Tu Jianfeng, Yang Yue, Zhang Jingzhu, Yang Qi, Lu Guotao, Li Baiqiang, Tong Zhihui, Ke Lu, Li Weiqin, Li Jieshou
Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College Hangzhou Medical College, Hangzhou, China.
Medicine (Baltimore). 2018 Jun;97(22):e10713. doi: 10.1097/MD.0000000000010713.
Endocrine pancreatic insufficiency secondary to acute pancreatitis (AP) drew increasing attention in the recent years. The aim of the present study was to assess the impact of pancreatic necrosis and organ failure on the risk of developing new-onset diabetes after AP.The follow-up study was conducted for patients recovered from AP in the treatment center of Jinling Hospital. Endocrine function was evaluated by simplified oral glucose tolerance test (OGTT). Pancreatic necrosis was examined by abdominal contrast-enhanced CT (CECT) scan during hospitalization. The data including APACHE II score, Balthazar's score, organ failure (AKI and ARDS) was also collected from the medical record database. All patients were divided into group diabetes mellitus (DM) and group non-DM according to the endocrine function and group pancreatic necrosis (PN) and persistent organ failure (OF), group PN and non-OF, group non-PN and OF, and group non-PN and non-OF according to the occurrence of pancreatic necrosis and persistent organ failure.Around 256 patients were included for the final analysis. 154 patients (60.2%) were diagnosed with DM (include impaired glucose tolerance, IGT), while 102 patients (39.8%) were deemed as normal endocrine function. APACHE II score and Balthazar score of the patients in the group DM were significant higher than those in the non-DM group (F = 6.09, P = .01; F = 10.74, P = .001). The incidence of pancreatic necrosis in group DM and group non-DM was, respectively, 64.7% and 53.0% (χ = 3.506, P = .06). The patients underwent necrosis debridement by percutaneous catheter drainage (PCD) and/or the operative necrosectomy (ON) were more likely to developed new onset DM than the patients without PCD or ON (χ = 2.385, P = .02). The morbidity of new-onset DM after AP gradually increased from group non-PN and non-OF, group non-PN and OF, group PN and non-OF to group PN and OF in order (χ = 4.587, P = .03). The value of HOMA-IR of patients at follow-up time was significant higher in group DM than group non-DM (F = 13.414, P = .000).Patients with both PN and persistent OF may were at increased risk of developing new-onset diabetes after AP. Insulin resistance could be the pivotal mechanism of the development of diabetes.
近年来，急性胰腺炎（AP）继发的内分泌性胰腺功能不全日益受到关注。本研究的目的是评估胰腺坏死和器官衰竭对AP后新发糖尿病风险的影响。对在金陵医院治疗中心康复的AP患者进行了随访研究。通过简化口服葡萄糖耐量试验（OGTT）评估内分泌功能。住院期间通过腹部增强CT（CECT）扫描检查胰腺坏死情况。还从病历数据库中收集了包括急性生理与慢性健康状况评分系统（APACHE II）评分、巴尔萨泽评分、器官衰竭（急性肾损伤和急性呼吸窘迫综合征）等数据。根据内分泌功能将所有患者分为糖尿病组（DM）和非糖尿病组，根据胰腺坏死和持续性器官衰竭的发生情况分为胰腺坏死组（PN）和持续性器官衰竭组（OF）、PN组和非OF组、非PN组和OF组、非PN组和非OF组。约256例患者纳入最终分析。154例患者（60.2%）被诊断为DM（包括糖耐量受损，IGT），而102例患者（39.8%）被认为内分泌功能正常。DM组患者的APACHE II评分和巴尔萨泽评分显著高于非DM组（F = 6.09，P = 0.01；F = 10.74，P = 0.001）。DM组和非DM组的胰腺坏死发生率分别为64.7%和53.0%（χ = 3.506，P = 0.06）。接受经皮导管引流（PCD）和/或手术清创术（ON）进行坏死清创的患者比未接受PCD或ON的患者更易发生新发DM（χ = 2.385，P = 0.02）。AP后新发DM的发病率从非PN组和非OF组、非PN组和OF组、PN组和非OF组到PN组和OF组依次逐渐升高（χ = 4.587，P = 0.03）。随访时DM组患者的稳态模型胰岛素抵抗指数（HOMA-IR）值显著高于非DM组（F = 13.414，P = 0.000）。PN和持续性OF并存的患者AP后发生新发糖尿病的风险可能增加。胰岛素抵抗可能是糖尿病发生的关键机制。
