Moon Seoil, Lee Mirang, Lee Jun Suh, Lee Jooyeop, Oh Tae Jung, Jang Myoung-Jin, Yoon Yoo-Seok, Han Youngmin, Kwon Wooil, Jang Jin-Young, Jung Hye Seung
Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea.
J Clin Endocrinol Metab. 2025 Jan 21;110(2):e249-e256. doi: 10.1210/clinem/dgae227.
With advancements in long-term survival after pancreatectomy, postpancreatectomy diabetes has become a concern, and the risk factors are not yet established. Pancreatic islets are susceptible to ischemic damage, though there is a lack of clinical evidence regarding glycemic deterioration.
To investigate association between hypotension during pancreatectomy and development of postpancreatectomy diabetes.
In this retrospective, longitudinal cohort study, we enrolled patients without diabetes who underwent distal pancreatectomy or pancreaticoduodenectomy between January 2005 and December 2018 from 2 referral hospitals in Korea.
Intraoperative hypotension (IOH) was defined as a 20% or greater reduction in systolic blood pressure. The primary and secondary outcomes were incident diabetes and postoperative Homeostatic Model Assessment (HOMA) indices.
We enrolled 1129 patients (average age, 59 years; 49% men; 35% distal pancreatectomy). IOH occurred in 83% (median duration, 25 minutes; interquartile range, 5-65). During a median follow-up of 3.9 years, diabetes developed in 284 patients (25%). The cumulative incidence of diabetes was proportional to increases in the duration and depth of IOH (P < .001). For the median duration in IOH compared with a reference time of 0 minutes, the hazard ratio was 1.48 (95% CI, 1.14-1.92). The effect of IOH was pronounced with distal pancreatectomy. Furthermore, the duration of IOH was inversely correlated with 1-year HOMA β-cell function (P < .002), but not with HOMA insulin resistance.
These results support the hypothesis that IOH during pancreatectomy may elevate risk of diabetes by inducing β-cell insufficiency.
随着胰腺切除术后长期生存率的提高，胰切除术后糖尿病已成为一个关注点，但其危险因素尚未明确。胰岛易受缺血损伤，尽管缺乏关于血糖恶化的临床证据。
探讨胰腺切除术中低血压与胰切除术后糖尿病发生之间的关联。
在这项回顾性纵向队列研究中，我们纳入了2005年1月至2018年12月期间在韩国两家转诊医院接受远端胰腺切除术或胰十二指肠切除术的无糖尿病患者。
术中低血压（IOH）定义为收缩压降低20%或更多。主要和次要结局分别是糖尿病的发生和术后稳态模型评估（HOMA）指数。
我们纳入了1129例患者（平均年龄59岁；49%为男性；35%接受远端胰腺切除术）。83%的患者发生了IOH（中位持续时间25分钟；四分位间距5 - 65）。在中位随访3.9年期间，284例患者（25%）发生了糖尿病。糖尿病的累积发病率与IOH的持续时间和程度增加成正比（P < 0.001）。与0分钟的参考时间相比，IOH中位持续时间的风险比为1.48（95%CI，1.14 - 1.92）。IOH对远端胰腺切除术的影响更为明显。此外，IOH的持续时间与1年HOMAβ细胞功能呈负相关（P < 0.002），但与HOMA胰岛素抵抗无关。
这些结果支持以下假设，即胰腺切除术中的IOH可能通过诱导β细胞功能不全而增加糖尿病风险。
