP is a simple and useful scoring system in early predicting severity and organ failure in acute pancreatitis.

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CLC: > Medicine, health > Internal Medicine > Digestive and abdominal diseases > Pancreatic diseases
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