Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Am J Gastroenterol. 2023 Jun 1;118(6):1080-1090. doi: 10.14309/ajg.0000000000002198. Epub 2023 Jan 30.
Hypertriglyceridemia is the third most common etiology of acute pancreatitis. Whether triglyceride variability, independent of absolute triglyceride levels, is a predictor of acute pancreatitis is unknown.
We identified 98,819 patients who were diagnosed with hyperlipidemia between January 1, 2007, and December 31, 2013, and had at least 1 triglyceride measurement annually for 4 consecutive years from the Chang Gung Research Database in Taiwan. Triglyceride variability, defined as variability independent of the mean, was calculated in the 4-year run-in period. The patients were stratified according to the quartiles of triglyceride variability and were followed until December 31, 2019, for first attack of acute pancreatitis.
During a mean follow-up of 5.9 years, 825 (0.83%) patients were newly diagnosed with acute pancreatitis (14.1 events per 10,000 person-years; 95% confidence interval 13.2-15.1). Triglyceride variability was significantly associated with an increased risk of acute pancreatitis, independent of baseline triglyceride and mean triglyceride levels (hazard ratio, 1.28 [95% confidence interval 1.05-1.57] for the highest vs the lowest quartiles of triglyceride variability; P for trend = 0.006 over the quartiles of triglyceride variability). Subgroup analysis showed that this association was more pronounced among the patients with a higher neutrophil-to-lymphocyte ratio ( P for trend = 0.022).
In this multi-institutional cohort study, high triglyceride variability was associated with an increased risk of first attack of acute pancreatitis, independent of baseline and mean triglyceride levels. The association between triglyceride variability and acute pancreatitis may be partly mediated by subclinical inflammation.
高甘油三酯血症是急性胰腺炎的第三大常见病因。甘油三酯的变异性（独立于绝对甘油三酯水平）是否是急性胰腺炎的预测因素尚不清楚。
我们从台湾长庚研究数据库中确定了 98819 名于 2007 年 1 月 1 日至 2013 年 12 月 31 日期间被诊断为高脂血症的患者，且在 4 年的纳入期内至少每年有 1 次甘油三酯测量值。甘油三酯变异性定义为独立于平均值的变异性，并在 4 年的纳入期内进行计算。根据甘油三酯变异性的四分位距将患者分层，并随访至 2019 年 12 月 31 日，以确定首次急性胰腺炎发作。
在平均 5.9 年的随访期间，有 825 名（0.83%）患者新诊断为急性胰腺炎（14.1 例/10000 人年；95%置信区间 13.2-15.1）。甘油三酯变异性与急性胰腺炎的风险增加显著相关，与基线甘油三酯和平均甘油三酯水平无关（最高四分位距与最低四分位距相比，风险比为 1.28 [95%置信区间 1.05-1.57]；四分位距的趋势 P 值=0.006）。亚组分析显示，在中性粒细胞与淋巴细胞比值较高的患者中，这种相关性更为明显（趋势 P 值=0.022）。
在这项多机构队列研究中，高甘油三酯变异性与首次急性胰腺炎发作的风险增加相关，与基线和平均甘油三酯水平无关。甘油三酯变异性与急性胰腺炎之间的关联可能部分由亚临床炎症介导。
