Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Norra Stationsgatan 67, SE-171 76 Stockholm, Sweden.
JAMA Intern Med. 2013 Mar 25;173(6):444-9. doi: 10.1001/jamainternmed.2013.2737.
Oral glucocorticoid use has been suggested to cause acute pancreatitis in several case reports. However, no epidemiological study has investigated this association.
To conduct a nationwide population-based case-control study to investigate the potential association between oral glucocorticoid use and acute pancreatitis.
In this population-based case-control study, all individuals aged 40 to 84 years who developed a first episode of acute pancreatitis between 2006 and 2008 in Sweden were identified.
Population-based, nationwide, register-based study.
A total of 6161 cases with a first episode of acute pancreatitis and 61,637 controls were included in the final analyses. Cases were all patients diagnosed as having a first episode of acute pancreatitis during the study period, defined by the diagnosis code K85 in the International Statistical Classification of Diseases, 10th Revision (ICD-10). Controls were randomly selected from the source population at risk of developing acute pancreatitis. For each case, 10 controls, matched for age, sex, and calendar period, were randomly selected from the general population. Oral glucocorticoid use was assessed from the Swedish Prescribed Drug Register. Current, recent, and former users were defined as patients who collected their glucocorticoid prescription within 30, 31 to 180, and after 180 days before the index date, respectively.
Unconditional logistic regression was performed to calculate the odds ratios (ORs) with 95% confidence intervals for the association between oral glucocorticoid use and acute pancreatitis. Multivariable adjustment was made for potential confounders including, among others, alcohol abuse, diabetes, and concomitant drug use.
The study included 6161 cases of acute pancreatitis and 61,637 controls. The risk of acute pancreatitis was increased among current users of oral glucocorticoids compared with nonusers (OR, 1.53; 95% CI, 1.27-1.84). This risk was highest 4 to 14 days after drug dispensation (OR, 1.73; 95% CI, 1.31-2.28) and attenuated thereafter. There was no association between oral glucocorticoid use and acute pancreatitis immediately after drug dispensation. There was no increased risk of acute pancreatitis among recent or former users of glucocorticoids compared with nonusers.
Current oral glucocorticoid use is associated with an increased risk of acute pancreatitis.
已有数份病例报告提示口服糖皮质激素的使用与急性胰腺炎有关。然而，尚无流行病学研究对此关联进行调查。
开展一项全国范围内基于人群的病例对照研究，以调查口服糖皮质激素使用与急性胰腺炎之间的潜在关联。
在这项基于人群的病例对照研究中，所有在瑞典于 2006 年至 2008 年期间首次出现急性胰腺炎发作的年龄在 40 至 84 岁之间的个体均被确定为研究对象。
基于人群的、全国范围的、基于登记的研究。
共有 6161 例首次发作的急性胰腺炎患者和 61637 例对照者纳入最终分析。病例均为研究期间经国际疾病分类第 10 版（ICD-10）诊断代码 K85 诊断为首次发作急性胰腺炎的患者。对照者是从可能发生急性胰腺炎的危险人群中随机选择的。每例病例均随机选择 10 名年龄、性别和时间匹配的对照者，来自普通人群。口服糖皮质激素的使用情况通过瑞典处方药物登记处进行评估。当前使用者、近期使用者和既往使用者分别定义为在索引日期前 30 天内、31 至 180 天内和 180 天后领取糖皮质激素处方的患者。
采用条件 logistic 回归计算口服糖皮质激素使用与急性胰腺炎之间关联的比值比（OR）及其 95%置信区间。调整了包括酒精滥用、糖尿病和同时使用药物等多种潜在混杂因素。
该研究纳入了 6161 例急性胰腺炎病例和 61637 例对照者。与非使用者相比，当前使用者发生急性胰腺炎的风险增加（OR，1.53；95%CI，1.27-1.84）。该风险在药物发放后 4 至 14 天最高（OR，1.73；95%CI，1.31-2.28），此后逐渐降低。药物发放后立即使用糖皮质激素与急性胰腺炎无关联。与非使用者相比，近期或既往使用者发生急性胰腺炎的风险无增加。
当前口服糖皮质激素的使用与急性胰腺炎风险增加有关。
