全胰切除术和胰岛自体移植治疗慢性胰腺炎

IF 25.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Pub Date : 2025-06-14 DOI:10.1053/j.gastro.2025.04.040

Guru Trikudanathan, Anne Eaton, Martin L. Freeman, Vikesh K. Singh, Sarah J. Schwarzenberg, Jaimie D. Nathan, Gregory J. Beilman, Maisam Abu-El-Haija, David Adams, Syed A. Ahmad, Srinath Chinnakotla, Elissa M. Downs, Mayha Faghih, Timothy B. Gardner, Luis F. Lara, Katherine Morgan, Sri Prakash Mokshagundam, Bashoo Naziruddin, Andrew Posselt, Timothy L. Pruett, Melena D. Bellin

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引用次数: 0

摘要

背景和目的全胰切除术联合胰岛自体移植（TPIAT）是一种新兴但有争议的治疗顽愈性疼痛性慢性胰腺炎（CP）和复发性急性胰腺炎（RAP）患者的方法。TPIAT的结果尚未在多中心研究中得到验证。方法在12个中心前瞻性纳入384名患者（平均年龄30岁（SD 17岁），其中34%为儿童，62%为女性），患有疼痛性CP和/或RAP，接受TPIAT治疗。在基线、TPIAT后6个月和1年收集疼痛评分、阿片类药物使用和健康相关的生活质量，包括身体成分总结（PCS）和精神成分总结（MCS）。用回归模型评估预测结果的因素。结果阿片类药物的使用，间隔14天，从TPIAT前的61%下降到TPIAT后1年的24% （p<0.001）。每日腹痛从65%下降到23%，而平均（SD）疼痛评分从4.9（2.3）下降到2.3 (2.5)（p<0.001）。在一个多变量模型中，1年的阿片类药物使用与tpiat前的年龄和阿片类药物使用相关（优势比9.21[95%置信区间3.93-25.7]）。PCS和MCS评分提高≥10分的分别为58%和35%。术后1年生活质量评分越高，术前评分越高，年龄越小。1年时，平均（SD） HbA1c为7(1.9%)，20%与胰岛素无关。病程、胰腺形态和病因不能预测TPIAT的疗效。结论在这项针对顽固性CP或RAP患者的前瞻性多中心研究中，TPIAT可显著减轻疼痛负担，改善生活质量。虽然年轻预示着更好的结果，但病程和病因却没有。

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Total Pancreatectomy and Islet Auto Transplant for Chronic Pancreatitis

Background and Aims

Total pancreatectomy with islet autotransplantation (TPIAT) is an emerging but controversial therapy for patients with intractably painful chronic pancreatitis (CP) and recurrent acute pancreatitis (RAP). Outcomes of TPIAT have not been validated in multicenter studies.

Methods

384 participants (mean age 30 (SD 17) years, 34% pediatric, 62% female) with painful CP and/or RAP undergoing TPIAT were prospectively enrolled at 12 centers. Numeric pain scores, opioid use, and health-related QOL, including physical component summary (PCS) and mental component summary (MCS), were collected at baseline and at 6 months and 1 year post TPIAT. Predictors of outcomes were evaluated with regression modeling.

Results

Opioid use, assessed over a 14 day interval, decreased from 61% before to 24% at 1 year after TPIAT (p<0.001). Daily abdominal pain decreased from 65% to 23%, while the mean (SD) pain score decreased from 4.9 (2.3) to 2.3 (2.5) (both p<0.001). In a multivariable model, opioid use at 1 year was associated with older age and opioid use pre-TPIAT (odds ratio 9.21 [95% confidence interval 3.93-25.7]). PCS and MCS score improved by ≥10 points in 58% and 35% respectively. Higher QOL scores at 1 year were associated with higher scores pre-surgery and younger age. Mean (SD) HbA1c was 7 (1.9%) with 20% insulin independent at 1 year. Duration of disease, pancreas morphology, and etiology did not predict response to TPIAT.

Conclusion

In this prospective multicenter study of patients with intractably painful CP or RAP, TPIAT significantly reduced pain burden and improved QOL. While young age predicted better outcomes, duration and etiology of disease did not.

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来源期刊

Gastroenterology 医学-胃肠肝病学

CiteScore

45.60

自引率

2.40%

发文量

4366

审稿时长

26 days

期刊介绍： Gastroenterology is the most prominent journal in the field of gastrointestinal disease. It is the flagship journal of the American Gastroenterological Association and delivers authoritative coverage of clinical, translational, and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. Some regular features of Gastroenterology include original research studies by leading authorities, comprehensive reviews and perspectives on important topics in adult and pediatric gastroenterology and hepatology. The journal also includes features such as editorials, correspondence, and commentaries, as well as special sections like "Mentoring, Education and Training Corner," "Diversity, Equity and Inclusion in GI," "Gastro Digest," "Gastro Curbside Consult," and "Gastro Grand Rounds." Gastroenterology also provides digital media materials such as videos and "GI Rapid Reel" animations. It is abstracted and indexed in various databases including Scopus, Biological Abstracts, Current Contents, Embase, Nutrition Abstracts, Chemical Abstracts, Current Awareness in Biological Sciences, PubMed/Medline, and the Science Citation Index.