ABSTRACT
ObjectiveTo investigate the influence of dyslipidemia and number of items conforming to the diagnostic criteria for dyslipidemia on new-onset acute pancreatitis (AP). MethodsA prospective cohort study was performed for 99 695 on-the-job or retired workers of Kailuan Group who underwent the first physical examination from 2006 to 2007. According to the number of items conforming to the diagnostic criteria for dyslipidemia in the first physical examination, they were divided into G0 group with 69 465 workers who did not meet the diagnostic criteria for dyslipidemia, G1 group with 23 921 workers who met one item of the diagnostic criteria for dyslipidemia, G2 group with 5791 workers who met two items of the diagnostic criteria for dyslipidemia, G3 group with 500 workers who met three items of the diagnostic criteria for dyslipidemia, and G4 group with 18 workers who met four items of the diagnostic criteria for dyslipidemia. New-onset AP cases were collected once every year during follow-up, and a multivariate Cox proportional hazards regression model analysis was used to analyze the influence of dyslipidemia on new-onset AP cases. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of AP in each group, and the log-rank test was used for comparison of cumulative incidence rate between groups. ResultsThe total follow-up time of all 99 695 workers was 782 395 person-years, and since no new-onset AP cases were observed in G4 group, G4 group was combined with G3 group for analysis. The incidence rates of AP in G0, G1, G2, and G3 groups were 1.61, 2.05, 2.59, and 7.72 per thousand person-years, respectively, and the cumulative incidence rates of AP in these four groups were 1.76‰, 2.40‰, 3.12‰, and 8.39‰, respectively. The log-rank test showed a significant difference in cumulative incidence rate between groups (χ2=15.18, P=0.004 3). After adjustment for the other risk factors, the Cox model showed that the hazard ratio (95% confidence interval) for AP was 1.23 (0.88-1.73) in G1 group, 1.58 (1.09-2.10) in G2 group, and 4.90 (1.81-13.37) in G3 group. ConclusionDyslipidemia is a risk factor for new-onset AP, and the risk of AP increases with the increase in the number of items conforming to the diagnostic criteria for dyslipidemia.
ABSTRACT
Objective To explore the predictive value of combined application of the different obesity measures on incident gallstone disease (GD) and find the optimal combination.Methods The retrospective cohort study was conducted.The data of 88 947 participants who participated in health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Jinggezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of general data between 2 genders;(2) incidence of GD;(3) risk factors analysis of the different obesity measures affecting incident GD;(4) comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident GD model.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were analyzed using the t test.Measurement data with skewed distribution were described as M (P25,P75),and comparisons between groups were analyzed using the rank sum test.Comparisons of count data were analyzed using the chi-square test.The incidences of GD between 2 genders were calculated by person-year of follow-up.The hazard ratio (HR) and 95％ confidence interval (CI) of the different obesity measures on incident GD were estimated by the COX proportional hazard model.The fitting degree of different combination of obesity measures on incident GD model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of general data between 2 genders:of 88 947 participants,age,body mass index (BMI),waist circumference (WC),systolic pressure,diastolic pressure,total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG),cases with diabetes,hypertension,smoking,drinking and physical exercise were respectively (51± 12) years old,(25±3) kg/m2,(88± 10) cm,(132±20) mmHg (1mmHg=0.133 kPa),(84± 12) mmHg,(4.95± 1.16) mmol/L,1.18 mmol/L (0.81 mmol/L,1.74 mmol/L),(5.5±1.6)mmol/L,6 223,31 816,26 993,15 779,11 063 in male participants and (49± 11)yearsold,(25±4)kg/m2,(83±11)cm,(124±21)mmHg,(7911)mmHg,(4.98±1.08)mmol/L,1.30 mmol/L (0.92 mmol/L,2.00 mmol/L),(5.3±1.6)mmol/L,1 409,5 866,248,87,2 450 in female participants,with statistically significant differences [t=587.20,894.27,1 064.97,813.49,986.22,630.97,H(x2)=642.39,t=452.87,x2=35.10,1 205.40,9 619.42,4 901.75,84.82,P＜0.05].(2) Incidence of GD:88 947 participants were followed up for 713 345 person-year,4 291 participants had incident GD,with a total person-year incidence of 6.02 thousand person / year.The total follow-up time,cases with incident GD and person-year incidence were respectively 562 821 person-year,3 268,5.81 thousand person / year in male participants and 150 524 person-year,1 023,6.80 thousand person / year in female participants.(3) Risk factors analysis of the different obesity measures affecting incident GD:the results of COX proportional hazard model:in male participants,adjusted for age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,BMI was associated with increased risk of incident GD (HR=1.35,1.63,95％CI:1.24-1.46,1.48-1.80,P＜0.05);WC was associated with increased risk of incident GD (HR=1.27,1.53,95％CI:1.15-1.40,1.39-1.67,P＜0.05);waist-to-height ratio (WHtR) was associated with increased risk of incident GD (HR=1.20,1.44,95％CI:1.09-1.32,1.31-1.58,P＜0.05).In female participants,BMI was associated with increased risk of incident GD (HR=1.35,1.77,95％CI:1.16-1.56,1.49-2.10,P＜0.05);WC was associated with increased risk of incident GD (HR=1.38,1.72,95％CI:1.15-1.66,1.44-2.07,P＜0.05);WHtR was associated with increased risk of incident GD (HR=1.34,1.71,95％CI:1.12-1.61,1.43-2.04,P＜0.05).(4) Comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident gallstone diseases model:multi-factor model of male participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 71 257 and 71 275.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+ WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 71 156 and 71 178,71 170 and 71 192,71 197 and 71 219,71 134 and 71 160,71 132 and 71 162,71 170 and 71 196,71 132 and 71 162.The minimal mode of AIC was multi-factor model+BMI+WC,with a difference of 123 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =123.00,P＜ 0.05).The multi-factor model of female participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 19 612 and 19 630.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 19 568 and 19 590,19 575 and 19 597,19 574 and 19 596,19 558 and 19 584,19 557 and 19 583,19 571 and 19 597,19 556 and 19 586.The minimal mode of AIC was multi-factor model+BMI+WHtR,with a difference of 55 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =55.00,P＜0.05).Conclusions The increased BMI,WC and WHtR are independent risk factors for incident GD,no matter the gender.In males,the combination of BMI and WC can improved the predictive value of the incident GD,while in females,BMI and WHtR are the best combination for predicting incident GD.
ABSTRACT
Objective To investigate the effects of fasting serum triglycerides (TG) levels at different baseline on the risk of new-onset acute pancreatitis (AP) in in-service and retired employees of Kailuan Group.Methods A total of 125 178 in-service and retired employees of Kailuan Group who received health check-ups from 2006 to 2009 and had no AP history but had complete TG data were prospectively enrolled.According to quantile level,the baseline serum fasting TG level of study subjects were divided into ＜1.01 mmol/L group (n=42 128),1.01 to 1.64 mmol/L group (n=41 711) and ＞ 1.64 mmol/L group (n=41 339).The incidence of new-onset AP of these three groups was analyzed.The survival curve was plotted by Kaplan-Meier method.The cumulative incidence rate was calculated and tested by log-rank method.And multivariate Cox proportional hazards regression model was performed to calculate hazard ratios (HR) of baseline fasting serum TG level for AP.Results After followed up for (7.36±1.23) years,a total of 193 cases of AP occurred.The incidences of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.43 events/10 000 person-years,2.37 events/10 000 person-years and 2.49 events/10 000 person-years,respectively.The cumulative incidence rates of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞1.64 mmol/L group were 0.10％ (44/42 128),0.18％ (73/41 711) and 0.18％ (76/41 339),respectively,and the difference was statistically significant (x2 =9.998,P=0.007).The results of multivariate Cox proportional hazards regression model analysis indicated that the risk of AP increased in 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group compared with that of ＜1.01 mmol/L group,HR and 95％ confidence interval (CI) were 1.56 (1.07 to 2.29) and 1.57 (1.06 to 2.32),respectively.After excluded onset AP within one year,with a control group of ＜1.01 mmol/L group,the results of multivariate Cox proportional hazards regression model analysis indicated that the HR and 95％CI for AP of 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.70 (1.11 to 2.58) and 1.69 (1.10 to 2.60),respectively.Conclusion Baseline fasting serum TG levels over 1.01 mmol/L may increase the risk of AP.