Department of General Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
National Translational Medicine of China, Beijing, China.
BMJ Open Diabetes Res Care. 2020 Oct;8(2). doi: 10.1136/bmjdrc-2020-001778.
Several previous studies have reported the incidence of new-onset diabetes mellitus (NODM) after pancreatectomy. Nevertheless, the results were inconsistent. The true rate of NODM after distal pancreatectomy (DP) is still unknown.
The aim of this study was to investigate the incidence of and the risk factors for NODM after DP. This study enrolled patients who underwent DP between January 2004 and February 2016 at Peking Union Medical College Hospital. Patients with preoperative diabetes mellitus or diagnosed with pancreatic cancer were excluded. The primary outcome was NODM.
A total of 485 patients were enrolled. The median (IQR) of follow-up duration was 30.95 (9.26-180.30) months. The accumulative incidence of NODM was 8.9% at postoperative 6 months, 14.0% at postoperative year one, 22.3% at year three, 27.1% at year five, and 35.5% at year ten. Multivariate analysis showed that the risk of postoperative NODM was positively correlated with age (HR 1.029 (1.013-1.045), p<0.001), preoperative body mass index (BMI) (HR 1.042 (1.003-1.083), p=0.001), operative blood loss (HR 1.0003 (1.0002-1.0010), p<0.001), and length of resected pancreas (HR 1.079 (1.013-1.148), p0.017). Moreover, concomitant splenectomy (HR 2.001 (1.202-3.331), p=0.008) was associated with significantly higher risk of postoperative NODM.
NODM incidence increased with postoperative time progression. Age, BMI, surgical blood loss, length of resected pancreas and splenectomy were independent risk factors for NODM after DP.
NCT03030209.
几项先前的研究报告了胰腺切除术后新发糖尿病（NODM）的发生率。然而，结果并不一致。远端胰腺切除术（DP）后 NODM 的真实发生率仍不清楚。
本研究旨在探讨 DP 后 NODM 的发生率和危险因素。本研究纳入了 2004 年 1 月至 2016 年 2 月期间在北京协和医学院医院接受 DP 的患者。排除术前患有糖尿病或诊断为胰腺癌的患者。主要结局是 NODM。
共纳入 485 例患者。中位（IQR）随访时间为 30.95（9.26-180.30）个月。术后 6 个月、1 年、3 年、5 年和 10 年的 NODM 累积发生率分别为 8.9%、14.0%、22.3%、27.1%和 35.5%。多因素分析显示，术后 NODM 的风险与年龄呈正相关（HR 1.029（1.013-1.045），p<0.001）、术前体重指数（BMI）（HR 1.042（1.003-1.083），p=0.001）、手术失血量（HR 1.0003（1.0002-1.0010），p<0.001）和切除胰腺的长度（HR 1.079（1.013-1.148），p=0.017）。此外，同时行脾切除术（HR 2.001（1.202-3.331），p=0.008）与术后 NODM 的高风险显著相关。
NODM 的发生率随术后时间的延长而增加。年龄、BMI、手术失血量、切除胰腺的长度和脾切除术是 DP 后发生 NODM 的独立危险因素。
NCT03030209。
