关键词: 血糖, 出血, 胃肠道, 空腹血糖, 上消化道出血, 队列研究

Abstract: Background　Upper gastrointestinal bleeding（UGIB）is one of the common and serious clinical diseases，with threatening to life safety and relating to high medical burden；the influence of diabetes on the risk of UGIB has been attracting attention increasingly in recent years，but there is no research about the influence of fasting blood glucose（FBG）on the risk of new-onset UGIB.This study was conducted based on the data of Kailuan Research，which is with relatively fixed queue，large sample size，good follow-up and high reliability.Methods　A total of 100 003 in-service and retired employees of Kailuan Group who received 2006 physical examination were selected based on Kailuan study cohort and divided into normal group（FBG<6.1 mmol/L，n=79 966），pre-diabetes group（6.1 mmol/L≤FBG<7.0 mmol/L，n=7 645）and diabetes group（FBG≥7.0 mmol/L，n=12 392）according to the FBG. Incidence of new-onset UGIB in the three groups was recorded based on annual follow-up with a deadline to December 31，2018；Kaplan-Meier method was used to calculate the cumulative incidence of new-onset UGIB in the three groups and Log-rank test was performed；annual human incidence（incidence density）in the three groups was calculated，and COX proportional hazard regression model analysis and sensitivity analysis were carried out to analyze the influence of FBG on the risk of new-onset UGIB.Results　100 003 cases of physical examination were followed up from 2 days to 15 years，at average of（10.6±1.7）years with a rate of lost to follow-up of 9.96%（9 960/100 003），a total of 942 cases occurred new-onset UGIB with an incidence density of 8.91 per 10 000 person-years，thereinto the number of new-onset UGIB cases in the normal group，pre-diabetic group，and diabetes group were 711，84，and 147，and the incidence density was 8.35，10.45，and 11.67 per 10 000 person-years，respectively. Kaplan-Meier curve showed that cumulative incidence of new-onset UGIB increased with the FBG elevating，and Log-rank test results showed that there is significant difference of cumulative incidence of new-onset UGIB among the three groups（χ2=14.84，P<0.01）. COX proportional hazard regression model analysis results showed that，after adjusting for confounding factors，risk of new-onset UGIB in pre-diabetes group and diabetes group was 1.30 times〔HR=1.30，95%CI（1.02，1.66），P=0.03〕and 1.35 times〔HR=1.35，95%CI（1.09，1.67），P<0.01〕compared with normal group，moreover the results of sensitivity analysis were basically consistent.Conclusion　Cumulative incidence of new-onset UGIB increases with increase of FBG，and FBG≥6.1 mmol/L can increase the risk of new-onset UGIB，moreover pre-diabetes and diabetes are independent risk factors of new-onset UGIB.

Key words: Blood glucose, Hemorrhage, Gastrointestinal tract, Fasting blood glucose, Upper gastrointestinal bleeding, Cohort study