急性胰腺炎患者的应激性高血糖与胰腺炎后新发糖尿病发病风险关联研究  

Study on the association between stress-induced hyperglycemia and the risk of new-onset diabetes after pancreatitis in acute pancreatitis patients

作　　者：田恬 吴兆荣 王倩[2] 张舒[2] 李雯 TIAN Tian;WU Zhao-rong;WANG Qian;ZHANG Shu;LI Wen(Nanjing University of Chinese Medicine Nursing College,Nanjing,Jiangsu 210023,China;不详)

机构地区：[1]南京中医药大学护理学院,江苏南京210023 [2]南京大学医学院附属鼓楼医院消化内科,江苏南京

出　　处：《现代预防医学》2024年第20期3810-3815,共6页Modern Preventive Medicine

基　　金：国家自然科学基金(82373068);江苏省研究生实践创新计划项目(SJCX24_0851);南京鼓楼医院护理科研项目(2024-B301)。

摘　　要：目的探究发生应激性高血糖的急性胰腺炎(Acute Pancreatitis,AP)患者与胰腺炎后新发糖尿病风险之间的关系。方法本研究选取2015—2019年于南京大学附属鼓楼医学院消化内科住院既往无糖尿病病史的AP患者作为研究对象,基于胰腺炎后新发糖尿病诊断标准判定新发糖尿病,使用COX比例风险模型评估入院应激性高血糖与新发糖尿病风险之间的关系。按性别、年龄、文化程度、居住地、婚姻情况、吸烟史、入院诊断、身体质量指数(Body Mass Index,BMI)、既往胰腺坏死/脓肿史及病情严重程度分组进行亚组分析。结果本研究共纳入1258名研究对象。随访糖尿病发生率为28.3%,入院发生应激性高血糖患者相比于正常血糖者有较高的糖尿病发病风险(HR=1.40,95%CI:1.06~1.85)。亚组分析显示老年(HR=2.01,95%CI:1.19~2.12)、男性(HR=1.17,95%CI:1.03~2.35)、居住农村(HR=1.37,95%CI:1.24~1.53)、有吸烟史(HR=1.25,95%CI:1.14~1.38)、有胰腺坏死/脓肿病史(HR=1.34,95%CI:1.07~1.98)、BMI≥28 kg/m^(2)(HR=2.33,95%CI:1.57~4.55)以及中重度胰腺炎(HR=1.45,95%CI:1.27~2.58;HR=1.23,95%CI:1.06~1.93)的患者发生应激性高血糖有更大的糖尿病发病风险。结论AP患者入院应激性高血糖与胰腺炎后新发糖尿病的发病风险有关,应加强发生应激性高血糖的高危AP患者的早期筛查与血糖管理,有助于降低新发糖尿病的发病风险。Objective To investigate the relationship between stress-induced hyperglycemia in acute pancreatitis(AP)patients and the risk of developing new-onset diabetes after pancreatitis.Methods This study selected patients with acute pancreatitis(AP)who had no prior history of diabetes and were hospitalized in the Department of Gastroenterology at Nanjing Drum Tower Hospital,affiliated with Nanjing University,2015-2019.New-onset diabetes after pancreatitis was diagnosed based on established criteria.The relationship between stress-induced hyperglycemia upon admission and the risk of developing new-onset diabetes was assessed using the COX proportional hazards model.Stratified analyses were conducted based on gender,age,education level,place of residence,marital status,smoking history,admission diagnosis,Body Mass Index(BMI),history of pancreatic necrosis/abscess,and severity of the condition.Results This study included a total of 1258 participants.The follow-up incidence of diabetes was 28.3%.Patients who experienced stress-induced hyperglycemia upon admission had a higher risk of developing new-onset diabetes compared to those with normal blood glucose levels(HR=1.40,95%CI:1.06-1.85).Subgroup analysis indicated that patients who were elderly(HR=2.01,95%CI:1.19-2.12),male(HR=1.17,95%CI:1.03-2.35),from rural areas(HR=1.37,95%CI:1.24-1.53),had a history of smoking(HR=1.25,95%CI:1.14-1.38),had a history of pancreatic necrosis/abscess(HR=1.34,95%CI:1.07-1.98),BMI≥28 kg/m?(HR=2.33,95%CI:1.57-4.553),or had moderate to severe pancreatitis(HR=1.45,95%CI:1.27-2.58;HR=1.23,95%CI:1.06-1.93),had a greater risk of developing new-onset diabetes if they experienced stress-induced hyperglycemia.Conclusion Stress hyperglycemia at admission is associated with an increased risk of new-onset diabetes after pancreatitis.Effective glucose management in high-risk AP patients with stress hyperglycemia may help reduce the risk of developing new-onset diabetes.

关 键 词：应激性高血糖 急性胰腺炎 糖尿病 COX比例风险回归模型 

分 类 号：R587.1[医药卫生—内分泌]