Risk factor analysis and nomogram development for steatorrhea in idiopathic chronic pancreatitis
Risk factor analysis and nomogram development for steatorrhea in idiopathic chronic pancreatitis
复制标题
特发性慢性胰腺炎脂肪泻的危险因素分析和列线图开发
DOI：
10.1111/1751-2980.13102
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发表时间：
2022-07-27
影响因子：
3.5
通讯作者：
Hu, Liang Hao
中科院分区：
文献类型：
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作者：
Liu, Yu;Yin, Xiao Yi;Hu, Liang Hao
目的脂溢症是严重的胰腺外分泌功能不全(PEI)的症状，与胰腺炎的后果有关。本研究旨在找出预测特发性慢性胰腺炎(ICP)并发脂肪泻的因素，并建立相应的标准图。方法对2000年1月至2013年12月在本院住院的妊娠肝内胆汁淤积症患者进行前瞻性队列研究，并随机分配到培训和验证队列中。计算累计脂溢率。使用COX比例风险回归模型来确定脂肪泻的预测因素，并构建诺模图。然后进行诺模图的内部和外部验证。结果1633例患者中位随访期为9.8年，20.8%(339/1633)的患者在发病后发生脂溢性腹泻。93例、115例和133例患者在CP确诊后1、3和5年出现脂肪泻，累积发生率分别为6.5%(95%可信区间5.1%-7.9%)、8.0%(95%可信区间6.2%-9.8%)和9.3%(95%可信区间6.6%-12.0%)。男性(危险比[HR]2.479，P<；0.001)、诊断时/诊断前糖尿病(HR 2.274，P=0.003)、发病年龄小于18岁(HR 0.095，P<；0.001)是脂肪泻的危险因素。最初的症状与脂肪泻的发展有关。诺模图被证明具有良好的一致性指标。结论我们确定了预测因素，并建立了预测妊娠期肝内胆汁淤积症的诺模图。建议密切跟踪高危人群，这可能有助于PEI的早期诊断和治疗。
Objectives Steatorrhea, a sign of severe pancreatic exocrine insufficiency (PEI), is related to consequences caused by pancreatitis. This study aimed to identify predictors and to construct a nomogram for steatorrhea in idiopathic chronic pancreatitis (ICP). Methods ICP patients admitted to our hospital from January 2000 to December 2013 were enrolled in this retrospective-prospective cohort study and randomly assigned to the training and validation cohorts. The cumulative rate of steatorrhea was calculated. A Cox proportional hazard regression model was used to identify predictors for steatorrhea and construct the nomogram. Internal and external validation of the nomogram was then performed. Results There were 1633 ICP patients enrolled, with a median follow-up duration of 9.8 years and 20.8% (339/1633) of patients developed steatorrhea following onset of ICP. Steatorrhea was observed in 93, 115, and 133 patients at 1, 3, and 5 years following diagnosis of CP, with a cumulative rate of 6.5% (95% confidence interval [CI] 5.1%-7.9%), 8.0% (95% CI 6.2%-9.8%), and 9.3% (95% CI 6.6%-12.0%), respectively. Male sex (hazard ratio [HR] 2.479, P < 0.001), diabetes mellitus at/before diagnosis of ICP (HR 2.274, P = 0.003), and aged less than 18 years at onset of ICP (HR 0.095, P < 0.001) were identified risk factors for steatorrhea. Initial manifestations were associated with development of steatorrhea. The nomogram was proven to have good concordance indexes. Conclusions We identified predictors and developed a nomogram for predicting steatorrhea in ICP. It was recommended that high-risk populations be followed up closely, which might contribute to the early diagnosis and treatment of PEI.