初发急性胰腺炎后新发糖尿病的危险因素评估

刘慧; 李贤秋; 罗刚; 唐世孝

doi:10.3969/j.issn.1001-5256.2020.12.026

初发急性胰腺炎后新发糖尿病的危险因素评估

DOI: 10.3969/j.issn.1001-5256.2020.12.026

西南医科大学附属医院消化内科

基金项目:

四川省泸州市人民政府-四川医科大学科技战略合作项目[2015LZCYD-SO1（9/15）]；

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中图分类号: R576;R587.1
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出版历程
- 收稿日期: 2020-06-29
- 出版日期: 2020-12-20

Risk factors for new-onset diabetes after incipient acute pancreatitis

Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University

Research funding:

摘要

摘要:
目的探索初发急性胰腺炎（AP）后新发糖尿病的相关危险因素。方法回顾性纳入2013年6月-2020年1月西南医科大学附属医院收治的初发AP后发生急性胰腺炎后糖尿病（PPDM-A）的患者95例,为PPDM-A组,以2∶1比例随机抽取同一时间段的初发AP后未发糖尿病的患者190例作为对照组,即非PPDM-A组,收集患者的基线资料和临床资料。计量资料组间比较采用t检验或U检验,计数资料组间比较采用χ2检验或Fisher精确检验,多因素分析采用logistic回归分析。结果两组BMI、体质量、饮酒史、高尿酸血症、脂肪肝比例差异均有统计学意义（P值均<0.>0. 05）。两组不同病因（胆源性、高脂血症性、酒精性AP）比较差异有统计学意义（P<0.>11. 1 mmol/L比例均高于非PPDM-A组（P值均<0.>0. 05）。PPDM-A...
- 急性胰腺炎 /
- 胰源性糖尿病 /
- 危险因素
Abstract:
Objective To investigate the risk factors for new-onset diabetes after incipient acute pancreatitis( AP). Methods A retrospective analysis was performed for 95 patients with post-acute pancreatitis diabetes mellitus( PPDM-A) after incipient AP who were admitted to The Affiliated Hospital of Southwest Medical University from June 2013 to January 2020( PPDM-A group),and 190 patients without diabetes after incipient AP during the same period of time were selected at a ratio of 2 ∶ 1 and were enrolled as non-PPDM-A group. Baseline data and clinical data were collected. The t-test or the U test was used for comparison of continuous data,and the chi-square test or the Fisher's exact test was used for comparison of categorical data; a logistic regression analysis was used for multivariate analysis. Results There were significant differences between the two groups in body mass index( BMI),body weight,and proportion of patients with a drinking history,hyperuricemia,or fatty liver disease( all P < 0. 05),while there were no significant differences between the two groups in age,male sex,and proportion of patients with a smoking history,a family history of diabetes,or hypertension( all P > 0. 05).There were also significant differences in etiologies( biliary,hyperlipidemic,and alcoholic AP) between the two groups( P < 0. 05). Compared with the non-PPDM-A group,the PPDM-A group had significantly higher triglyceride,blood glucose,white blood cell count( WBC),C-reactive protein,and proportion of patients with blood glucose > 11. 1 mmol/L on admission( all P < 0. 05),while there were no significant differences in Ca2 +,blood amylase,and blood lipase between the two groups( all P >0. 05). Compared with the non-PPDM-A group,the PPDM-A group had significantly higher incidence rates of acute peripancreatic necrotic collections and acute peripancreatic fluid collections,proportion of patients with multiple onset of AP,and proportion of patients with CTSI score > 4( all P < 0. 05),while there were no significant differences in the proportion of patients with systemic inflammatory response syndrome and disease severity between the two groups( both P > 0. 05). The multivariate analysis showed that the outcome of PPDM-A in alcoholic AP patients was 5. 868 times that in biliary AP patients( 95% confidence interval [CI]: 1. 607-21. 418,P = 0. 007),and the outcome of PPDM-A in hyperlipidemic AP patients was 3. 312 time that in biliary AP patients( 95% CI: 1. 593-6. 887,P = 0. 001). The outcome of PPDM-A in overweight patients was 3. 694 times that in patients with normal BMI( 95% CI: 1. 575-8. 667,P = 0. 003),and the outcome of PPDM-A in obese patients was 5. 964 times that in patients with normal BMI( 95% CI: 2. 516-14. 139,P < 0. 001). Multiple onset of AP( OR = 4. 522,95%CI: 2. 298-8. 900,P < 0. 001),blood glucose on admission > 11. 1 mmol/L( OR = 6. 749,95% CI: 3. 381-13. 469,P < 0. 001),CTSI score > 4( OR = 1. 176,95% CI: 1. 008-1. 371,P = 0. 039),and WBC( OR = 1. 082,95% CI: 1. 009-1. 160,P = 0. 026) were independent risk factors for PPDM-A. Conclusion Multiple onset of AP,alcoholic AP,hyperlipidemic AP,blood glucose on admission > 11. 1 mmol/L,overweight or obesity,CTSI score > 4,and WBC are independent risk factors for PPDM-A,which can provide a reference for formulating strategies to prevent or reduce the onset of PPDM-A.
- acute pancreatitis /
- pancreatic diabetes mellitus /
- risk factors

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