高甘油三酯血症（HTG）或严重高甘油三酯血症（sHTG）患者急性胰腺炎的风险

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.093

Kirti Batra MBA, Qiana Amos PhD, Seth Baum MD, Montserrat Vera-Llonch PhD, Daniel Soffer MD, Asia Sikora Kessler PhD

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引用次数: 0

摘要

背景/概要：tg与急性胰腺炎（AP）风险增加相关。然而，评估不同甘油三酯（TG）水平升高时AP风险的真实证据有限。目的/目的本研究评估HTG和sHTG水平患者与正常TG水平患者AP事件的发生率。方法本回顾性队列研究于2016年1月1日至2022年3月31日期间使用Optum研究数据库进行。纳入年龄≥18岁且血清/血浆TG诊断试验≥1项的成年人。患者被分为4组：TG正常(35≤TG <；150 mg/dL)， HTG(150≤TG <；500 mg/dL), sHTG(放入500≤TG <；880 mg/dL或TG≥880 mg/dL队列)。指标日期是针对队列的最早TG测量。患者至少有12个月的指数前后连续登记。主要研究结果为AP事件，定义为具有以下之一：≥2例AP特异性医疗索赔；≥1次AP住院索赔；≥1例上腹痛（UAP）和血清/血浆脂肪酶或淀粉酶水平索赔；UAP索赔后15天内200u /L。计算每100,000人年（PY）的危险发生率。通过Kaplan-Meier分析和调整后的Cox比例风险模型来估计HTG组和sHTG组与正常TG组相比AP事件的风险。结果在四个队列中共确定了134,316例患者。患者平均（SD）年龄为56.3（15.7）岁，男性占54%，平均随访987天。HTG组（171.8）、500≤TG <；880 mg/dL（377.8）和TG≥880 mg/dL（977.6）队列，与正常TG队列相比(92.2；所有p <；0.001)。HTG组3年AP事件累计发生率为0.5%，500≤TG组为1.1%；在TG≥880 mg/dL的队列中，这一比例为2.8%，而在正常TG队列中，这一比例为0.3%(图；所有p <；0.001)。在调整后的Cox回归模型中，HTG组AP的风险比（95% CI）为1.50(1.20 ~ 1.87)，500≤TG <组AP的风险比为2.63 (2.06 ~ 3.35)；与正常TG组相比，TG≥880 mg/dL组为4.78(3.45-6.61)（表）。结论TG水平升高的患者与正常水平的患者相比，AP事件的风险更高，并且随着TG水平的升高AP的风险增加，表明需要改进治疗干预措施，重点关注sHTG的临床管理。

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Risk of acute pancreatitis among patients with hypertriglyceridemia (HTG) or severe hypertriglyceridemia (sHTG)

Background/Synopsis

HTG is associated with an increased risk of acute pancreatitis (AP). However, real-world evidence evaluating the risk of AP at varying levels of elevated triglycerides (TG) is limited.

Objective/Purpose

This study evaluates the incidence of AP event in patients with HTG and sHTG levels compared to normal TG levels.

Methods

This retrospective cohort study was conducted using the Optum Research Database between 01 January 2016 – 31 March 2022. Adults 18 years and older with ≥ 1 diagnostic test for serum/plasma TG were included. Patients were assigned to four cohorts: normal TG (35 ≤ TG < 150 mg/dL), HTG (150 ≤ TG < 500 mg/dL), and sHTG (placed into 500 ≤ TG < 880 mg/dL or TG ≥ 880 mg/dL cohorts). The index date was the cohort-specific earliest TG measurement. Patients had at least 12 months of pre- and post-index continuous enrollment. The primary study outcome was AP event, defined as having one of the following: ≥ 2 AP-specific medical claims; ≥ 1 claim for AP hospitalization; ≥ 1 claim for upper abdominal pain (UAP) and serum/plasma lipase or amylase level > 200 U/L within 15 days of the UAP claim. Incidence rates were calculated per 100,000 person-years (PY) at risk. Kaplan-Meier analysis and an adjusted Cox proportional hazards model were conducted to estimate the risk of AP event in the HTG cohort and sHTG cohorts compared with the normal TG cohort.

Results

A total of 134,316 patients were identified across the four cohorts. The mean (SD) age of patients was 56.3 (15.7) years, 54% were males, and the mean follow-up was 987 days. AP incidence rates were significantly higher for the HTG (171.8), the 500 ≤ TG < 880 mg/dL (377.8), and the TG ≥ 880 mg/dL (977.6) cohorts, compared to the normal TG cohort (92.2; all p < 0.001). The cumulative incidence of AP events at 3 years was 0.5% in the HTG cohort, 1.1% in the 500 ≤ TG < 880 mg/dL cohort, and 2.8% in the TG ≥ 880 mg/dL cohort, compared to 0.3% in the normal TG cohort (Figure; all p < 0.001). In the adjusted Cox regression model, the hazard ratio (95% CI) of AP was 1.50 (1.20–1.87) in the HTG cohort, 2.63 (2.06–3.35) in the 500 ≤ TG < 880 mg/dL cohort, and 4.78 (3.45–6.61) in the TG ≥ 880 mg/dL cohort, compared to the normal TG cohort (Table).

Conclusions

Patients with elevated TG levels had higher risk of AP event compared to patients with normal levels, with risk of AP increasing with higher TG levels, demonstrating the need for improved therapeutic interventions focused on the clinical management of sHTG.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.