东西方国家急性坏死性胰腺炎影响因素的Meta分析  

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

作　　者：马书丽 杨晓曦[1,3] 陈晨 喻静 周游 路国涛 向晓星[1] 龚卫娟 陈炜炜 陈娟 MA Shuli;YANG Xiaoxi;CHEN Chen;YU Jing;ZHOU You;LU Guotao;XIANG Xiaoxing;GONG Weijuan;CHEN Weiwei;CHEN Juan(Department of Gastroenterology,Subei People’s Hospital,Yangzhou,Jiangsu 225000,China;Department of Gastroenterology,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226000,China;School of Nursing,Yangzhou University,Yangzhou,Jiangsu 225000,China;Department of Gastroenterology,The Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225000,China)

机构地区：[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

出　　处：《临床肝胆病杂志》2023年第7期1643-1656,共14页Journal of Clinical Hepatology

基　　金：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)。

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。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:

关 键 词：胰腺炎 急性坏死性 影响因素 META分析 

分 类 号：R576[医药卫生—消化系统]