非肥胖人群基线三酰甘油水平与急性胰腺炎发病风险关系的前瞻性队列研究  

Baseline Triglyceride and Risk of Acute Pancreatitis in a Nonobese Health Check-up Population:a Prospective Cohort Study

作　　者：苏阿芳 王银洁 王凤飞 赵秀娟 辛英瑛 陈朔华 朱国玲[1] 王珊[1] 蒋晓忠[1] 张杰[1] 吴寿岭[5] SU Afang;WANG Yinjie;WANG Fengfei;ZHAO Xiujuan;XIN Yingying;CHEN Shuohua;ZHU Guoling;WANG Shan;JIANG Xiaozhong;ZHANG Jie;WU Shouling(Department of Gastroenterology,Kailuan General Hospital,Tangshan 063000,China;Emergency Department,Kailuan General Hospital,Tangshan 063000,China;ICU,Kailuan General Hospital,Tangshan 063000,China;Healthcare Center of Kailuan Group,Tangshan 063000,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China)

机构地区：[1]开滦总医院消化内科,河北省唐山市063000 [2]开滦总医院急诊科,河北省唐山市063000 [3]开滦总医院重症医学科,河北省唐山市063000 [4]开滦员工健康保障中心,河北省唐山市063000 [5]开滦总医院心内科,河北省唐山市063000

出　　处：《中国全科医学》2022年第26期3240-3245,共6页Chinese General Practice

摘　　要：背景近年来高三酰甘油血症作为急性胰腺炎(AP)发病的危险因素逐渐受到重视,目前关于肥胖是否增加AP发病风险尚存在争议,非肥胖人群基线三酰甘油(TG)是否影响AP的发病风险尚无定论。目的探讨开滦研究队列非肥胖人群基线TG水平与AP发病风险的关系。方法采用前瞻性队列研究方法,以参加开滦(集团)有限责任公司2006—2007年和2008—2009年健康体检、无AP病史和TG资料完整的非肥胖人群为观察队列,研究按基线TG三分位数分为3组。以新发AP事件、死亡或至随访结束(2020-12-31)为随访终点。采用Kaplan-Meier法绘制累积发病率曲线图并用Log-rank法进行组间检验,并采用多因素Cox比例风险回归模型分析不同TG水平对新发AP事件的影响。结果共纳入统计分析者102358例,按基线TG三分位数分为Q1(TG≤0.96 mmol/L)、Q2(0.96 mmol/L<TG<1.52 mmol/L)、Q3(TG≥1.52 mmol/L)组,分别为34288、33689、34381例。3组间性别、年龄、收缩压(SBP)、舒张压(DBP)、空腹血糖、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及吸烟、饮酒、受教育程度≥9年、高血压病史、糖尿病病史、胆石症病史所占比例比较,差异均有统计学意义(P<0.05)。本研究平均随访(12.8±2.4)年,共新发AP 316例,总人群发病密度为2.41例/万人年。3组AP发病密度分别为1.82例/万人年、2.22例/万人年、3.17例/万人年,AP累积发病率分别为2.33%、2.85%、4.07%,Log-rank检验结果显示,Q1~Q3组AP累积发病率比较,差异有统计学意义(χ^(2)=17.27,P<0.001)。以Q1组为参照,进一步校正了性别、年龄、HDL-C、TC、吸烟、饮酒、受教育年限、高血压病史、糖尿病病史、胆石症病史后,Q3组发生AP的HR为1.66〔95%CI(1.25,2.19)〕。在模型3的基础上,排除随访1年内发生的AP病例,校正因素与模型3相同,Q3组发生AP的HR为1.68〔95%CI(1.25,2.24)〕。结论非肥胖人群基线TG水平≥1.52Background Hypertriglyceridemia has been increasingly valued as a risk factor for acute pancreatitis(AP).However,the relationship between obesity and AP has not yet been confirmed,whether baseline triglyceride(TG)affects the risk of AP in non-obese people is still inconclusive.Objective To explore the association between baseline serum triglyceride(TG)and the risk of AP in a nonobese cohort from Kailuan Group.Methods A prospective cohort study was performed among in-service and retired workers of Kailuan Group(non-obese,without a history of AP,with complete TG information)who first attended the annual health screening for workers of the group as a benefit conducted between 2006 and 2007 or between 2008-2009.The cumulative incidence of AP across serum TG tertile groups:〔Q1 group(TG≤0.96 mmol/L),Q2 group(0.96 mmol/L<TG<1.52 mmol/L),Q3 group(TG≥1.52 mmol/L)〕was described using Kaplan-Meier curve,and compared by the Log-rank test.The new AP event,death or the end of follow-up(December 31,2020)was taken as the end point of follow-up.Cox regression model was used to estimate the association of baseline TG levels and new incidence of AP.Results The study included a total of 102358 subjects.Q1,Q2 and Q3 groups had significant differences in sex ratio,average age,systolic blood pressure,diastolic blood pressure,fasting blood glucose,total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C),and prevalence of smoking,drinking,previous hypertension,previous diabetes,previous cholelithiasis,as well as having at least 9 years of education(P<0.05).Three hundred and sixteen cases developed AP during an average follow-up of(12.8±2.4)years,with an incidence density of AP of 2.41 per 10000 person-years.The incidence density was 1.82,2.22,and 3.17 per 10000 person-years in Q1,Q2,and Q3 groups,respectively.The cumulative incidence of AP was 2.33%,2.85%and 4.07%,respectively,in Q1,Q2,and Q3 groups,with statistically differences detected by the log-rank test(χ^(2)=17.27,P

关 键 词：非肥胖人群 三酰甘油 急性胰腺炎 队列研究 前瞻性研究 唐山 

分 类 号：R576[医药卫生—消化系统]