Risk factors for hyperamylasemia after endoscopic retrograde cholangiopancreatography
-
摘要: 目的探讨经内镜逆行胰胆管造影(ERCP)术后高淀粉酶血症(PEPH)发生的危险因素。方法对2012年1月-2014年12月在新疆维吾尔自治区人民医院行治疗性ERCP并符合纳入标准的233例患者的临床资料进行回顾性分析,提取患者年龄、性别、饮酒史、单发结石、甘油三酯、民族等基本信息并详细录入ERCP术中操作、术中诊断以及并发症等情况。计数资料组间比较采用χ2检验,采用Logistic回归分析寻找PEPH发生的危险因素。结果 PEPH发生率为26.6%(62/233)。单因素分析显示女性(χ2=3.320,P=0.045)、有饮酒史(χ2=6.108,P=0.010)、胆总管狭窄(χ2=5.767,P=0.012)、单发结石(χ2=9.121,P=0.020)、十二指肠乳头憩室(χ2=28.170,P<0.001)、异常的甘油三酯(χ2=54.717,P<0.001)为PEPH发生的影响因素。多因素Logistic回归分析显示女性[比值比(OR)=1.616,P=0.025]、饮酒史(OR=2.360,P=0.010)、胆总管狭窄(OR=2.163,P=0.012)、十二指肠乳...
-
关键词:
- 高淀粉酶血症 /
- 胰腺炎 /
- 胰胆管造影术,内窥镜逆行 /
- 危险因素
Abstract: Objective To investigate the risk factors for the development of post- endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia( PEPH) after endoscopic retrograde cholangiopancreatography( ERCP). Methods The clinical data of 233 patients who underwent therapeutic ERCP from January 2012 to December 2014 in our hospital and met the inclusion criteria were analyzed retrospectively. Basic information including age,sex,drinking history,single stone,triglyceride,and nationality was extracted,and detailed information on intraoperative procedure,intraoperative diagnosis,and complications for ERCP was carefully recorded. Chi- square test was applied for comparison of categorical data between groups,and Logistic regression analysis were applied to determine the risk factors for the development of PEPH. Results The incidence of PEPH was 26. 6%( 62 /233). Univariate analysis showed that female sex( χ2= 3. 320,P= 0. 045),drinking history( χ2= 6. 108,P = 0. 010),common bile duct stenosis( χ2= 5. 767,P = 0. 012),single stone( χ2= 9. 121,P= 0. 020),juxta- ampullary duodenal diverticula( χ2= 28. 170,P < 0. 001),and abnormal triglyceride( χ2= 54. 717,P < 0. 001) might be the risk factors for PEPH,and these factors differed significantly between the two groups. Multivariate analysis showed that female sex( OR = 1. 616,P = 0. 025) drinking history( OR = 2. 360,P = 0. 010),common bile duct stenosis( OR = 2. 163,P = 0. 012),juxta- ampullary duodenal diverticula( OR = 5. 502,P < 0. 001),and abnormal triglyceride( OR = 12. 924,P < 0. 001) were independent risk factors for PEPH. Conclusion Female sex,drinking history,common bile duct stenosis,juxta- ampullary duodenal diverticula,and abnormal triglyceride are independent risk factors for PEPH,and targeted preventive measures for such high- risk populations can effectively reduce the incidence of PEPH. -
[1]JIA YL,JIANG H,HAN Z,et al.Clinical research on the bleeding in ERCP and EST[J].Chin J Clin Pharmacol Ther,2014,19(4):450-453.(in Chinese)贾玉良,姜华,韩真,等.ERCP与EST并发出血的相关临床研究[J].中国临床药理学与治疗学,2014,19(4):450-453. [2]YU L,DENG T,ZHAN YJ,et al.The clinical value of ENBD in the prevention of post-ERCP pancreatitis and hyperamylasemia in patients with common bile duct stones[J].Chin J Gastroenterol Hepatol,2012,21(4):316-318.(in Chinese)余璐,邓涛,占义军,等.ENBD预防胆总管结石ERCP术后急性胰腺炎及高淀粉酶血症的临床价值[J].胃肠病学和肝病学杂志,2012,21(4):316-318. [3]LI X,MENG W,ZHANG L,et al.Risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis:a retrospective analysis of 7,168 cases[J].Pancreatology,2011,11(3):399-405. [4]TUENNEMANN J,MSSNER J,BEER S.Acute pancreatitis:guideline-based diagnosis and treatment[J].Internist(Berl),2014,55(9):1045-1056. [5]DING BJ,LI S,LIU C,et al.The value of preoperative MRCP on the diagnosis of CBD after cholecystectomy before operating ERCP:an analysis of 139 cases[J].Chin J Pract Intern Med,2015,35(5):449-450.(in Chinese)丁百静,李生,刘充,等.ERCP术前经磁共振胰胆管造影对胆囊切除术后胆总管结石139例诊断价值探讨[J].中国实用内科杂志,2015,35(5):449-450. [6]SHAH TU,LIDDLE R,BRANCH MS,et al.Pilot study of aprepitant for pr evention of post-ERCP pancreatitis in high risk patients:a phaseⅡrandomized,double-blind placebo controlled trial[J].JOP,2012,13(2):514-518. [7]WANG P,LI ZS,LIU F,et al.Risk factors for ERCP-related complications:a prospective multicenter study[J].Am J Gastroenterol,2009,104(7):31-40. [8]TSUJINO T,KOMATSU Y,ISAYAMA H,et al.Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography:a randomized,controlled trial[J].Clin Gastroenterol Hepatol,2005,3(1):376-383. [9]ELMUNZER BJ,SCHEIMAN JM,LEHMAN GA,et al.A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis[J].N Engl J Med,2012,366(11):1414-1422. [10]KOBAYASHI Y,KANEMITU T,KAMOTO A,et al.Painless acute pancreatitis associated with sorafenib treatment:a case report[J].Med Oncol,2011,28(3):463-465. [11]FREEMAN LD,KRIO JA,NDSON VB,et al.Risk factors of post-ERCP pancreatitis:a pmspective,muhicenteraudypl[J].Gastrintesf Eudose,2001,54(4):425-434. [12]WANG P,LI ZS,LIU F,et al.Risk factors for ERCP-related complications:a prospective multicenter study[J].Am J Gastroentero,2009,104(1):31-40. [13]CHOUDHARY A,BECHTOLD ML,ARIF M,et al.Pancreatic stents for prophylaxis against post-ERCP pancreatitis:a meta-analysis and systematic review[J].Gastrointest Endosc,2011,73(4):275-282. [14]LEGHARI A,GHAZANFAR S,QURESHI S,et al.Frequency and risk factors in the post-ERCP pancreatitis in a tertiary care centr[J].J Coll Physicians Surg Pak,2013,23(9):620-624. [15]CHEN JJ,WANG XM,LIU XQ,et al.Risk factors for post-ERCP pancreatitis:a systematic review of clinical trials with a large sample size in the past 10 years[J].Eur J Med Res,2014,19(26):1-7.
本文二维码
计量
- 文章访问数: 1802
- HTML全文浏览量: 16
- PDF下载量: 433
- 被引次数: 0