【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。更多还原

【Abstract】 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: 1.58-9.51, P<0.01), alcoholic etiology(OR=0.61, 95%CI: 0.42-0.87, P<0.01), and organ failure(OR=3.63, 95%CI: 1.11-11.92, P=0.03) were the influencing factors for IPN. Conclusion Current evidence shows that biliary etiology and alcoholic etiology are unique influencing factors for ANP in the Eastern population, while Ranson score is a unique influencing factor in the Western population. BMI and extent of necrosis ≥30% are unique influencing factors for IPN in the Eastern population, while alcoholic etiology is a unique influencing factor in the Western population.更多还原