体质指数与病因性急性胰腺炎风险：韩国国家筛查队列的前瞻性分析。

Body mass index and the risk of acute pancreatitis by etiology: A prospective analysis of Korean National Screening Cohort.

机构信息

Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University, Gangneung, Korea.

Department of Preventive Medicine and Public Health, College of Medicine, Catholic Kwandong University, Gangneung, Korea.

出版信息

J Gastroenterol Hepatol. 2019 Mar;34(3):603-611. doi: 10.1111/jgh.14570. Epub 2019 Jan 8.

DOI:10.1111/jgh.14570

PMID:30552723

Abstract

BACKGROUND

It is unclear whether obesity increases the incidence of acute pancreatitis (AP) in the general population. Further, no study has prospectively examined the associations of the risk of AP by etiology with measured body mass index (BMI) values.

METHODS

A total of 512 928 Korean participants in routine health examinations during 2002-2003 were followed up until 2013 via linkage to national hospital discharge records to assess AP incidence. Multivariable-adjusted hazard ratios were calculated using BMI measurements.

RESULTS

During 10.5 mean years of follow-up, 1656 persons developed AP (337 gallstone related and 1319 non-gallstone related). Nonlinear associations were found: U-curves for total and non-gallstone-related AP and a reverse L-curve for gallstone-related AP. Each 5 kg/m increment in BMI increased gallstone-related AP by 123% (95% confidence interval = 48-234%) and non-gallstone-related AP by 42% (9-84%) in the range ≥ 25 kg/m (P = 0.068). Obese persons had a doubled risk of gallstone-related AP compared with normal-weight persons. In the range < 25 kg/m , BMI had inverse association with non-gallstone-related AP but no association with gallstone-related AP (P < 0.001). In subgroup analyses, for non-gallstone-related AP, hazard ratios per each 5 kg/m BMI increment were 0.50 (men), 0.73 (women), 0.46 (alcohol drinkers), 0.69 (alcohol non-drinkers), 0.43 (ever smokers), and 0.73 (never smokers).

CONCLUSIONS

Gallstone-related AP and non-gallstone-related AP have different nonlinear associations with BMI. Higher BMI increases the risk of both gallstone-related AP and non-gallstone-related AP but more strongly for gallstone-related AP. For non-gallstone-related AP, in the range < 25 kg/m , BMI has inverse associations that were stronger in men, current alcohol drinkers, and ever smokers than in their counterparts.

摘要

背景

目前尚不清楚肥胖是否会增加普通人群患急性胰腺炎（AP）的风险。此外，尚无研究前瞻性地检查病因相关的 AP 风险与测量的体重指数（BMI）值之间的关系。

方法

对 2002-2003 年接受常规体检的 512928 名韩国参与者进行了随访，通过与国家住院记录进行链接，以评估 AP 的发病率。使用 BMI 测量值计算多变量调整后的危险比。

结果

在 10.5 年的平均随访期间，有 1656 人发生了 AP（337 例与胆石症相关，1319 例与非胆石症相关）。发现非线性关联：总 AP 和非胆石症相关 AP 的 U 形曲线和胆石症相关 AP 的反向 L 形曲线。BMI 每增加 5kg/m，胆石症相关 AP 增加 123%（95%置信区间 48-234%），非胆石症相关 AP 增加 42%（9-84%），范围≥25kg/m（P=0.068）。肥胖者患胆石症相关 AP 的风险是正常体重者的两倍。在<25kg/m 的范围内，BMI 与非胆石症相关 AP 呈反比关系，但与胆石症相关 AP 无关（P<0.001）。在亚组分析中，对于非胆石症相关 AP，每增加 5kg/m BMI 的危险比分别为 0.50（男性）、0.73（女性）、0.46（饮酒者）、0.69（非饮酒者）、0.43（曾吸烟者）和 0.73（从不吸烟者）。

结论

胆石症相关 AP 和非胆石症相关 AP 与 BMI 呈不同的非线性关系。较高的 BMI 增加了胆石症相关 AP 和非胆石症相关 AP 的风险，但对胆石症相关 AP 的影响更大。对于非胆石症相关 AP，在<25kg/m 的范围内，BMI 呈反比关系，在男性、当前饮酒者和曾吸烟者中比在相应的对照组中更强。