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1型和2型糖尿病患者的死亡率和心血管疾病结局
Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes


Aidin Rawshani ... 心脑血管疾病 糖尿病 • 2017.04.13
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降低糖尿病致死率与心血管疾病要致力于未病已病

 

刘海霞†,单忠艳‡*

† 大连医科大学附属第二医院;‡ 中国医科大学附属第一医院

* 通讯作者

 

糖尿病导致死亡率及心血管疾病发病率增高已是不争的事实。近十几年来对糖尿病的认识与干预所致的死亡率与心血管疾病发病率的总体趋势究竟如何走向,鲜有研究报告。而本期《新英格兰医学杂志》发表的一篇基于1998~2014年瑞典国家糖尿病登记中心登记的1型与2型糖尿病患者死亡率和心血管疾病发病率与普通人群相比的研究则诠释了这一问题1

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摘要


目的

1型或2型糖尿病患者死亡和心血管结局的过高危险度的长期趋势尚未经过广泛研究。

 

方法

我们纳入了1998~2014年在瑞典国家糖尿病登记研究(Swedish National Diabetes Register)中注册的患者,我们采用Cox回归和标准化的发生率估计死亡和心血管事件的趋势。对每例患者,我们根据年龄、性别和郡(county)匹配在一般人群中随机选取对照。

 

结果

在1型糖尿病患者中,研究期间每10,000人年的前哨结局(sentinel outcome)发生率的绝对变化分别是:任何原因死亡,-31.4(95%置信区间[CI],-56.1~-6.7);心血管疾病导致的死亡,-26.0(95% CI,-42.6~-9.4);冠心病导致的死亡,-21.7(95% CI,-37.1~-6.4);心血管疾病导致的住院,-45.7(95% CI,-71.4~-20.1)。在2型糖尿病患者中,每10,000人年的绝对变化分别是:任何原因死亡,-69.6(95% CI,-95.9~-43.2);心血管疾病导致的死亡,-110.0(95% CI,-128.9~-91.1);冠心病导致的死亡,-91.9(95% CI,-108.9~-75.0);心血管疾病导致的住院,-203.6(95% CI,-230.9~-176.3)。和对照组相比,1型糖尿病患者心血管事件结局的降幅大约超出40%,而2型糖尿病患者的降幅大约超出20%。1型糖尿病患者和对照组在致死性结局方面的降幅相似,而2型糖尿病患者在致死性结局方面的降幅小于对照组。

 

结论

1998~2014年,瑞典糖尿病患者的死亡率和心血管结局的发生率明显下降,虽然2型糖尿病患者在致死性结局方面的降幅小于对照组(由瑞典地方政府和地区学会[Swedish Association of Local Authorities and Regions]等资助)。





作者信息

Aidin Rawshani, M.D., Araz Rawshani, M.D., Ph.D., Stefan Franzén, Ph.D., Björn Eliasson, M.D., Ph.D., Ann-Marie Svensson, Ph.D., Mervete Miftaraj, M.Sc., Darren K. McGuire, M.D., M.H.Sc., Naveed Sattar, M.D., Ph.D., Annika Rosengren, M.D., Ph.D., and Soffia Gudbjörnsdottir, M.D., Ph.D.
From the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg (Aidin Rawshani, Araz Rawshani, B.E., A. Rosengren, S.G.), and the Swedish National Diabetes Register, Center of Registers in Region (Aidin Rawshani, Araz Rawshani, S.F., B.E., A.-M.S., M.M., S.G.), Gothenburg, Sweden; the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (D.K.M.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (N.S.). Address reprint requests to Dr. Aidin Rawshani at the Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, SE-41390 Gothenburg, Sweden, or at aidin.rawshani@gu.se.

 

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