Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
J Gastroenterol Hepatol. 2020 Feb;35(2):343-352. doi: 10.1111/jgh.14785. Epub 2019 Aug 15.
Diabetes mellitus (DM) is a common complication of idiopathic chronic pancreatitis (ICP), which impairs the quality of life for patients. This study aimed to identify risk factors and develop nomogram for DM in ICP to help early diagnosis.
Idiopathic chronic pancreatitis patients admitted to our center from January 2000 to December 2013 were included. Cumulative rates of DM were calculated by Kaplan-Meier method. Patients were randomly assigned, in a 2:1 ratio, to the training and validation cohort. Based on training cohort, risk factors for DM were identified through Cox proportional hazards regression model, and nomogram was developed. Internal and external validations were performed based on the training and validation cohort, respectively.
Totally, 1633 patients with ICP were finally enrolled. The median follow-up duration was 9.8 years. DM was found in 26.3% (430/1633) of patients after the onset of CP. Adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct were identified risk factors for DM development. The nomogram achieved good concordance indexes in the training and validation cohorts, respectively, with well-fitted calibration curves.
Risk factors were identified, and nomogram was developed to determine the risk of DM in ICP patients. Patients with one or more of the risk factors including adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct have higher incidence of DM.
糖尿病（DM）是特发性慢性胰腺炎（ICP）的常见并发症，会降低患者的生活质量。本研究旨在确定危险因素，并为 ICP 患者建立 DM 列线图以帮助早期诊断。
纳入 2000 年 1 月至 2013 年 12 月期间在我院就诊的特发性慢性胰腺炎患者。通过 Kaplan-Meier 方法计算 DM 的累积发生率。将患者按 2:1 的比例随机分配到训练和验证队列。基于训练队列，通过 Cox 比例风险回归模型确定 DM 的危险因素，并建立列线图。基于训练和验证队列分别进行内部和外部验证。
共纳入 1633 例 ICP 患者。中位随访时间为 9.8 年。CP 发病后，430 例（26.3%）患者出现 DM。CP 发病时年龄较大、CP 诊断前存在胆管狭窄、CP 诊断前存在脂肪泻和主胰管复杂病理改变是 DM 发生的危险因素。列线图在训练和验证队列中的一致性指数均较好，拟合校准曲线也较好。
确定了危险因素，并建立了列线图以确定 ICP 患者发生 DM 的风险。具有 CP 发病时年龄较大、CP 诊断前存在胆管狭窄、CP 诊断前存在脂肪泻和主胰管复杂病理改变等一个或多个危险因素的患者，DM 发生率更高。
