Study on the association between the Chinese visceral adiposity index and the risk of acute pancreatitis
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摘要:
目的 内脏脂肪多与人体的代谢相关，本文旨在探究中国人群中国内脏脂肪指数(CVAI)的变化及其与急性胰腺炎(AP)的关联。 方法 选择参加开滦集团2006—2009年度首次健康查体且符合条件的123 461名职工为观察队列，根据CVAI四分位数水平分为4组：Q1组(31 015例，CVAI≤7.07 mmol/L)、Q2组(30 817名，7.07 < CVAI≤38.92 mmol/L)、Q3组(30 816名，38.92 < CVAI≤70.74 mmol/L)、Q4组(30 813名，CVAI>70.74 mmol/L)。采用Kaplan-Meier法及log-rank检验对AP累积发病率进行分析，采用多因素Cox比例风险回归模型分析不同CVAI分组对随访期间新发AP事件的影响。 结果 最终共有123 461名纳入研究，随访(13.71±2.65)年，共发生AP 418例，4组间累积发病率差异有统计学意义(log-rank χ2=8.862，P=0.031)。以Q1组为对照，Q4组发生AP的HR为1.504(95% CI：1.126~2.010, P=0.006)；男性Q4组新发AP的HR为1.368(95% CI：1.007~1.858，P=0.045)；排除随访2年内发生AP的患者，Q4组发生AP的HR为1.553(95% CI：1.141~2.112，P=0.005)。 结论 CVAI是AP发病的影响因素，可作为预测AP发病的有效指标。 Abstract:Objective Visceral fat is mostly related to metabolic disorders. This study aimed to explore the relationship between the chinese visceral adiposity index (CVAI) in the Chinese population and the risk of acute pancreatitis (AP). Methods A total of 123 461 eligible participants from the Kailuan cohort who participated their first physical examination between 2006 and 2009 were included. Participants were divided into four groups according to the CVAI quartile level. Group Q1 (31 015 cases, CVAI≤7.07 mmol/L), Group Q2 (30 817 cases, 7.07 mmol/L < CVAI≤38.92 mmol/L), Group Q3 (30 816 cases, 38.92 mmol/L < CVAI≤70.74 mmol/L), and Group Q4 (30 813 cases, CVAI>70.74 mmol/L). The cumulative incidence of AP was calculated by Kaplan-Meier method and compared across groups with the log-rank. Multivariate Cox proportional hazard regression model was applied to analyze the evaluated the association between CVAI quartiles and incident AP during follow-up. Results Over a mean followed up period of (13.71±2.65) years, 418 cases of AP were identified among 123 416 participants. There were significant differences in the cumulative incidence of AP were observed among the four CVAI quartile groups (χ2=8.862, P=0.031). Multivariate analysis showed that participants in the Q4 group had a significantly high risk of AP (HR=1.504, 95% CI: 1.126-2.010, P=0.006) compared to the Q1 group. In males, the HR (95% CI) for AP in the Q4 group was 1.368 (95% CI: 1.007-1.858, P=0.045). After excluding AP cases that occurred within 2 years of follow-up, the association remained significant (HR=1.553, 95% CI: 1.141-2.112, P=0.005). Conclusion Higher CVAI are associated with an increased risk of acute pancreatitis. CVAI may serve as an effective indicator for identifying individuals at elevated risk of AP disease. -
Key words:
- Chinese visceral adiposity index /
- Acute pancreatitis /
- Cohort studies
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表 1 不同CVAI分组研究对象基线资料比较
Table 1. Baseline data of observed subjects in different CVAI groups
项目 Q1
(n=31 015)Q2
(n=30 817)Q3
(n=30 816)Q4
(n=30 813)统计量 P值 性别(男性/女性, 例) 27 649/3 366 25 313/5 504 23 920/6 896 21 711/9 102 3 551.046a < 0.001 年龄(x±s, 岁) 48.97±14.78 50.46±12.61 51.81±11.63 52.93±11.97 552.819b < 0.001 BMI(x±s) 21.43±2.02 23.97±1.86 25.80±1.99 28.82±2.91 59 826.461b < 0.001 收缩压(x±s, mmHg) 124.00±19.37 128.08±19.72 131.51±19.41 136.70±19.37 2 357.076b < 0.001 舒张压(x±s, mmHg) 79.46±10.85 82.29±11.10 84.43±11.13 87.37±11.36 2 801.541b < 0.001 甘油三酯[M(P25, P75)，mmol/L] 0.94(0.68, 1.31) 1.15(0.84, 1.65) 1.39(1.01, 2.05) 1.77(1.25, 2.66) 20 472.546c < 0.001 总胆固醇(x±s, mmol/L) 4.79±1.03 4.90±1.05 4.97±1.08 5.05±1.11 328.988b < 0.001 高密度脂蛋白胆固醇(x±s, mmol/L) 1.64±0.55 1.54±0.39 1.48±0.37 1.43±0.37 1 309.185b < 0.001 低密度脂蛋白胆固醇(x±s, mmol/L) 2.31±0.82 2.40±0.83 2.42±0.84 2.41±0.87 106.161b < 0.001 尿酸(x±s, mmol/L) 277.60±75.98 283.36±82.05 292.32±85.78 308.86±90.19 814.100b < 0.001 eGFR[x±s，mL/(min·1.73m2)] 87.38±26.58 82.92±25.00 81.22±25.56 79.12±22.84 589.362b < 0.001 空腹血糖(x±s, mmol/L) 5.25±1.52 5.40±1.56 5.55±1.69 5.76±1.84 527.013b < 0.001 饮酒[例(%)] 2 764(8.91) 2 473(8.03) 2 332(7.57) 2 075(6.73) 106.301a < 0.001 吸烟[例(%)] 13 112(42.28) 11 119(36.08) 10 048(32.61) 9 160(29.73) 1 186.994a < 0.001 教育年限≥9年[例(%)] 8 163(26.32) 7 332(23.79) 6 974(22.63) 7 221(23.43) 128.934a < 0.001 体育锻炼≥3次/周[例(%)] 4 623(14.91) 4 774(15.49) 5 024(16.30) 5 551(18.02) 243.003a < 0.001 高血压史[例(%)] 13 688(44.13) 15 744(51.09) 17 682(57.38) 20 944(67.97) 3 836.587a < 0.001 糖尿病史[例(%)] 6 854(22.10) 7 305(23.70) 7 679(24.92) 8 792(28.53) 371.583a < 0.001 胆石症史[例(%)] 787(2.54) 1 016(3.30) 1 240(4.02) 1 612(5.23) 335.755a < 0.001 注：a为χ2值，b为F值，c为H值。1 mmHg=0.133 kPa。 
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表 2 不同CVAI分组AP新发情况
Table 2. The incidence of AP among different CVAI groups
组别 例数 发病例数 发病密度(例/万人年) 累计发病率(%) Q1 31 015 83 1.962 0.268 Q2 30 817 99 2.340 0.321 Q3 30 816 112 2.644 0.363 Q4 30 813 124 2.933 0.402 注：4组累计发病率比较，差异有统计学意义(log-rank χ2=8.862，P=0.031)。
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表 3 不同CVAI分组对AP事件影响的多因素Cox回归分析
Table 3. Cox proportional hazards models for AP across CVAI groups
变量 B SE Waldχ2 P值 HR值 95% CI 模型1 第2分位组 0.174 0.149 1.362 0.243 1.190 0.889~1.593 第3分位组 0.296 0.145 4.191 0.041 1.345 1.013~1.787 第4分位组 0.401 0.142 7.989 0.005 1.493 1.131~1.972 1SD 0.154 0.048 10.283 0.001 1.167 1.062~1.283 模型2 第2分位组 0.180 0.149 1.461 0.227 1.197 0.894~1.604 第3分位组 0.303 0.146 4.334 0.037 1.354 1.018~1.802 第4分位组 0.421 0.144 8.484 0.004 1.523 1.147~2.021 1SD 0.161 0.049 10.820 0.001 1.175 1.067~1.293 模型3 第2分位组 0.172 0.150 1.318 0.251 1.187 0.886~1.592 第3分位组 0.282 0.147 3.659 0.056 1.325 0.993~1.769 第4分位组 0.408 0.148 7.626 0.006 1.504 1.126~2.010 1SD 0.161 0.051 10.123 0.002 1.174 1.064~1.297 年龄 0.010 0.004 4.944 0.026 1.010 1.001~1.019 男性 0.402 0.148 7.394 0.007 1.119 1.119~1.996 教育年限 -0.477 0.143 11.130 0.001 0.621 0.469~0.822 体育锻炼 -0.261 0.126 4.278 0.038 0.770 0.601~0.986 胆石症病史 1.049 0.160 42.967 < 0.001 2.856 2.087~3.908 注：均以第1分位组为参照。模型1为单因素模型；模型2校正年龄、性别；模型3在模型2的基础上进一步校正吸烟、饮酒、体育锻炼、教育、高血压、糖尿病、eGFR、低密度脂蛋白胆固醇、胆石症。赋值方法如下，性别，男性=0，女性=1；吸烟、饮酒、体育锻炼、糖尿病病史、高血压病史、胆石症病史，否=0，是=1；受教育程度 < 9年=0，≥9年=1；其余自变量为连续变量，以实际值赋值。
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表 4 不同性别人群不同CVAI分组对AP事件影响的多因素Cox回归分析(模型4)
Table 4. Cox proportional hazards models for AP across CVAI groups stratified by sex (Model 4)
变量 B SE Waldχ2 P值 HR值 95% CI 男性 第2分位组 0.049 0.162 0.091 0.763 1.050 0.764~1.444 第3分位组 0.285 0.155 3.381 0.066 1.330 0.981~1.802 第4分位组 0.313 0.156 4.012 0.045 1.368 1.007~1.858 女性 第2分位组 0.317 0.481 0.433 0.511 1.372 0.534~3.526 第3分位组 0.848 0.474 3.207 0.073 2.336 0.923~5.915 第4分位组 0.743 0.521 2.037 0.154 2.102 0.758~5.830 注：均以第1分位组为参照。
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表 5 排除随访2年内发生AP事件人群后重复多因素Cox回归分析(模型5)
Table 5. Cox proportional hazards models for AP after a 2-year follow-up (Model 5)
变量 B SE Waldχ2 P值 HR值 95% CI 第2分位组 0.176 0.159 1.225 0.268 1.193 0.873~1.631 第3分位组 0.316 0.156 4.082 0.043 1.371 1.009~1.862 第4分位组 0.440 0.157 7.856 0.005 1.553 1.141~2.112 注：以第1分位组为参照。
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