老年人慢性胰腺炎的病因及临床特点分析

doi:10.3969/j.issn.1006-7795.2018.02.024

摘要/Abstract

摘要： 目的研究北京地区106例老年人慢性胰腺炎的病因及临床特点。方法回顾性分析首都医科大学宣武医院10年间（2007年1月至2017年1月）诊治为慢性胰腺炎的106例老年患者，与同期132例非老年慢性胰腺炎患者进行对比，比较其病因构成、性别构成、临床表现、合并症以及影像学诊断的差异。结果 106例慢性胰腺炎老年人中，男性：女性=1.72：1，平均年龄（65.3±4.7）岁。老年慢性胰腺炎的病因分析中，胆道系统疾病占47.28%，其次为乙醇中毒21.70%，这与非老年人慢性胰腺炎以乙醇中毒为首要病因不同。老年人慢性胰腺炎虽仍以腹痛（64.15%）和腹胀（33.96%）为主要临床表现，但腹胀发生率与非老年慢性胰腺炎相比显著提高。老年慢性胰腺炎与非老年慢性胰腺炎的合并症相似。老年组的影像检测阳性率由高到低依次为逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）、超声内镜（endoscopicultrasound，EUS）、磁共振（magnetic resonance imaging，MRI）/磁共振胰胆管成像（magnetic resonancecholangiopancreatography，MRCP）、计算机断层扫描（computed tomography，CT）、B超，不同影像检测方法在老年组和非老年组差异有统计学意义，但相同影像方法对两组的检查差异无统计学意义。结论老年人慢性胰腺炎相较于非老年慢性胰腺炎具有一定的特点，其病因中以胆系疾病居首位，腹胀的发生率增加，其诊断应根据老年患者具体情况选择安全的、诊断率高的影像学方法。

关键词: 老年人, 慢性胰腺炎, 病因学分析, 临床特征

Abstract: Objective To investigate the etiology and clinical features of 106 elderly cases of chronic pancreatitis in Beijing. Methods Retrospective analysis of 106 elderly patients with diagnosis and treatment of chronic pancreatitis within 10 years in Xuanwu Hospital of Capital Medical University (January 2007 to January 2017), was compared with 132 cases of non-elderly patients with chronic pancreatitis in the same period. We compared the gender, etiology, clinical manifestations, complications and imaging diagnosis between two groups. Results The average age was (65.3±4.7) years old and male:female was 1.72:1 in 106 elderly patients. In the etiology analysis of elderly chronic pancreatitis, the biliary tract diseases accounted for 47.28%, followed by alcoholism 21.70%, which was the main cause in non-elderly people with chronic pancreatitis. The main clinical manifestations of chronic pancreatitis in the elderly were abdominal pain (64.15%) and abdominal distension (33.96%), which were significantly different from those of non-elderly patients with chronic pancreatitis. The complications of chronic pancreatitis in elderly patients were similar to those in non-elderly. The elderly group, image detection positive rate from high to low occurred in the order of endoscopic retrograde cholangiopancreatography (ERCP), endoscopicultrasound (EUS), magnetic resonance imaging (MRI)/magnetic resonancecholangiopancreatography (MRCP),computed tomography (CT) and ultrasound. Different image detection methods had significant difference both in the elderly group and non-elderly group. However there was no difference between the two groups for the same image method. Conclusion The main causes of chronic pancreatitis in the elderly were biliary diseases and alcohol abuse. The clinical manifestations were abdominal pain and abdominal distension, and the diagnosis should be based on the specific conditions of the elderly patients, and choose safe and high diagnostic imaging methods.

Key words: elderly, chronic pancreatitis, etiology analysis, clinical characteristics

中图分类号:

R576

池添雨, 张玫. 老年人慢性胰腺炎的病因及临床特点分析[J]. 首都医科大学学报, 2018, 39(2): 286-291.

Chi Tianyu, Zhang Mei. Analysis of etiology and clinical features of chronic pancreatitis in the elderly[J]. Journal of Capital Medical University, 2018, 39(2): 286-291.

参考文献

[1] Conwell D L, Banks P A. Chronic pancreatitis[J]. Curr Opin Gastroenterol, 2008, 24(5):586-590.
[2] Conwell D L, Lee L S, Yadav D, et al. American pancreatic association practice guidelines in chronic pancreatitis:evidence-based report on diagnostic guidelines[J]. Pancreas, 2014, 43(8):1143-1162.
[3] Stram M, Liu S, Singhi A D. Chronic Pancreatitis[J].Surg Pathol Clin,2016,9(4):643-659.
[4] 于庆功, 郑清华, 王飞. 老年重症急性胰腺炎的临床诊治总结与体会[J].中国医药导报, 2010,7(19):63-64.
[5] Garg P K, Tandon R K. Survey on chronic pancreatitis in the asia-pacific region[J]. J Gastroenterol Hepatol,2004, 19(9):998-1004.
[6] Kamisawa T, Yoshiike M, Egawa N, et al. Chronic pancreatitis in the elderly in Japan[J].Pancreatology,2004,4(3-4):223-228.
[7] 杨帅,令狐恩强,李闻,等.中国北方地区慢性胰腺炎的病因分析[J].胃肠病学和肝病学杂志,2015,24(4):471-472.
[8] Yousuf Tasneem A A, Yousuf H A, Luck N H. Autoimmune pancreatitis with extraocular muscles involvement[J]. J Pak Med Assoc, 2015,65(10):1125-1127.
[9] 王洛伟,李兆申,李淑德,等.慢性胰腺炎全国多中心流行病学调查[J].胰腺病学,2007,7(1):1-5.
[10] 钱家鸣,李景南,田自力,等.215例慢性胰腺炎病因学分析[J]. 胃肠病学, 2001,6(3):153-155.
[11] 叶博,胡良皞,廖专,等. 2180例慢性胰腺炎临床特征及治疗模式变迁分析[J].中华消化内镜杂志,2013,30(1):10-14.
[12] 赖雅敏,郭涛,丁辉,等.北京协和医院346例慢性胰腺炎人口学特征、病因变迁及临床特点[J]. 协和医学杂志,2015,6(2):89-95.
[13] 吴丽丽,李闻.自身免疫性胰腺炎临床特征分析[J].中华内科杂志,2010,49(11):943-946.
[14] Mayerle J, Hoffmeister A, Werner J, et al. Chronic pancreatitis-definition, etiology, investigation and treatment[J]. Dtsch Arztebl Int,2013, 110(22):387-393.
[15] 王兴鹏,张汝玲. 慢性胰腺炎的病因和发病机制[J].中国实用外科杂志,2011,31(9):778-780.
[16] 陈雪,文保钢.自身免疫性胰腺炎的诊治进展[J].国际检验医学杂志,2016,37(7):950-952.
[17] 王卫卫,王伟,廖专, 等.无痛性慢性胰腺炎患者的临床特征[J].中华胰腺病杂志, 2010,10(6):445-446.
[18] 中华医学会外科学分会胰腺外科学组.慢性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(3):277-282.
[19] 赵佳佳, 王拥军.Oddi括约肌测压[J].首都医科大学学报,2014,35(4):516-520.
[20] 王凯,胥佳,胡荣荣,等.慢性胰腺炎致门静脉高压综合征上消化道大出血[J].临床误诊误治,2016,29(12):24-25.
[21] 金士毛,孙辉,谈春晓.内镜逆行胰胆管造影对慢性胰腺炎的治疗价值[J].中华消化杂志,2011,31(6):416-417.
[22] Seicean A. Endoscopic ultrasound in chronic pancreatitis:Where are we now?[J].World J Gastroenterol, 2010,16(34):4253-4263.