Correlation And Clinical Intervention Between Recurrent Acute Pancreatitis And Chronic Pancreatitis

Part one Etiology and clinical outcome of recurrent acute pancreatitisObjective: The clinical diagnosis rate of recurrent acute pancreatitis(RAP)is increasing year by year,the RAP brings great pain to patients and many troubles to clinicians.For rap,etiological diagnosis is of great significance for guiding clinical treatment.At present,the clinical outcome and etiology have became research focus.Methods:From January 2005 to December 2015,the clinical data of RAP patients were collected through electronic the case management system of hospital.Retrospective analysis of the clinical data of the patients and the logistic regression model was used to explore the risk factors for the progression of rap patients into CP.Results:1.A total of 893 patients with RAP were collected and 792 were finally inrolled.The average age of onset was 37.71 ± 15.16 years.The average frequency of onset was 3.03 ± 3.51 per year.There were 293(37.0%)had smoking history with the volume of 480.97.In terms of etiological analysis,31 cases were alcoholic(3.9%),59 were biliary(7.4%),82 were hyperlipidemic(10.4%),106 cases were IPMN(13.4%),311 cases were idiopathic(39.3%),and 130 cases(16.4%)were finally diagnosed as CP.Endoscopy therapy(n = 321,40.5%)and medical treatment(n = 414,52.3%)were the main methods.2.Four potential risk factors for CP progression were found: AP attack frequency(or = 1.150,P < 0.001);diabetes mellitus(or = 5.741,P < 0.001);fatty diarrhea(or = 3.697,P < 0.001)and alcohol consumption(or = 2.610,P < 0.001).Conclusion:In this study,idiopathic is the main etiology of RAP(39.3%),and about 16.4% of them were CP.Frequency of AP attack,diabetes,fatty diarrhea and alcohol consumption are potential risk factors.Part two Prognosis and clinical intervention of recurrent acute pancreatitisObjective: With the improvement of people's living level and the development of diagnostic technology,the incidence rate of RAP is increasing yearly.The unknown etiology of IRAP is not only caused repeated attacks,but also brings great burden and risk to patients.At present,the research on the clinical treatment effect of IRAP is not rich,especially for ERCP.This study aims to establish a prospective cohort study of IRAP and explore the effect of clinical intervention of IRAP.Methods:The inclusion / exclusion criteria and screening items were designed beforehand,and the cases were included according to the criteria from January 2016 to January 2019.All patients received "clinical medical management" and ERCP would be added to treatment methods if the patient met the ERCP indication standard.The end point of follow-up was January 2020.The intervention effect of the two groups was analyzed and evaluated.Results: 235/307 were finally inrolled into the study.There were 185 patients completed the follow-up study,151 of them relapsed(81.6%).There were 16 cases recurred within 3 months(8.65%),29 recurred between 3-6 months(15.68%),45 cases recurred between 6-12 months(24.32%),60 cases recurred for the first time after more than 1 year(32.43%).Adolescents(RR: 0.304,95% CI: 0.094-0.982),diabetes mellitus(RR: 0.158,95% CI: 0.036-0.701)was the predictor of frequent of AP,while ERCP(RR: 1.785,95% CI: 1.058-3.013)was the protective factor.In the intervention evaluation of the two groups,there was no statistical difference in the AP frequency between ERCP group and control group(0.97 vs 0.77 times per year,P = 0.463),and there was statistical difference in the recurrence within 3 months(P < 0.001)Conclusion:There is a high relapse rate in IRAP,but the frequency of AP and the pain could be improved.The risk factors of AP frequency are adolescents and diabetes mellitus while ERCP intervention seems to play a protective role.In the comparison of the results of ERCP n group and control group,the AP frequency of the two groups was both significantly reduced,but the difference was not obvious,but ERCP intervention can effectively reduce the recurrence within 3 months.Part three Screening and clinical characteristics of CP susceptible genes in IRAP patientsObjective: The role of a variety of genes with rare pathogenic mutations in the disease evolution of IRAP and CP has been reported.However,there is no genetic study on the relationship between IRAP and CP.To explore the potential genetic risk of progression from IRAP to CP,in this chapter,a cohort study was established to screen and verify the role of some known CP susceptible gene mutations in the natural course of IRAP patients.Methods:CRF table and blood samples were collected from IRAP patients who came to Changhai Hospital from January 2016 to September 2017.Combining the sequencing results with the Ex AC database,the mutation sites of CP susceptible genes were verified and screened.Finally,the follow-up results of clinical cases with these mutation sites were analyzed.Results: 176 mutations were detected in 25 genes,including 32 mutations from 4 CP susceptible genes.There were 7 rare pathogenic mutations in this cohort were preliminarily screened and verified: c.194 t + 2T > C in SPINK1 gene,c.1408 a > G in CFTR gene,c.3874 a > G,c.2084 a > G,c.2750 a > t,c.1666 a > G,c.50 t > C.In the follow-up and analysis,it was found that c.194 t + 2T > C(or = 12.535,P = 0.001)and c.50 t > C(or = 12.495,P = 0.002)were the risk factors of progressive CP.In addition,by comparing the cumulative rate K-M curve between the "carrying at least two mutations" group and the "not carrying susceptible mutations" group,we found that the incidence of CP was statistically different(log rank = 25.275,P < 0.001).Conclusion:IRAP gene mutation is variable,including the susceptible genes of CP.With cross validation screening,the mutation of two rare pathogenic mutations is the risk factor for CP.Multiple site mutations have potential synergistic effects on the CP process.