基线空腹血糖水平与急性胰腺炎发病风险的前瞻性队列研究

背景　急性胰腺炎发病人数呈逐年上升趋势，国内外流行病学调查聚焦急性胰腺炎高危因素的研究，绝大多数研究内容集中在急性胰腺炎发病后与血糖的关系，鲜有关于空腹血糖与急性胰腺炎发病风险的前瞻性队列研究。目的　探讨基线空腹血糖水平对新发急性胰腺炎事件的影响。方法　采用前瞻性队列研究方法，以首次参加2006-2007、2008-2009年健康体检、无急性胰腺炎病史及空腹血糖资料完整的开滦研究人群作为观察队列，其中符合入选标准的研究对象共125 088人，观察该研究对象中新发急性胰腺炎发病率，计算累积发病率，以Log-Rank法进行检验，并采用多因素Cox比例风险回归分析基线空腹血糖水平对新发急性胰腺炎事件的影响。结果　研究人群按空腹血糖四分位水平（≤4.69、>4.69~5.13、>5.13~5.72、>5.72 mmol/L）分为4组，平均随访（10.14±1.71）年，共发生急性胰腺炎297例，发病率分别为1.83/万人年、2.38/万人年、2.00/万人年、3.18/万人年。Cox比例风险回归分析结果显示，校正多种混杂因素后，空腹血糖>5.72 mmol/L组急性胰腺炎发病风险是空腹血糖≤4.69 mmol/L组的1.44倍〔HR（95%CI）=1.44（1.04，2.01）〕。结论　基线空腹血糖水平在5.72 mmol/L以上增加了急性胰腺炎的发病风险。

Baseline Fasting Glucose and Risk of Acute Pancreatitis:a Prospective Cohort Study

Background The number of patients with acute pancreatitis is increasing year by year.Epidemiological surveys at home and abroad focus on the study of high-risk factors of acute pancreatitis.Most of the studies focus on the relationship between the incidence of acute pancreatitis and blood glucose.There are few prospective cohort studies on the relationship between fasting blood glucose and the risk of acute pancreatitis.Objective To investigate the association of baseline fasting glucose and the incidence of new-onset acute pancreatitis.Methods A prospective study was conducted among a cohort of eligible workers(n=125088)from Kailuan Group who received the initial staff physical examination from 2006 to 2007 or from 2008 to 2009,with no history of acute pancreatitis and complete data of fasting glucose levels.The incidence of new-onset acute pancreatitis was recorded,and the cumulative incidence of this disease was calculated.Log-Rank test was performed to validate the result.Multivariable Cox proportional hazards regression was used to evaluate the association of baseline fasting glucose and incidence of new-onset acute pancreatitis.Results A follow-up lasting for(10.14±1.71)years on average was given to the participants,during which there were a total of 297 cases of new-onset acute pancreatitis,with incidence rate of 1.83/10000,2.38/10000,2.00/10000,and 3.18/10000 person-years for those with baseline fasting glucose level of≤4.69,>4.69-5.13,>5.13-5.72,and>5.72 mmol/L,respectively.After adjusting for confounding factors,multivariable Cox proportional hazards regression analysis found that,the risk of acute pancreatitis in the subgroup with baseline fasting glucose>5.72 mmol/L was 1.44 times higher than that of subgroup with baseline fasting glucose≤4.69 mmol/L〔HR(95%CI)=1.44(1.04,2.01)〕.Conclusion Baseline fasting glucose level more than 5.72 mmol/L may increase the risk of acute pancreatitis.