血脂异常对急性胰腺炎发病影响的前瞻性队列研究

Association between dyslipidemia and acute pancreatitis: A prospective cohort study

目的探讨血脂异常及达到血脂异常的标准数量对新发急性胰腺炎(AP)的影响。方法采用前瞻性队列研究方法,以参加2006年-2007年健康查体的开滦集团在职及离退休职工99 695人作为观察队列,人群按首次体检(2006年-2007年)血脂异常的诊断标准分为5组:G0组(69 465例),未达到任意1条血脂异常诊断标准;G1组(23 921例),达到任意1条血脂异常诊断标准;G2组(5791例),达到任意2条血脂异常诊断标准;G3组(500例),达到任意3条血脂异常诊断标准;G4组(18例),达到4条血脂异常诊断标准。随访期间每年收集1次新发AP病例,并采用多因素Cox比例风险回归模型分析血脂异常分组对新发AP事件的影响。计量资料多组间比较采用单因素方差分析,计数资料组间比较采用χ^2检验。采用Kaplan-Meier法计算不同分组中AP的累积发病率,累积发病率的组间比较采用log-rank法。结果对99 695例观察对象的总随访时间为782 395人年,G4组人数过少无新发AP,故将G4组与G3组合并进行研究。G0~G3组AP发病率分别为1. 61/1000人年、2. 05/1000人年、2. 59/1000人年、7. 72/1000人年。G0~G3组的AP累积发病率分别为1. 76‰、2. 40‰、3. 12‰、8. 39‰。经log-rank检验,累积发病率的组间比较差异有统计学意义(χ^2=15. 18,P=0. 004 3)。在校正了其他危险因素的影响后,Cox模型显示:以G1组为参照,G2组、G3组和G4组发生AP的风险比(95%可信区间)分别为1. 23(0. 88~1. 73)、1. 58(1. 09~2. 10)、4. 90(1. 81~13. 37)。结论血脂异常是新发AP的危险因素,人群满足血脂异常的条数越多,风险越大。

Objective To investigate the influence of dyslipidemia and number of items conforming to the diagnostic criteria for dyslipidemia on new-onset acute pancreatitis (AP). Methods A prospective cohort study was performed for 99 695 on-the-job or retired workers of Kailuan Group who underwent the first physical examination from 2006 to 2007. According to the number of items conforming to the diagnostic criteria for dyslipidemia in the first physical examination, they were divided into G0 group with 69 465 workers who did not meet the diagnostic criteria for dyslipidemia, G1 group with 23 921 workers who met one item of the diagnostic criteria for dyslipidemia, G2 group with 5791 workers who met two items of the diagnostic criteria for dyslipidemia, G3 group with 500 workers who met three items of the diagnostic criteria for dyslipidemia, and G4 group with 18 workers who met four items of the diagnostic criteria for dyslipidemia. New-onset AP cases were collected once every year during follow-up, and a multivariate Cox proportional hazards regression model analysis was used to analyze the influence of dyslipidemia on new-onset AP cases. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of AP in each group, and the log-rank test was used for comparison of cumulative incidence rate between groups. Results The total follow-up time of all 99 695 workers was 782 395 person-years, and since no new-onset AP cases were observed in G4 group, G4 group was combined with G3 group for analysis. The incidence rates of AP in G0, G1, G2, and G3 groups were 1.61, 2.05, 2.59, and 7.72 per thousand person-years, respectively, and the cumulative incidence rates of AP in these four groups were 1.76‰, 2.40‰, 3.12‰, and 8.39‰, respectively. The log-rank test showed a significant difference in cumulative incidence rate between groups (χ^2=15.18, P =0.004 3). After adjustment for the other risk factors, the Cox model showed that the hazard ratio (95% confidence interval) for AP was 1.23 (0.88-1.73) in G1 group, 1.58 (1.09-2.10) in G2 group, and 4.90 (1.81-13.37) in G3 group. Conclusion Dyslipidemia is a risk factor for new-onset AP, and the risk of AP increases with the increase in the number of items conforming to the diagnostic criteria for dyslipidemia.