沒有照片 作者: 沈修年
班別: 碩士班
畢業年度: 99
指導老師: 李中一
論文題目: 糖尿病與急性胰臟炎的雙向關係研究

[ 摘要 ]
急性胰臟炎的發生率和糖尿病的盛行率在大多數西方國家都在增加。糖尿病可能在急性胰臟炎後發生;因此,在急性胰臟炎患者中會有較高的糖尿病患就不足為奇。有趣的是,急性胰臟炎也在糖尿病患者中有較高的發生率。基於缺乏在台灣急性胰臟炎流行病學數據以及此症與糖尿病間有趣的相互關係,我們便進行此項研究,目的是描述在台灣急性胰臟炎的流行病學變化,並進一步探討這兩種疾病之間的雙向關聯。此研究是採用台灣全民健康保險研究資料庫;首先,我們分析了2000和2009年間共107,349例首次急性胰臟炎病患資料,發現其發生率平均是每1,000人年有0.37例,在研究期間的改變很小。其次,我們分析年齡和性別相匹配的糖尿病患(N = 547,554)和非糖尿病患(N = 584,373),發現此兩組在追蹤8年期間急性胰臟炎的發生率分別是每1,000人年有2.98和1.68例,經Cox模型調整後的危險比是1.53(95%信賴區間[CI] 1.49-1.58)。同時也發現糖尿病患與嚴重急性胰臟炎的發生有關(危險比1.46,95%CI 1.36-1.57),尤其是與局部併發症的關係更強(危險比1.65,95%CI 1.14-2.39)。最後,我們分析另一組年齡和性別匹配的急性胰臟炎(N=2,966)和非急性胰臟炎(N=11,864)病患,追蹤10年。在前三個月的追蹤期,糖尿病的發生率分別是每1,000人年60.8和8.0例,經Cox模型調整後的危險比是5.88(95%CI 3.36-10.29);在三個月後的追蹤期,糖尿病的發生率分別是每1,000人年22.5和6.7例(危險比2.56,95%CI 2.14-3.06);而且男性風險大於女性(在三個月後的追蹤期風險比分別是3.22與 1.57),嚴重胰臟炎患者風險大於輕微胰臟炎患者(在三個月後的追蹤期風險比分別是2.79與2.51)。總結來說,在台灣首次急性胰臟炎的發生率近年來變化不大,此與大多數西方國家觀察到的增加趨勢不同。糖尿病患的急性胰臟炎與嚴重急性胰臟炎的發生率都比非糖尿病患多出五成;然而,無論輕重,在急性胰臟炎後發生糖尿病的風險卻增加了一倍以上。因此,有需要對所有急性胰臟炎病患做長期的糖尿病篩選。未來的研究需要進一步去研究最符合成本效益的追蹤方式,並探討此兩疾病間的雙向關係之機轉。
 
[ 英文摘要 ]
Both the incidence of acute pancreatitis (AP) and the prevalence of diabetes mellitus (DM) are increasing in most Western countries. DM may develop after AP. Therefore, it is not surprising to find a higher prevalence of DM in patients with AP. Interestingly, the incidence of AP is also much higher in patients with DM. Given the lack of epidemiological data on AP in Taiwan and the interesting interrelation of DM and AP, this research aims to describe the epidemiology of AP in Taiwan, and to further explore the bidirectional association between these two diseases. Using Taiwan’s National Health Insurance Research Database, we first analyzed 107,349 patients with first-attack AP between 2000 and 2009, and found that the incidence of first-attack AP was average 0.37 per 1,000 person-years and changed only slightly. We then investigated a study cohort enrolling age-and-sex-matched groups of patients with (n=547,554) and without (n=584,373) DM over an 8-year follow-up period. We found that the incidence of AP was 2.98 and 1.68 per 1,000 person-years for patients with and without DM, respectively; representing a covariate adjusted hazard ratio (HR) of 1.53 (95% confidence interval [CI] 1.49-1.58) in a Cox regression model. DM was also significantly associated with an increased HR of severe AP (1.46, 95% CI 1.36-1.57), and especially of AP with local complications (1.65, 95% CI 1.14-2.39). Finally, we investigated another study cohort enrolling 2,966 AP patients and 11,864 non-AP general controls individually matched on age and sex. The incidence of DM in the first partition of time (<3 months) was 60.8 and 8.0 per 1,000 person-years for AP and control groups, respectively; representing a covariate-adjusted HR of 5.88 (95% CI 3.36-10.29). In the second partition of time (≥3 months), the incidence of DM was 22.5 and 6.7 per 1,000 person-years for AP and control groups (HR 2.56, 95% CI 2.14-3.06). Risk of DM was greater in men than in women (HR 3.22 vs. 1.57 for the second partition) and in severe AP than in mild AP (HR 2.79 vs. 2.51 for the second partition). In conclusion, the overall incidence of first-attack AP changed slightly in Taiwan, which differs from the increasing trend observed in most Western countries. DM is associated with approximately 50% increased risk of overall and severe AP; and the risk of DM more than doubles after AP regardless of the severity. These findings indicate a need of long-term screening for DM after an AP attack regardless of the severity. Future research is needed to find the most cost-effective follow-up strategy, and to explore the underlying mechanisms of the bidirectional relationship between DM and AP.
 
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