胰十二指肠切除术后新发非酒精性脂肪性肝病的相关因素分析

Risk factors of newly developed nonalcoholic fatty liver disease after pancreaticoduodenectomy

目的探讨胰十二指肠切除术(PD)后患者新发非酒精性脂肪性肝病(NAFLD)的相关因素。方法回顾性收集2018年6月至2020年12月南京大学医学院附属鼓楼医院肝胆胰中心连续收治的130例接受PD的患者资料。男性74例,女性56例,年龄[M(IQR)]为62(16)岁(范围:22~84岁)。其中29例患者术后发生NAFLD,设为NAFLD组;101例患者未发生NAFLD,设为非NAFLD组。观察指标:(1)两组患者术前一般情况、术中与术后相关指标;(2)PD术后新发NAFLD的相关因素。分类资料的比较采用χ^(2)检验或Fisher确切概率法,定量资料的比较采用独立样本t检验或Mann-Whitney U检验,多因素分析采用逐步向前法的Logistic回归模型。结果130例患者均成功完成PD,术后6个月内NAFLD的发生率为22.3%(29/130)。单因素分析结果显示,体重指数、糖尿病、术前甘油三酯水平、胰腺癌是发生NAFLD的相关因素(t=-2.655、χ^(2)=4.563、U=-2.192、χ^(2)=7.044,P值均<0.05)。多因素分析结果显示,性别、体重指数、是否患有胰腺癌是PD术后患者发生NAFLD的独立相关因素(OR=2.849、1.214、4.165,P值均<0.05)。结论性别、体重指数、是否患有胰腺癌是PD术后患者出现NAFLD的独立相关因素。

Objective To identify the risk factors of newly developed nonalcoholic fatty liver disease(NAFLD)after pancreaticoduodenectomy(PD).Methods The clinical data of 130 patients who had undergone PD at Department of Hepatopancreatobiliary Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Medical School of Nanjing University from June 2018 to December 2020 were collected retrospectively.There were 74 males and 56 females,with age(M(IQR))of 62(16)years(range:22 to 84 years).Twenty-nine patients who developed NAFLD were divided into NAFLD group and 101 patients who did not suffer NAFLD were divided into no NAFLD group.Observation indications included:(1)preoperative demographics,intraoperative and postoperative characteristics;(2)the risk factors of newly developed NAFLD after PD.Count data were analyzed usingχ^(2) test or Fisher′s exact test.Measurement data were analyzed by student t test or Mann-Whitney U test.Multivariate analysis was performed using Logistic regression model with a stepwise forward approach.Results All 130 patients successfully underwent PD and 29 cases(22.3%)developed NAFLD in 6 months after PD.The results of univariate analysis showed that gender,diabetic mellitus,the level of triglyceride preoperatively,and pancreatic ductal adenocarcinoma were the related factors of the development of NAFLD after PD(t=-2.655,χ^(2)=4.563,U=-2.192,χ^(2)=7.044;all P<0.05).Multivariate analysis revealed that gender,body mass index and pancreatic ductal adenocarcinoma were independent risk factors for the development of NAFLD after PD(OR=2.849,1.214,4.165,all P<0.05).Conclusion Gender,body mass index and pancreatic ductal adenocarcinoma were independent risk factors for the development of NAFLD after PD.