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初发急性胰腺炎后新发糖尿病的危险因素评估
Risk factors for new-onset diabetes after incipient acute pancreatitis
文章发布日期:2020年11月13日  来源:  作者:刘慧,李贤秋,罗刚,等  点击次数:2714次  下载次数:30次

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【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<0.05);两组间年龄和男性、吸烟史、糖尿病家族史及高血压的比例差异均无统计学意义(P值均>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<0.05)。PPDM-A组TG、血糖、WBC、CRP水平和入院血糖>11.1 mmol/L比例均高于非PPDM-A组(P值均<0.05);两组间Ca+、血淀粉酶、血脂肪酶的比例均无明显差异(P值均>0.05)。PPDM-A组患者急性胰周坏死物聚集、急性胰周液体聚集发生率、AP多次发生比例、CTSI评分>4比例均高于非PPDM-A组(P值均<0.05),两组间发生全身性炎症反应综合征的比例和疾病严重程度差异均无统计学意义(P值均>0.05)。多因素分析结果表明:与胆源性AP患者相比,酒精性AP发生PPDM-A的结局是其5.868倍(95%CI: 1.607~ 21.418,P=0.007);高脂血症性AP发生PPDM-A的结局是其3.312倍(95%CI: 1.593~6.887,P=0.001);超重及肥胖患者发生PPDM-A的结局分别是BMI正常患者的3.694倍(95%CI: 1.575~8.667,P=0.003)、5.964倍(95%CI:2.516~14.139,P<0.001)。AP多次发生(OR=4.522,95%CI: 2.298~8.900,P<0.001)、入院血糖>11.1 mmol/L(OR=6.749,95%CI: 3.381~13.469,P<0.001)、CTSI评分>4(OR=1.176,95%CI: 1.008~1.371,P=0.039)、WBC(OR=1.082,95% CI: 1.009~1.160,P=0.026)均是导致患者出现PPDM-A的独立危险因素。结论 AP多次发生,酒精性AP、高脂血症AP、入院时Glu>11.1 mmol/L、超重或肥胖、CTSI评分>4、WBC是发生PPDM-A的独立危险因素,可以为制订预防或降低PPDM-A发病的策略提供参考依据。
【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.
【关键字】:急性胰腺炎; 胰源性糖尿病; 危险因素
【Key words】:acute pancreatitis; pancreatic diabetes mellitus; risk factors
【引证本文】:LIU H, LI XQ, LUO G, et al. Risk factors for new-onset diabetes after incipient acute pancreatitis[J]. J Clin Hepatol, 2020, 36(12): 2771-2776. (in Chinese)
刘慧, 李贤秋, 罗刚, 等. 初发急性胰腺炎后新发糖尿病的危险因素评估[J]. 临床肝胆病杂志, 2020, 36(12): 2771-2776.

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