摘要
目的观察慢性胰腺炎(chronic pancreatitis,CP)患者伴发糖尿病的发生率,探讨影响其发生的相关因素。方法分析笔者医院慢性胰腺炎患者的临床资料,检测伴发糖尿病患者的胰岛功能,通过寿命表法计算首次疼痛后糖尿病的累计发生率,以COX比例风险模型分析可能导致胰腺炎患者发生糖尿病的危险因素。结果入组病例共342例,首发年龄37.9±16.7岁,随访时间43.2±29.7个月;总糖尿病发生率16.1%(55/342)。内镜介入或外科手术治疗前33例已确诊,治疗后新发22例;两种糖尿病患者胰岛功能比较差异无统计学意义(P>0.05);其中25.5%(14/55)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4.7%、6.3%、8.9%、19.8%;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(年支定义为每天吸烟支数×吸烟年数)、轻度腹痛、体重减轻、胰腺钙化为风险因素,风险比(HR)分别为3.3、5.3、2.4、2.1;新发糖尿病组中,吸烟量>200年支、持续或新发体重减轻、胰腺尾部或胰体尾部切除等因素为风险因素。风险比分别为2.9、2.7、7.1。结论吸烟量>200年支、胰腺钙化、轻度腹痛、体重减轻以及胰腺尾部或胰体尾部切除是CP患者伴发糖尿病的危险因素,对有这些情况的患者应注意发生糖尿病的可能。
Objective To investigate the incidence of diabetes mellitus in chronic pancreatitis（CP） patients and to explore the in- fluence factors for the disease. Methods The clinical data of patients with chronic pancreatitis in our hospital were analyzed. Islet func- tion of the patients with diabetes mellitus were detected. A life - table method was used to estimate the cumulative probability of the devel- opment of diabetes mellitus once clinical onset of abdominal pain. COX proportional - hazards model was used for multivariate analysis of the variables that could lead to panereatitis patients with diabetes risk factors. Results Data were obtained from 342 patients with mean age at onset of pain 37.9 ~ 16.7 years. The mean follow -up period was 43.2 ~ 29.7 months. The rate of diabetes mellitus in CP patients was 16.1% （55/342）. Thirty - three cases were diagnosed before endoscopic intervention and surgery, and 22 cases were new - onset dia- betes after treatment. The islet function of two kinds of patients with diabetes has no significant difference （ P 〉 0.05 ）. There was a high incidence （25.5% , 14/55） of diabetes mellitus 1 year before the episodes of abdominal pain. The cumulative risk of diabetes mellitus in subjects 1 , 3, 5, and 10 years after the episodes of pain was 4.7%0 , 6.3% , 8.9% and 19.8% , respectively. COX proportional - haz- ards model selected smoking （ 〉 10 pack years） （ hazard ratio, HR = 3.3 ） , mild abdominal pain （ HR = 5.3 ） , weight loss （ HR = 2.4） and pancreatic calcifications （HR =2.1 ） 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 = 2.9） , weight loss （ HR = 2.7 ） and distal pancreatectomy （ HR = 7.1 ） 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. Patients with these conditions should be paid attention to the possibility of developing diabetes.
出处
《医学研究杂志》
2015年第2期62-66,共5页
Journal of Medical Research
基金
全军医学科技青年培育项目(13QNP018)
中国人民解放军总后勤部卫生部"十一五"滚动课题(应用基础研究项目)(06BG033)
关键词
慢性胰腺炎
糖尿病
风险因素
Chronic pancreatitis
Diabetes
Risk factors
