摘要
目的分析慢性胰腺炎（CP）糖尿病发生率及可能风险因素。方法分析和随访1997年1月-2007年7月疼痛性CP患者资料，寿命表法计算首次腹痛后累积糖尿病发生率，Cox比例风险模型逐步回归分析风险因素，包括年龄、性别、吸烟、饮酒、病因、胰腺肿块、胰腺钙化、治疗方案、伴腹泻、体重减轻和腹痛程度。结果入组病例共354例，男：女=2．1：1，首发年龄（38．1±17．6）岁，随访时间（45．2±32．9）个月；酒精性CP18．1％；总糖尿病发生率16．1％，其中需胰岛素治疗者40．3％。内镜介入和外科手术治疗前34例已确诊，治疗后新发23例；29．8％糖尿病发生于腹痛1年内；首次腹痛后1、3、5、10年内的累积糖尿病发生率分别为4．9％、6．5％、9．3％、20．7％；Cox风险比例模型回归分析显示，治疗前糖尿病组中吸烟量〉200年支（年支定义每天吸烟支数×吸烟年数）、轻度腹痛、体重减轻、胰腺钙化为风险因素，风险比分别为3．3、5．2、2．6、2．2；新发糖尿病组中，吸烟量〉200年支、持续或新发体重减轻、胰尾／体尾部切除术等因素为风险因素，风险比分别为3．0、2．8、7．3。结论对吸烟量〉200年支、胰腺钙化、轻度腹痛、体重减轻以及接受胰尾／体尾部切除治疗的CP患者尤应注意伴发糖尿病的可能。
Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis （CP） patients. Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan. 1997 to July 2007 were conducted. A life table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain. Cox proportional-hazards model was used for multivariate analysis of the variables including age, sex, drinking and smoking habits, etiological factor, presence of pancreatic masses, pancreatic calcifications, measure of intervention, diarrhea, weight loss and degree of pain. Results Data were obtained from 354 patients （239 males, mean age at onset of pain （38.1± 17.6） years; alcoholic origin 18.1%） with painful CP. The mean follow-up period was （45.2±32.9） months. The rate of diabetes mellitus in CP patients was 16.1%. There was a high incidence （29.8%） of diabetes mellitus 1 year before the episodes of abdominal pain. The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7% , respectively. Cox proportional hazards model selected smoking （〉 10 pack years） （hazard rate （HR） =3. 3）, mild abdominal pain （HR=5. 2）, weight loss （HR=2. 6） and pancreatic calcifications （HR=2. 2） as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention. Smoking （〉 10 pack years） （HR = 3.0）,weight loss （HR=2.8） and distal pancreatectomy （HR=7.3） were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention. Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking （〉10 pack years）, mild abdominal pain, weight loss, pancreatic calcifications and distal pancreatectomy.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2009年第6期365-369,共5页
Chinese Journal of Digestion
关键词
慢性胰腺炎
糖尿病
风险因素
Chronic pancreatitis
Diabetes mellitus
Risk factors
