高甘油三酯血症及其与全因死亡率和胰腺炎的关系：来自大型回顾性临床登记研究的结果

Hypertriglyceridemia and its relationship with all-cause mortality and pancreatitis: Results from a large retrospective clinical registry.

作者信息

Vlacho Bogdan, Julve Josep, Genua Idoia, Fernández-Camins Berta, Real Jordi, Franch-Nadal Josep, Mauricio Didac, Ortega Emilio

机构信息

CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain (Drs Vlacho, Julve, Nadal, and Mauricio); DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain (Drs Vlacho, Camins, Real, Nadal, and Mauricio).

CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain (Drs Vlacho, Julve, Nadal, and Mauricio); Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (Drs Julve, Genua, and Mauricio); Research Group in Endocrinology, Diabetes and Nutrition. Institut de Recerca SANT PAU, Barcelona, Spain (Drs Julve, Genua, and Mauricio).

出版信息

J Clin Lipidol. 2025 Jul-Aug;19(4):922-930. doi: 10.1016/j.jacl.2025.04.195. Epub 2025 May 5.

DOI:10.1016/j.jacl.2025.04.195

PMID:40467441

Abstract

BACKGROUND

Hypertriglyceridemia (HTG) is a potential risk factor for mortality and pancreatitis; however, real-world data remain limited.

OBJECTIVE

We aimed to investigate whether elevated triglyceride (TG) levels may identify individuals at a higher risk of all-cause mortality or increased incidence of all-cause pancreatitis in our Mediterranean primary care population.

METHODS

We conducted a retrospective analysis using the SIDIAP primary care database to assess HTG prevalence and its association with all-cause mortality and pancreatitis. Subjects were categorized into 5 TG level groups, (from <150 mg/dL to >880 mg/dL). Logistic and Cox regression models adjusted for different covariates were used.

RESULTS

HTG (>150 mg/dL) had a prevalence of 22.8%, whereas that of severe HTG (>500 mg/dL) was 0.8%. From 2010 to 2020, 2,256,261 individuals were followed up for a median of 7.78 years. The cumulative incidence rates for all-cause pancreatitis and all-cause mortality were 0.44% and 8.37%, respectively. Individuals with previously reported pancreatitis (n = 6527, 0.3%) showed higher incidence rates of all-cause pancreatitis (7.37%) and all-cause mortality (22.54%) than those without previous history of this outcome (pancreatitis: 0.42%; mortality: 8.33%, respectively). Adjusted analyses revealed an increasingly higher risk of all-cause pancreatitis across TG categories, with the highest risk for TG ≥ 880 mg/dL levels (hazard ratio [HR]: 3.79, 95% CI: 3.10; 4.63). The risk for all-cause mortality (HR: 1.08, 95% CI: 1.06; 1.09 and HR: 1.11, 95% CI: 1.07; 1.14) was observed for TG (150-299, 300-499) compared to those with TG < 150 mg/dL. Individuals with TG ≥ 500 mg/dL had the highest excess risk for all-cause pancreatitis (HR: 2.66, 95% CI: 2.30; 3.07) and mortality (HR: 1.15, 95% CI: 1.08; 1.23), even after adjusting for confounders.

CONCLUSION

HTG is common and independently predicts mortality and pancreatitis in a real-world primary care setting. Future trials should evaluate lifestyle and TG-lowering interventions to mitigate these risks.

摘要

背景

高甘油三酯血症（HTG）是导致死亡和胰腺炎的潜在风险因素；然而，实际数据仍然有限。

目的

我们旨在调查甘油三酯（TG）水平升高是否可识别在地中海初级保健人群中全因死亡率较高或全因胰腺炎发病率增加风险较高的个体。

方法

我们使用SIDIAP初级保健数据库进行回顾性分析，以评估HTG患病率及其与全因死亡率和胰腺炎的关联。受试者被分为5个TG水平组（从<150mg/dL到>880mg/dL）。使用针对不同协变量进行调整的逻辑回归和Cox回归模型。

结果

HTG（>150mg/dL）的患病率为22.8%，而重度HTG（>500mg/dL）的患病率为0.8%。2010年至2020年期间，对2,256,261名个体进行了中位时间为7.78年的随访。全因胰腺炎和全因死亡率的累积发病率分别为0.44%和8.37%。既往有胰腺炎报告的个体（n = 6527，0.3%）的全因胰腺炎发病率（7.37%）和全因死亡率（22.54%）高于无此结局既往史的个体（胰腺炎：0.42%；死亡率：8.33%）。调整分析显示，TG各分类中全因胰腺炎风险逐渐升高，TG≥880mg/dL水平风险最高（风险比[HR]：3.79，95%置信区间：3.10；4.63）。与TG<150mg/dL的个体相比，TG（150 - 299、300 - 499）的全因死亡率风险（HR：1.08，95%置信区间：1.06；1.09和HR：1.11，95%置信区间：1.07；1.14）。即使在调整混杂因素后，TG≥500mg/dL的个体全因胰腺炎（HR：2.66，95%置信区间：2.30；3.07）和死亡率（HR：1.15，95%置信区间：1.08；第1.23页）的额外风险最高。