东西方国家急性坏死性胰腺炎影响因素的Meta分析

马书丽; 杨晓曦; 陈晨; 喻静; 周游; 路国涛; 向晓星; 龚卫娟; 陈炜炜; 陈娟

doi:10.3969/j.issn.1001-5256.2023.07.019

东西方国家急性坏死性胰腺炎影响因素的Meta分析

DOI: 10.3969/j.issn.1001-5256.2023.07.019

马书丽^{1, 2, 3},
杨晓曦^{1, 3},
陈晨³,
喻静³,
周游³,
路国涛⁴,
向晓星¹,
龚卫娟³,
陈炜炜¹,
陈娟^1, , ,

1.
苏北人民医院消化内科，江苏扬州 225000
2.
南通大学附属医院消化内科，江苏南通 226000
3.
扬州大学护理学院，江苏扬州 225000
4.
扬州大学附属医院消化内科，江苏扬州 225000

基金项目:

国家自然科学基金 (82004291);

江苏省自然科学基金 (BK20190907);

江苏省六大人才高峰项目 (WSN-325)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：陈娟负责论文设计和拟定写作思路；马书丽、杨晓曦负责文献检索、整理并分析数据；马书丽负责解读数据并撰写论文初稿；陈晨指导分析数据，修改论文；喻静、周游、路国涛、向晓星、龚卫娟、陈炜炜指导撰写文章并最后定稿。

详细信息

通信作者:
陈娟，chenjuan406512@163.com (ORCID: 0000-0002-2181-2636)

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出版历程
- 收稿日期: 2022-03-18
- 录用日期: 2022-04-24
- 出版日期: 2023-07-20

Influencing factors for acute necrotizing pancreatitis in Eastern and Western countries: A meta-analysis

Shuli MA^{1, 2, 3},
Xiaoxi YANG^{1, 3},
Chen CHEN³,
Jing YU³,
You ZHOU³,
Guotao LU⁴,
Xiaoxing XIANG¹,
Weijuan GONG³,
Weiwei CHEN¹,
Juan CHEN^{1
, ,
,}

1.
Department of Gastroenterology, Subei People's Hospital, Yangzhou, Jiangsu 225000, China
2.
Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China
3.
School of Nursing, Yangzhou University, Yangzhou, Jiangsu 225000, China
4.
Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, China

Research funding:

National Natural Science Foundation (82004291);

Natural Science Foundation of Jiangsu Province (BK20190907);

Six Talent Peaks Project of Jiangsu Province (WSN-325)

More Information

Corresponding author: CHEN Juan, chenjuan406512@163.com (ORCID: 0000-0002-2181-2636)

摘要

摘要: 目的探讨东西方国家急性坏死性胰腺炎(ANP)及感染性坏死性急性胰腺炎(IPN)影响因素的区别, 为预测和预防ANP的发生提供理论依据。方法在PubMed、Embase、Cochrane library、Web of Science等数据库检索公开发表的有关ANP、IPN的影响因素, 检索期限为建库至2021年1月21日, 运用Meta分析方法进行整合分析。结果共纳入59项研究, 其中22项来自东方国家, 37项来自西方国家。结果显示, ANP的影响因素: 在东方为男性(OR=1.51, 95%CI: 1.18~1.91, P < 0.01)、CRP (SMD=1.39, 95%CI: 1.06~1.71, P < 0.01)、D-二聚体(SMD=0.44, 95%CI: 0.07~0.81, P=0.02)、APACHE-Ⅱ评分(MD=3.51, 95%CI: 1.38~5.64, P < 0.01)、酒精性病因(OR=3.57, 95%CI: 2.68~4.75, P < 0.01)、胆源性病因(OR=0.60, 95%CI: 0.46~0.77, P < 0.01);在西方为男性(OR=1.63, 95%CI: 1.30~2.05, P < 0.01)、CRP (SMD=2.09, 95%CI: 1.12~3.05, P < 0.01)、APACHE-Ⅱ评分(MD=4.28, 95%CI: 2.73~5.83, P < 0.01)、Ranson评分(MD=2.99, 95%CI: 2.50~3.47, P < 0.01)和器官衰竭(OR=10.87, 95%CI: 2.62~45.04, P < 0.01)。IPN的影响因素: 在东方为年龄(MD=2.16, 95%CI: 0.43~3.89, P=0.01)、BMI (MD=1.74, 95%CI: 1.23~2.25, P < 0.01)、白蛋白水平(SMD=-0.43, 95%CI: -0.75~-0.12, P < 0.01)、CRP (SMD=0.58, 95%CI: 0.04~1.11, P=0.03)、PCT (SMD=0.80, 95%CI: 0.56~1.04, P < 0.01)、D-二聚体(MD=0.23, 95%CI: 0.15~0.31, P < 0.01)、APACHE-Ⅱ评分(MD=2.47, 95%CI: 0.73~4.22, P < 0.01)、Ranson评分(MD=1.60, 95%CI: 1.46~1.73, P<0.01)和坏死范围≥30%(OR=2.52, 95%CI: 1.26~5.06, P < 0.01);在西方为年龄(MD=4.07, 95%CI: 1.82~6.31, P < 0.01)、APACHE-Ⅱ评分(MD=3.28, 95%CI: 1.39~5.17, P < 0.01)、Ranson评分(MD=2.18, 95%CI: 1.75~2.62, P < 0.01)、SIRS评分(OR=3.88, 95%CI: 1.58~9.51, P < 0.01)、酒精性病因(OR=0.61, 95%CI: 0.42~0.87, P < 0.01)和器官衰竭(OR=3.63, 95%CI: 1.11~11.92, P=0.03)。结论当前证据显示, 东方人群ANP的特异性影响因素为胆源性病因及酒精性病因, 而Ranson评分是西方人群ANP的特异性影响因素; BMI和坏死范围≥30%是东方人群IPN特异性影响因素, 酒精性病因是西方人群IPN特异性影响因素。
- 胰腺炎, 急性坏死性 /
- 影响因素 /
- Meta分析
Abstract: Objective To investigate the differences in the influencing factors for acute necrotizing pancreatitis (ANP) and infectious pancreatic necrosis (IPN) between Eastern and Western countries, and to provide a theoretical basis for the prediction and prevention of ANP. Methods Databases including PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles on the influencing factors for ANP and IPN published up to January 21, 2021, and a Meta-analysis was performed. Results A total of 59 studies were included, with 22 studies from Eastern countries and 37 studies from Western countries.The Meta-analysis showed that in Eastern countries, male sex (odds ratio[OR]=1.51, 95% confidence interval[CI]: 1.18-1.91, P < 0.01), C-reactive protein (CRP)(standardized mean difference[SMD]=1.39, 95%CI: 1.06-1.71, P < 0.01), D-dimer (SMD=0.44, 95%CI: 0.07-0.81, P=0.02), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score (mean difference[MD]=3.51, 95%CI: 1.38-5.64, P < 0.01), alcoholic etiology (OR=3.57, 95%CI: 2.68-4.75, P < 0.01), and biliary etiology (OR=0.60, 95%CI: 0.46-0.77, P < 0.01) were the influencing factors for ANP, and in Western countries, male sex (OR=1.63, 95%CI: 1.30-2.05, P < 0.01), CRP (SMD=2.09, 95%CI: 1.12-3.05, P < 0.01), APACHE-Ⅱ score (MD=4.28, 95%CI: 2.73-5.83, P < 0.01), Ranson score (MD=2.99, 95%CI: 2.50-3.47, P < 0.01), and organ failure (OR=10.87, 95%CI: 2.62-45.04, P < 0.01) were the influencing factors for ANP.In Eastern countries, age (MD=2.16, 95%CI: 0.43-3.89, P=0.01), body mass index (BMI)(MD=1.74, 95%CI: 1.23-2.25, P < 0.01), albumin level (SMD=-0.43, 95%CI: -0.75 to-0.12, P < 0.01), CRP (SMD=0.58, 95%CI: 0.04-1.11, P=0.03), procalcitonin (SMD=0.80, 95%CI: 0.56-1.04, P < 0.01), D-dimer (MD=0.23, 95%CI: 0.15-0.31, P < 0.01), APACHE-Ⅱ score (MD=2.47, 95%CI: 0.73-4.22, P < 0.01), Ranson score (MD=1.60, 95%CI: 1.46-1.73, P < 0.01), and extent of necrosis ≥30%(OR=2.52, 95%CI: 1.26-5.06, P < 0.01) were the influencing factors for IPN, while in Western countries, age (MD=4.07, 95%CI: 1.82-6.31, P < 0.01), APACHE-Ⅱ score (MD=3.28, 95%CI: 1.39-5.17, P < 0.01), Ranson score (MD=2.18, 95%CI: 1.75-2.62, P < 0.01), SIRS score (OR=3.88, 95%CI: 1.58-9.51, P < 0.01), alcoholic etiology (OR=0.61, 95%CI: 0.42-0.87, P < 0.01), and organ failure (OR=3.63, 95%CI: 1.11-11.92, P=0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population.BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.
- Pancreatitis, Acute Necrotizing /
- Influencing Factors /
- Meta-analysis

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图 1 文献筛选流程图

Figure 1. Flow-chart of study selection

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表 1 纳入文献的基本特征

Table 1. Basic characteristics of included studies

第一作者	年份	国家	研究类型	例数	观察比较	影响因素	质量评分
西方
Büchler M^[13]	1986	德国	队列研究	35	ANP vs non-ANP	年龄、性别、酒精性病因、胆源性病因	5
Büchler M^[14]	1989	德国	队列研究	48	ANP vs non-ANP	Ranson评分	5
Domschke S^[15]	1993	德国	病例对照研究	40	ANP vs non-ANP	CRP、白蛋白	5
Kaufmann P^[16]	1996	奥地利	队列研究	25	ANP vs non-ANP	年龄、性别、CRP、酒精性病因、胆源性病因	7
Schmid SW^[17]	1996	德国	队列研究	40	ANP vs non-ANP	Ranson评分、年龄、性别	6
Manes G^[18]	1997	德国	队列研究	36	ANP vs non-ANP	CRP	5
Rau B^[19]	1997	德国	队列研究	50	ANP vs non-ANP/IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、年龄、性别、酒精性病因、胆源性病因	6
Tenner S^[20]	1997	美国	病例对照研究	51	IPN vs non-IPN	器官衰竭	6
Baillargeon JD^[21]	1998	美国	病例对照研究	64	ANP vs non-ANP	HCT、APACHE-Ⅱ评分、年龄、性别、酒精性病因、胆源性病因	7
Rau B^[22]	1998	德国	队列研究	70	ANP vs non-ANP	APACHE-Ⅱ评分、Ranson评分、年龄、性别	6
Hietaranta A^[23]	1999	芬兰	队列研究	57	IPN vs non-IPN	SIRS	7
Brown A^[24]	2000	美国	队列研究	53	ANP vs non-ANP	HCT、年龄、性别、器官衰竭	6
Buttenschoen K^[25]	2000	德国	队列研究	34	ANP vs non-ANP	Ranson评分、性别	5
Mándi Y^[26]	2000	匈牙利	队列研究	20	IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、年龄、性别、酒精性病因、SIRS、胆源性病因	6
Müller CA^[27]	2000	瑞士	队列研究	64	ANP vs non-ANP/IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、年龄、性别、坏死范围≥30%、酒精性病因、器官衰竭、胆源性病因	6
Rau B^[28]	2000	德国	队列研究	66	ANP vs non-ANP	APACHE-Ⅱ评分、Ranson评分、年龄、性别、酒精性病因、胆源性病因	5
Rau B^[29]	2000	德国	队列研究	61	ANP vs non-ANP/IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、年龄、性别、酒精性病因、胆源性病因	6
Khan AA^[30]	2002	美国	病例对照研究	93	ANP vs non-ANP	APACHE-Ⅱ评分	7
Müller CA^[31]	2002	瑞典	队列研究	85	ANP vs non-ANP	Ranson评分、年龄、性别、酒精性病因、胆源性病因	6
Perez A^[32]	2002	美国	病例对照研究	99	ANP vs non-ANP	APACHE-Ⅱ评分、器官衰竭	7
Riché FC^[33]	2003	法国	队列研究	48	IPN vs non-IPN	Ranson评分、年龄、性别、酒精性病因、胆源性病因	7
Barauskas G^[34]	2004	立陶宛	病例对照研究	78	ANP vs non-ANP	性别、CRP、酒精性病因、胆源性病因	7
Papachristou GI^[35]	2006	美国	病例对照研究/队列研究	436	ANP vs non-ANP	BMI、HCT、年龄、性别、吸烟、胆源性病因	6
Dambrauskas Z^[36]	2007	立陶宛	队列研究	52	IPN vs non-IPN	年龄、性别、坏死范围≥30%、酒精性病因、胆源性病因	9
López A^[37]	2007	西班牙	队列研究	84	ANP vs non-ANP	年龄、性别、酒精性病因、胆源性病因	7
Muller CA^[38]	2007	德国	队列研究	109	ANP vs non-ANP/IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、年龄、性别、CRP、酒精性病因、胆源性病因	6
Rahman SH^[39]	2007	英国	队列研究	64	ANP vs non-ANP	APACHE-Ⅱ评分、CRP	7
De Campos T^[40]	2008	巴西	病例对照研究	39	ANP vs non-ANP	HCT、APACHE-Ⅱ评分、年龄、性别、CRP、酒精性病因、改良版Marshall评分、SOFA评分	6
Muddana V^[41]	2009	美国	队列研究	129	ANP vs non-ANP	BMI、APACHE-Ⅱ评分、Ranson评分、年龄、性别、酒精性病因、器官衰竭、胆源性病因、CTSI	7
Lipinski M^[42]	2013	波兰	病例对照研究	103	ANP vs non-ANP	Cre	7
Talukdar R^[43]	2013	美国	队列研究	281	IPN vs non-IPN	BMI、HCT、年龄、性别、BUN、Cre、SIRS	8
Kostic I^[44]	2015	塞尔维亚	队列研究	52	ANP vs non-ANP	年龄、性别	7
Easler JJ^[45]	2016	美国	队列研究	423	ANP vs non-ANP	酒精性病因	6
Moran RA^[46]	2016	美国	队列研究	142	IPN vs non-IPN	年龄、性别、酒精性病因、器官衰竭、EEN、胆源性病因	6
Garret C^[47]	2018	法国	队列研究	132	IPN vs non-IPN	BMI、年龄、性别、酒精性病因、合并糖尿病、器官衰竭、吸烟、胆源性病因、CTSI	5
Verdonk RC^[48]	2018	德国	队列研究	285	ANP vs non-ANP	酒精性病因、胆源性病因	6
Szakacs Z^[49]	2019	匈牙利	队列研究	1 198	ANP vs non-ANP	年龄	7
东方
Isogai M^[50]	1998	日本	病例对照研究	22	ANP vs non-ANP	淀粉酶、年龄、性别、AST	6
Mettu SR^[51]	2003	印度	病例对照研究	40	IPN vs non-IPN	APACHE-Ⅱ评分、MCTSI	6
Garg PK^[52]	2005	印度	队列研究	104	IPN vs non-IPN	坏死范围≥30%	7
Gardner TB^[53]	2006	黎巴嫩	病例对照研究	230	ANP vs non-ANP	性别、酒精性病因、胆源性病因	7
Ueda T^[54]	2007	日本	队列研究	75	IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分	6
Guo J^[55]	2012	中国	队列研究	35	ANP vs non-ANP	APACHE-Ⅱ评分、Ranson评分、年龄、性别、胆源性病因	7
Ke L^[56]	2012	中国	队列研究	45	ANP vs non-ANP	D-二聚体	7
Lu Z^[57]	2012	中国	队列研究	30	IPN vs non-IPN	APACHE-Ⅱ评分、Ranson评分、淀粉酶、年龄、性别、CRP、合并糖尿病、WBC、PCT、坏死范围≥30%、酒精性病因、胆源性病因、CTSI	7
Guo Q^[58]	2014	中国	队列研究	447	IPN vs non-IPN	BMI、年龄、性别、坏死范围≥30%、MCTSI、酒精性病因、胆源性病因	6
Erbis H^[59]	2015	土耳其	病例对照研究	76	ANP vs non-ANP	年龄、性别、CRP、WBC	6
Shen X^[60]	2015	中国	队列研究	153	IPN vs non-IPN	BMI、HCT、APACHE-Ⅱ评分、淀粉酶、年龄、性别、CRP、白蛋白、WBC、酒精性病因、胆源性病因、CTSI	8
Thandassery RB^[61]	2015	印度	队列研究	81	IPN vs non-IPN	器官衰竭	6
Ji L^[62]	2016	中国	队列研究	115	IPN vs non-IPN	BMI、HCT、APACHE-Ⅱ评分、Imrie评分、年龄、性别、CRP、BUN、WBC、酒精性病因、PLT、Cre、D-二聚体、EEN、胆源性病因、改良版Marshall评分	7
Chen HZ^[63]	2017	中国	队列研究	215	IPN vs non-IPN	HCT、APACHE-Ⅱ评分、Imrie评分、性别、CRP、BUN、WBC、坏死范围≥30%、MCTSI、酒精性病因、器官衰竭、PLT、Cre、D-二聚体、胆源性病因、改良版Marshall评分	8
Chen Y^[64]	2017	中国	队列研究	57	ANP vs non-ANP/IPN vs non-IPN	SAP、APACHE-Ⅱ评分、CRP、PCT、D-二聚体、SOFA评分	9
Zhang Y^[65]	2017	中国	病例对照研究	1 131	ANP vs non-ANP	Ranson评分、年龄、性别、WBC、酒精性病因、Cre、吸烟、AST、胆源性病因	8
Cao X^[66]	2018	中国	病例对照研究	111	IPN vs non-IPN	BMI、HCT、年龄、性别、CRP、合并糖尿病、白蛋白、BUN、WBC、PCT、坏死范围≥30%、MCTSI	8
Noda Y^[67]	2018	日本	病例对照研究	56	ANP vs non-ANP	BMI、年龄、性别	7
Tan C^[1]	2020	中国	队列研究	2 130	IPN vs non-IPN	SIRS	7
Ding L^[4]	2019	中国	队列研究	142	IPN vs non-IPN	年龄、性别、坏死范围≥30%、酒精性病因、胆源性病因	9
Ünal Y^[68]	2019	土耳其	病例对照研究	96	ANP vs non-ANP	淀粉酶、性别、CRP、酒精性病因、胆源性病因	6
Wan J^[69]	2019	中国	队列研究	2 478	ANP vs non-ANP/IPN vs non-IPN	SAP、D-二聚体	5
注：APACHE-Ⅱ，急性生理和慢性健康评估Ⅱ；BUN，血尿素氮；Cre，肌酐；CRP，C反应蛋白；CTSI，CT严重指数；EEN，早期肠内营养；HCT，红细胞压积；MCTSI，改良CT严重指数；PLT，血小板；SAP，重度急性胰腺炎；SIRS，全身炎症反应综合征；SOFA，序贯器官衰竭评估；PCT，降钙素原。

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表 2 西方ANP的影响因素

Table 2. Influencing factors for ANP in the West

影响因素	研究个数	OR/MD/SMD(95%CI)	P值	I²值(%)	P值¹⁾
年龄	18^{[13, 16-17, 19, 21-22, 24, 27-29, 31, 35, 37-38, 40-41, 44, 49]}	-1.91(-4.84~1.03)	0.20	73	＜0.01
男性	19^{[13, 16-17, 19, 21-22, 24-25, 27-29, 31, 34-35, 37-38, 40-41, 44]}	1.63(1.30~2.05)	＜0.01	19	0.21
BMI	2^{[35, 41]}	1.58(-3.52~6.67)	0.54	90	＜0.01
HCT	4^{[21, 24, 35, 40]}	3.24(-0.26~6.74)	0.07	87	＜0.01
CRP	7^{[15-16, 18, 34, 38-40]}	2.09(1.12~3.05)	＜0.01	91	＜0.01
APACHE-Ⅱ评分	10^{[19, 21-22, 28-30, 32, 39-41]}	4.28(2.73~5.83)	＜0.01	77	＜0.01
Ranson评分	11^{[14, 17, 19, 22, 25, 27-29, 31, 38, 41]}	2.99(2.50~3.47)	＜0.01	66	＜0.01
胆源性病因	14^{[13, 16, 19, 21, 27-29, 31, 34-35, 37-38, 41, 48]}	0.84(0.66~1.08)	0.17	49	0.02
酒精性病因	15^{[13, 16, 19, 21, 27-29, 31, 34, 37-38, 40-41, 45, 48]}	1.49(1.00~2.24)	0.05	57	＜0.01
器官衰竭	4^{[24, 27, 32, 41]}	10.87(2.62~45.04)	＜0.01	83	＜0.01
注：1)为异质性检验的P值。

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表 3 东方ANP的影响因素

Table 3. Influencing factors for ANP in the East

影响因素	研究个数	OR/MD/SMD (95%CI)	P值	I²值(%)	P值¹⁾
年龄	5^{[50, 55, 59, 65, 67]}	1.21(-3.54~5.97)	0.62	57	0.06
男性	7^{[50, 53, 55, 59, 65, 67-68]}	1.51(1.18~1.91)	＜0.01	0	0.47
WBC	2^{[59, 65]}	1.95(-0.23~4.12)	0.08	69	0.07
AST	2^{[50, 65]}	0.09(-0.04~0.22)	0.16	0	0.37
淀粉酶	2^{[50, 68]}	0.11(-0.73~0.96)	0.79	56	0.13
CRP	3^{[59, 64, 68]}	1.39(1.06~1.71)	＜0.01	0	0.95
D-二聚体	3^{[56, 64, 69]}	0.44(0.07~0.81)	0.02	53	0.12
APACHE-Ⅱ评分	2^{[55, 64]}	3.51(1.38~5.64)	＜0.01	1	0.32
Ranson评分	2^{[55, 64]}	1.08(-0.59~2.75)	0.21	54	0.03
胆源性病因	3^{[55, 65, 68]}	0.60(0.46~0.77)	＜0.01	9	0.33
酒精性病因	2^{[65, 68]}	3.57(2.68~4.75)	＜0.01	9	0.30
注：1)为异质性检验的P值。

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表 4 西方IPN的影响因素

Table 4. Influencing factors for IPN in the West

影响因素	研究个数	OR/MD/SMD(95%CI)	P值	I²值(%)	P值¹⁾
年龄	10^{[19, 26-27, 29, 33, 36, 38, 43, 46-47]}	4.07(1.82~6.31)	＜0.01	44	0.06
男性	10^{[19, 26-27, 29, 33, 36, 38, 43, 46-47]}	1.31(0.92~1.88)	0.13	0	0.81
BMI	2^{[43, 47]}	0.86(-0.69~2.41)	0.27	0	0.39
APACHE-Ⅱ评分	5^{[19, 26-27, 29, 38]}	3.28(1.39~5.17)	＜0.01	55	0.07
Ranson评分	6^{[19, 26-27, 29, 33, 38]}	2.18(1.75~2.62)	＜0.01	42	0.12
SIRS	5^{[19, 23, 26, 29, 43]}	3.88(1.58~9.51)	＜0.01	0	0.77
胆源性病因	9^{[19, 26-27, 29, 33, 36, 38, 46-47]}	1.30(0.90~1.89)	0.16	0	0.81
酒精性病因	9^{[19, 26-27, 29, 33, 36, 38, 46-47]}	0.61(0.42~0.87)	＜0.01	43	0.08
器官衰竭	4^{[20, 27, 46-47]}	3.63(1.11~11.92)	0.03	76	＜0.01
坏死范围≥30%	2^{[27, 36]}	9.36(0.69~127.00)	0.09	59	0.12
注：1)为异质性检验的P值。

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表 5 东方IPN的影响因素

Table 5. Influencing factors for IPN in the East

影响因素	研究个数	OR/MD/SMD (95%CI)	P值	I²值(%)	P值¹⁾
年龄	6^{[4, 57-58, 60, 62, 66]}	2.16(0.43~3.89)	0.01	35	0.17
男性	7^{[4, 57-58, 60, 62-63, 66]}	1.16(0.90~1.51)	0.26	9	0.36
BMI	4^{[58, 60, 62, 66]}	1.74(1.23~2.25)	＜0.01	0	0.56
HCT	4^{[60, 62-63, 66]}	2.30(2.02~6.23)	0.30	96	＜0.01
WBC	6^{[57-58, 60, 62-63, 66]}	0.50(-0.35~1.35)	0.25	51	0.07
PLT	3^{[57, 63, 66]}	-0.13(-0.61~0.35)	0.60	82	＜0.01
白蛋白	2^{[60, 66]}	-0.43(-0.75~-0.12)	＜0.01	0	0.65
BUN	3^{[62-63, 66]}	-0.34(-1.28~0.59)	0.47	94	＜0.01
Cre	2^[62-63]	0.20(-0.13~0.53)	0.23	50	0.16
淀粉酶	2^{[57, 60]}	0.03(-0.32~0.38)	0.87	0	0.64
CRP	5^{[57, 60, 62-63, 66]}	0.58(0.04~1.11)	0.03	87	＜0.01
PCT	3^{[57, 63, 66]}	0.80(0.56~1.04)	＜0.01	0	0.89
D-二聚体	2^[62-63]	0.23(0.15~0.31)	＜0.01	0	0.90
APACHE-Ⅱ评分	6^{[51, 54, 57, 60, 62-63]}	2.47(0.73~4.22)	＜0.01	91	＜0.01
Ranson评分	2^{[54, 57]}	1.60(1.46~1.73)	＜0.01	0	0.70
CTSI	3^{[57, 60, 62]}	2.69(-0.97~6.35)	0.15	99	＜0.01
MCTSI	4^{[51, 58, 63, 66]}	1.90(-0.39~4.20)	0.10	99	＜0.01
Imrie评分	2^[62-63]	0(-0.19~0.19)	＞0.05	0	＞0.05
改良版Marshall评分	2^[62-63]	0(-0.19~0.19)	＞0.05	0	＞0.05
胆源性病因	6^{[4, 57-58, 60, 62-63]}	0.91(0.70~1.19)	0.50	21	0.27
酒精性病因	6^{[4, 57-58, 60, 62-63]}	0.66(0.35~1.27)	0.21	51	0.07
合并糖尿病	2^{[57, 66]}	0.66(0.20~2.21)	0.50	0	0.99
SAP	3^{[60, 64, 69]}	5.51(0.35~86.42)	0.22	95	＜0.01
器官衰竭	2^{[61, 63]}	1.19(0.67~2.10)	0.56	0	0.99
坏死范围≥30%	6^{[4, 52, 57-58, 63, 66]}	2.52(1.26~5.06)	＜0.01	76	＜0.01
注：1)为异质性检验的P值。

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