基线BMI水平对急性胰腺炎发病风险影响的前瞻性队列研究

A prospective cohort study on BMI levels and risk of acute pancreatitis

目的探讨不同BMI水平对新发急性胰腺炎(AP)发病风险的影响。方法观察人群来自开滦研究队列,按基线BMI水平分为:正常体重组(BMI<24 kg/m2),超重组(BMI 24~28 kg/m2)和肥胖组(BMI≥28 kg/m2),观察不同BMI组人群新发AP发病密度。经Kaplan-Meier法绘制生存曲线,计算累积发病率,以log-rank法进行检验,并采用多因素Cox比例风险回归模型分析基线BMI水平对新发AP事件的影响。结果共纳入统计分析者123841人,随访(11.94±2.13)年,共发生AP 395例,总人群AP发病密度为2.67例/万人年,正常体重组、超重组和肥胖组AP发病密度分别为2.20、2.72和3.58例/万人年,累积发病率分别为0.32%、0.40%和0.49%。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)=13.17,P<0.01)。校正多因素Cox比例风险回归模型分析显示,与正常体重组比较,肥胖组AP发病风险增加,HR=1.45(95%CI:1.10~1.92)。对年龄及性别进行分层,年龄<60岁时,肥胖组发生AP的HR=1.58(95%CI:1.14~2.19);男性肥胖组发生AP的HR=1.40(95%CI:1.03~1.90)。排除随访2年内发生的AP病例,肥胖组发生AP的HR=1.60(95%CI:1.18~2.15)。结论肥胖是新发AP的危险因素,中青年男性肥胖人群发病风险更高。

Objective To investigate the effects of body mass index(BMI)levels at different baseline on the risk of new-onset acute pancreatitis(AP).Methods The subjects were from the Kailuan Study Cohort and divided into 3 groups according to baseline BMI levels:BMI<24 kg/m2,normal weight;BMI 24-28 kg/m2,overweight;BMI≥28 kg/m2,obesity.The incidence of new-onset AP in these three groups was analyzed.The survival curve was plotted by Kaplan-Meier method,the cumulative incidence was calculated and tested by log-rank method.Multivariate Cox proportional hazards regression model was used to calculate HR of baseline BMI levels for AP.Results A total of 123841 subjects were included and followed up for(11.94±2.13)years,during which,395 cases were found with AP.The incidence of AP was 2.67 per 10000 person years in total population,and the incidences of AP were 2.20,2.72 and 3.58 per 10000 person-years in the normal,overweight and obesity groups,respectively.The cumulative incidences of AP was 0.32%,0.40%and 0.49%in normal,overweight and obesity groups,respectively,which showed a significant inter-group difference by log-rank test(χ^(2)=13.17,P<0.01).The results of multivariable adjusted Cox proportional hazards regression model analysis indicated that obesity group(HR=1.45,95%CI:1.10-1.92)had a higher risk for AP compared with the normal BMI group.The subgroup analyses by age and sex showed that compared with the normal weight group,the HRs for AP in the obesity group was 1.58(95%CI:1.14-2.19)and 1.40(95%CI:1.03-1.90)among subjects younger than 60 years old and male subjects,respectively.After excluded onset AP within two years from baseline,with a control group from normal weight,the results of multivariate Cox proportional hazards regression model analysis indicated that the AP in the obesity group was 1.60(95%CI:1.18-2.15).Conclusion Obesity may increase the risk of developing AP,particularly among young and middle-aged men.