急性胰腺炎并发胰腺假性囊肿危险因素的meta分析

doi:10.3969/j.issn.1004-583X.2023.04.001

摘要/Abstract

摘要：

目的运用meta分析系统评价急性胰腺炎并发胰腺假性囊肿的危险因素,为预防胰腺假性囊肿形成及治疗提供循证医学依据。方法检索Medline数据库、Embase、Cochrane Library、web of science、中国知网、CBM、万方数据库、维普数据库自建库至2022年11月收录的所有相关文献,按纳入和排除标准筛选文献,用纽卡斯尔-渥太华量表(NOS)进行质量评价,Review Manager 5.4、Stata 14软件进行meta分析,用漏斗图评价发表偏倚。结果共纳入14篇文献,meta分析结果示:男性OR=3.94,95%CI(2.12,7.31),P<0.01;糖尿病病史OR=2.62,95%CI(2.04,3.36),P<0.01;CT严重指数(CTSI)OR=1.50,95%CI(1.31,1.72),P<0.01;血清白蛋白水平OR=0.88,95%CI(0.83,0.92),P<0.01;既往饮酒史OR=4.36,95%CI(2.77,6.88),P<0.01;既往胰腺炎病史OR=2.73,95%CI(1.15,6.51),P<0.01。结论本研究显示男性、糖尿病病史、CTSI、血清白蛋白水平、既往饮酒史、既往胰腺炎病史与急性胰腺炎并发胰腺胰假性囊肿有关。

关键词: 急性出血性胰腺炎, 胰腺假性囊肿, 危险因素, meta分析

Abstract:

Objective To evaluate the risk factors of pancreatic pseudocysts in acute pancreatitis using a meta-analysis system, providing evidence based medical evidence for the prevention and treatment of pancreatic pseudocyst. Methods All relevant literature included in Medline database, Embase, Cochrane Library, web of science, CNKI, CBM, Wanfang database and VIP database from the establishment to November 2022 were first searched. The literature were then screened according to the inclusion and exclusion criteria. The Newcastle-Ottawa Scale (NOS) was used for quality evaluation. Review Manager 5.4 and Stata 14 software were applied for meta-analysis. Publication bias was evaluated by Funnel plot. Results A total of 14 articles were finally included. Meta-analysis results showed that male OR=3.94, 95%CI=(2.12-7.31), P<0.01; diabetes history OR=2.62, 95%CI=(2.04-3.36), P<0.01; CT severity index (CTSI) OR=1.5, 95%CI=(1.31-1.72), P<0.01; serum albumin level OR=0.88, 95%CI=(0.83-0.92), P<0.01; previous drinking history OR=4.36, 95%CI=(2.77-6.88), P<0.01; previous history of pancreatitis OR=2.73, 95%CI=(1.15-6.51), P<0.01; the differences were statistically significant. Conclusion Male, diabetes history, CTSI, serum albumin level, previous drinking history, and previous history of pancreatitis were associated with acute pancreatitis complicated with pancreatic pseudocyst.

Key words: pancreatitis, acute hemorrhagic, pancreatic pseudocyst, risk factors, meta-analysis

中图分类号:

R576.1

马明福, 魏志国, 何铁英. 急性胰腺炎并发胰腺假性囊肿危险因素的meta分析[J]. 临床荟萃, 2023, 38(4): 293-301.

Ma Mingfu, Wei Zhiguo, He Tieying. Meta-analysis of risk factors for pancreatic pseudocyst in acute pancreatitis[J]. Clinical Focus, 2023, 38(4): 293-301.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.04.001

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I4/293

图/表 16

图1 文献检索流程图

Fig.1 Flow chart of literature retrieval

表1 最终纳入研究的NOS评分

Tab.1 NOS score of finally included studies

纳入研究	研究对象选择	组间可比性	暴露或结果评价	总分
范丽玉^[9]	4	2	3	9
高道键^[10]	4	1	3	8
李凡^[11]	4	2	3	9
谭蕾^[12]	4	1	3	8
徐太军^[13]	4	1	3	8
杨永明^[14]	4	1	2	7
杨子云^[15]	4	2	3	9
Maringhini^[16]	4	1	3	8
Cui^[17]	4	1	2	7
Diculescu^[18]	4	1	2	7
Kim^[19]	4	2	3	9
Poornachandra^[20]	4	1	2	7
Tan^[21]	4	2	3	9
白建平^[22]	4	1	3	8

表2 纳入研究文献基本特征

Tab. 2 Basic characteristics of included literatures

第一作者	发表年份	国家	研究类型	病例组	对照组	危险因素
范丽玉^[9]	2018	中国	病例对照	143	317	①②④⑤⑥
高道键^[10]	2008	中国	队列研究	30	70	⑥⑦
李凡^[11]	2021	中国	病例对照	70	646	②⑥⑦⑧⑨
谭蕾^[12]	2021	中国	病例对照	48	94	⑥⑦⑩11
徐太军^[13]	2022	中国	病例对照	58	342	②11121314
杨永明^[14]	2019	中国	病例对照	51	75	①②⑦14
杨子云^[15]	2020	中国	病例对照	78	493	②⑧121516
Maringhini^[16]	1996	意大利	队列研究	16	84	②③④
Cui^[17]	2014	韩国	队列研究	19	90	17
Diculescu^[18]	2005	罗马尼亚	队列研究	13	49	1218
Kim^[19]	2012	韩国	病例对照	51	350	121519
Poornachandra^[20]	2011	印度	队列研究	34	31	①③⑤⑥
Tan^[21]	2018	中国	病例对照	654	3 233	121520
白建平^[22]	2014	中国	队列研究	40	80	⑥⑦

图2 性别森林图

Fig.2 Forest plot of gender

图3a 糖尿病病史森林图

Fig.3a Forest plot of history of diabetes

图3b 糖尿病病史敏感性分析

Fig.3b Sensitivity analysis of history of diabetes

图4a CTSI森林图

Fig.4a Forest plot of CTSI

图4b CTSI敏感性分析

Fig.4b Sensitivity analysis of CTSI

图5 血清白蛋白水平森林图

Fig.5 Forest plot of serum albumin level

图6a 饮酒史森林图

Fig.6a Forest plot of drinking history

图6b 饮酒史敏感性分析

Fig.6b Sensitivity analysis of drinking history

图7 既往胰腺炎病史森林图

Fig.7 Forest plot of previous history of pancreatitis

图8 糖尿病病史漏斗图

Fig.8 Funnel plot of history of diabetes

图9 CTSI漏斗图

Fig.9 Funnel plot of CTSI

图10 血清白蛋白水平漏斗图

Fig.10 Funnel plot of serum albumin level

图11 饮酒史漏斗图

Fig.11 Funnel plot of drinking history

参考文献 38

[1]	Wang GJ, Gao CF, Wei D, et al. Acute pancreatitis: Etiology and common pathogenesis[J]. World J Gastroenterol, 2009, 15(12): 1427-1430. doi: 10.3748/wjg.15.1427 URL
[2]	Hines OJ, Pandol SJ. Management of severe acute pancreatitis[J]. BMJ, 2019, 367: 16227.
[3]	Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed?[J]. Gastroenterol Clin North Am, 1999, 28(3): 615-639. doi: 10.1016/S0889-8553(05)70077-7 URL
[4]	Khanna AK, Tiwary SK, Kumar P. Pancreatic pseudocyst: Therapeutic dilemma[J]. Int J Inflam, 2012, 2012: 279476.
[5]	Redwan AA, Hamad MA, Omar MA. Pancreatic pseudocyst dilemma: Cumulative multicenter experience in ma nagement using endoscopy, laparoscopy, and open surgery[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1022-1030. doi: 10.1089/lap.2017.0006 pmid: 28459653
[6]	Magyar A, Tihanyi T, Szlávik R, et al. Pancreatic pseudocysts causing compression symptoms[J]. Acta Chir Hung, 1994, 34(1-2): 59-67. pmid: 7604630
[7]	Vignesh S, Brugge WR. Endoscopic diagnosis and treatment of pancreatic cysts[J]. J Clin Gastroenterol, 2008, 42(5): 493-506. doi: 10.1097/MCG.0b013e3181616159 pmid: 18344889
[8]	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9): 603-605. doi: 10.1007/s10654-010-9491-z pmid: 20652370
[9]	范丽玉. 急性胰腺炎并发胰腺假性囊肿形成的危险因素分析[D]. 青岛大学, 2018.
[10]	高道键, 李兆申, 张文俊, 等. 重症急性胰腺炎后假性囊肿形成的早期危险因素分析[J]. 中华胰腺病杂志, 2008, 8(4):243-245.
[11]	李凡. 急性胰腺炎后并发胰腺假性囊肿的危险因素及预测分析[D]. 兰州大学, 2021.
[12]	谭蕾, 高青. 重症急性胰腺炎患者胰腺假性囊肿形成的相关因素分析[J]. 中华胰腺病杂志, 2021, 21(4):266-270.
[13]	徐太军, 王翔, 徐蕊, 等. 急性胰腺炎并发胰腺假性囊肿常见危险因素分析[J]. 河北医药, 2022, 44(8):1215-1217.
[14]	杨永明. 急性胰腺炎后并发胰腺假性囊肿形成的相关危险因素分析[D]. 昆明医科大学, 2019.
[15]	杨子云, 张海蓉, 何佳薇, 等. 急性胰腺炎并发胰腺假性囊肿危险因素分析[J]. 中国全科医学, 2020, 23(29):3682-3689. doi: 10.12114/j.issn.1007-9572.2020.00.013
[16]	Maringhini A, Ciambra M, Patti R, et al. Ascites, pleural, and pericardial effusions in acute pancreatitis. A prospective study of incidence, natural history, and prognostic role[J]. Dig Dis Sci, 1996, 41(5): 848-852. doi: 10.1007/BF02091521 URL
[17]	Cui ML, Kim KH, Kim HG, et al. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis[J]. Dig Dis Sci, 2014, 59(5): 1055-1062. doi: 10.1007/s10620-013-2967-4 URL
[18]	Diculescu M, Ciocîrlan M, Ciocîrlan M, et al. Predictive factors for pseudocysts and peripancreatic collections in acute pancreatitis[J]. Rom J Gastroenterol, 2005, 14(2): 129-134. pmid: 15990931
[19]	Kim KO, Kim TN. Acute pancreatic pseudocyst: Incidence, risk factors, and clinical outcomes[J]. Pancreas, 2012, 41(4): 577-581. doi: 10.1097/MPA.0b013e3182374def URL
[20]	Poornachandra KS, Bhasin DK, Nagi B, et al. Clinical, biochemical, and radiologic parameters at admission predicting formation of a pseudocyst in acute pancreatitis[J]. J Clin Gastroenterol, 2011, 45(2): 159-163. doi: 10.1097/MCG.0b013e3181dd9d14 pmid: 20628310
[21]	Tan JH, Zhou L, Cao RC, et al. Identification of risk factors for pancreatic pseudocysts formation, intervention and recurrence: A 15-year retrospective analysis in a tertiary hospital in China[J]. BMC Gastroenterol, 2018, 18(1):143. doi: 10.1186/s12876-018-0874-z
[22]	白建平. 急性重症胰腺炎后假性囊肿形成早期危险因素分析[J]. 中外医疗, 2014, 33(2): 40-41.
[23]	Hamada S, Masamune A, Kikuta K, et al. Nationwide epidemiological survey of acute pancreatitis in Japan[J]. Pancreas, 2014, 43(8): 1244-1248. doi: 10.1097/MPA.0000000000000200 URL
[24]	Kristiansen L, Grønbaek M, Becker U, et al. Risk of pancreatitis according to alcohol drinking habits: A population-based cohort study[J]. Am J Epidemiol, 2008, 168(8): 932-937. doi: 10.1093/aje/kwn222 pmid: 18779386
[25]	Criddle DN. The role of fat and alcohol in acute pancreatitis: A dangerous liaison[J]. Pancreatology, 2015, 15(< W>4 Suppl): S6-S12.
[26]	Pandol SJ, Lugea A, Mareninova OA, et al. Investigating the pathobiology of alcoholic pancreatitis[J]. Alcohol Clin Exp Res, 2011, 35(5): 830-837. doi: 10.1111/j.1530-0277.2010.01408.x pmid: 21284675
[27]	Zhang XP, Li ZJ, Zhang J. Inflammatory mediators and microcirculatory disturbance in acute pancreatitis[J]. Hepatobiliary Pancreat Dis Int, 2009, 8(4): 351-357.
[28]	高鸿亮, 王磊, 廖如奕. 体质量指数、血糖水平与急性胰腺炎相关性分析[J]. 中华实用诊断与治疗杂志, 2012, 26(1): 27-28.
[29]	Martínez J, Sánchez-Payá J, Palazón JM, et al. Is obesity a risk factor in acute pancreatitis? A meta-analysis[J]. Pancreatology, 2004, 4(1): 42-48. doi: 10.1159/000077025 pmid: 14988657
[30]	Shen HN, Chang YH, Chen HF, et al. Increased risk of severe acute pancreatitis in patients with diabetes[J]. Diabet Med, 2012, 29(11): 1419-1424. doi: 10.1111/dme.2012.29.issue-11 URL
[31]	张冰, 朱国玲, 孙秋, 等. 基线空腹血糖水平与急性胰腺炎发病风险的前瞻性队列研究[J]. 中国全科医学, 2021, 24(1): 60-64. doi: 10.12114/j.issn.1007-9572.2020.00.602
[32]	袁琳, 李学良. 急性胰腺炎与新发糖尿病的关系[J]. 胃肠病学, 2015, 20(8): 500-502.
[33]	Sun YF, Song Y, Liu CS, et al. Correlation between the glucose level and the development of acute pancreatitis[J]. Saudi J Biol Sci, 2019, 26(2): 427-430. doi: 10.1016/j.sjbs.2018.11.012 URL
[34]	蒋丽丽, 李兆申. 急性胰腺炎复发诱因及内镜治疗[J]. 中华胰腺病杂志, 2010, 10(2):75-78.
[35]	Rehan A, Shabbir Z, Shaukat A, et al. Diagnostic accuracy of modified CT severity index in assessing severity of acute pancreatitis[J]. J Coll Physicians Surg Pak, 2016, 26(12): 967-970.
[36]	Lee WS, Huang JF, Chuang WL. Outcome assessment in acute pancreatitis patients[J]. Kaohsiung J Med Sci, 2013, 29(9): 469-477. doi: 10.1016/j.kjms.2012.10.007 URL
[37]	Vincent JL, Russell JA, Jacob M, et al. Albumin administration in the acutely ill: What is new and where next?[J]. Crit Care, 2014, 18(4): 231. doi: 10.1186/cc13991 URL
[38]	Zhang W, Hu J, Yao B, et al. Evaluation of early prognostic factors of mortality in patients with acute pancreatitis: A retrospective study[J]. Gastroenterol Res Pract, 2017, 2017: 8363561.