糖尿病与脑卒中发病风险的前瞻性研究

Prospective study of the relationship between diabetes and the risk of stroke

目的了解金昌队列人群脑卒中的发病状况,探讨糖尿病及FPG与脑卒中发病之间的联系,为有效控制糖尿病、预防脑卒中的发生提供科学依据。方法以金昌队列为研究平台,采用前瞻性队列研究的方法分析糖尿病及FPG水平与脑卒中发病风险间的关系,运用限制样条法拟合FPG水平与脑卒中发病风险间的剂量反应关系。结果本研究共纳入32 736例研究对象,平均随访2.2年后,脑卒中累积发病率为8.77‰,其中糖尿病组脑卒中发病率为23.38‰,高于对照组发病率6.67‰。调整混杂因素后,糖尿病患者和空腹血糖受损人群中脑卒中的发病风险分别是对照组的2.257倍(HR=2.257, 95%CI:1.658~3.072,P<0.001)和1.396倍(HR=1.396, 95%CI:1.039~1.877,P=0.027)。以FPG<5.6 mmol/L作为对照组,控制混杂因素后,总人群中FPG≥5.6 mmol/L组和FPG≥6.1 mmol/L组脑卒中的发病风险分别增加48.1%(HR=1.481, 95%CI:1.040~2.108,P=0.030)和49.3%(HR=1.493, 95%CI:1.044~2.136,P=0.028);当FPG≥7.0 mmol/L时,男性和女性脑卒中的发病风险分别是对照组的1.614倍(HR=1.614,95%CI:1.068~2.438)和2.742倍(HR=2.742, 95%CI:1.355~5.547)。在总人群和女性中FPG与脑卒中发病风险间呈非线性剂量反应关系,男性中FPG与脑卒中发病风险间呈线性剂量反应关系。结论糖尿病是脑卒中的独立危险因素,且FPG水平与脑卒中的发病风险间存在剂量反应关系。

Objective To analyze the incidence of stroke in the population of Jinchang Cohort, and explore the relationship of diabetes and fasting plasma glucose(FPG) with the risk of stroke, to provide a scientific basis for the control and prevention of stroke. Methods The prospective cohort study was used to analyze the relationship of diabetes and blood glucose levels with the risk of stroke in Jinchang Cohort. The restriction spline method was used to analyze the dose-response relationship between FPG and the risk of stroke. Results A total of 32 736 people were included in this study. After an average follow-up of 2.2 years, the cumulative incidence of stroke was 8.77‰, among which the incidence of stroke in the diabetic group was 23.38‰, which was 6.67‰ higher than that in the control group. After adjusting for confounding factors, the risk of stroke in diabetes group and pre-diabetes group was 2.257 times that of the control group(HR=2.257, 95% CI: 1.658-3.072, P<0.001) and 1.396 times(HR=1.396, 95% CI: 1.039-1.877, P=0.027), respectively. After controlling for confounding factors, compared with FPG<5.6 mmol/L, the risk of stroke in the FPG≥5.6 mmol/L group and FPG≥7.0 mmol/L group increased by 48%(HR=1.481, 95% CI: 1.040-2.108) and 49%(HR=1.493, 95% CI: 1.044-2.136) among the total population, respectively;when FPG ≥ 7.0 mmol/L, the risk of stroke in men and women was 1.614 times(HR=1.614, 95% CI: 1.068-2.438) and 2.742 times(HR=2.742, 95% CI: 1.355-5.547) then that of the control group, respectively. There was a nonlinear dose-response relationship between FPG and the risk of stroke among the total population and women. In addition, there was a linear dose-response relationship between FPG and the risk of stroke among men. Conclusion Diabetes is an independent risk factor for stroke, and there is a dose-response relationship between PFG and the risk of stroke.