与慢性胰腺炎向内分泌功能不全进展相关的危险因素。
Risk Factors Associated With Progression Toward Endocrine Insufficiency in Chronic Pancreatitis.
机构信息
From the Department of Surgery, University of Minnesota Medical School.
Division of Biostatistics, University of Minnesota.
出版信息
Pancreas. 2019 Oct;48(9):1160-1166. doi: 10.1097/MPA.0000000000001394.
OBJECTIVE
Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).
METHODS
In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.
RESULTS
Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).
CONCLUSIONS
We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.
目的
关于慢性胰腺炎（CP）患者胰岛功能和血糖控制随时间变化的数据较少。
方法
我们对 325 例接受 2 次混合餐耐量试验和/或糖化血红蛋白（HbA1c）水平检测的 CP 患者进行研究，估计每 6 个月代谢指标的变化率，并使用多变量回归模型评估糖尿病潜在危险因素与变化率之间的关系。
结果
每 6 个月，HbA1c 增加 0.062%，标准误差为 0.029%（P = 0.037），混合餐耐量试验中 C 肽与血糖的比值（曲线下面积（AUC））降低 0.0028，标准误差为 0.0011（P = 0.014）。我们观察到吸烟者（AUC C 肽，P = 0.043）和接受手术引流（AUC 血糖，P = 0.001；比值，P = 0.03）或患有钙化性胰腺炎（HbA1c，P = 0.003）的患者下降速度更快。在多变量模型中，吸烟者的 AUC C 肽和比值以及胰腺钙化患者的 HbA1c 下降速度更快（均 P < 0.05）。
结论
我们观察到 CP 患者的β细胞功能和血糖控制出现了可测量的下降。有吸烟史、手术引流或胰腺钙化的患者可能风险最高。
Zotero 插件