糖尿病累积暴露时长对新发心肌梗死影响的前瞻性队列研究

A PROSPECTIVE COHORT STUDY OF EFFECT OF CUMULATIVE EXPOSURE TO DIABETES ON NEW-ONSET ACUTE MYOCARDIAL INFARCTION

目的探讨糖尿病累积暴露时长对新发急性心肌梗死(AMI)的影响。方法本研究对连续参加开滦集团2006年度、2008年度、2010年度体检且无心肌梗死病史、卒中病史、肿瘤病史的开滦集团在职及离退休员工共52568例进行分析,根据糖尿病累积暴露时长将观察对象分为三组:糖尿病累积暴露0年为0年组,糖尿病累积暴露2年为2年组,糖尿病累积暴露4年或6年为4年组。采用多因素COX回归模型分析糖尿病累积暴露时长对新发AMI的影响。分别删除服用降脂药、服用降压药、服用降糖药人群,进行敏感性分析。结果在52568例观察对象中糖尿病累积暴露0年组、2年组、4年组AMI的发病密度为9.82/万人年、19.10/万人年和26.51/万人年,各组累积发病率分别为0.79%、1.49%和1.95%(χ^(2)=66.57,P<0.01)。在多因素COX回归模型分析中以糖尿病累积暴露0年组为对照组,校正其他混杂因素后发现糖尿病累积暴露2年组、4年组发生AMI的HR(95%CI)分别为1.32(1.03~1.70)、1.66(1.19~2.33)。在增加校正2006年度单次空腹血糖(FBG)测量值后,以糖尿病累积暴露0年组为对照组,校正其他混杂因素后发现糖尿病累积暴露2年组、4年组发生AMI的HR(95%CI)分别为1.30(1.01~1.66)、1.54(1.09~2.19)。在敏感性分析中分别删除服用降脂药、服用降压药、服用降糖药人群后上述结果趋势一致。结论FBG的长期变化存在“累积暴露”现象,糖尿病累积暴露是AMI的危险因素,且独立于单次FBG测量值。

Objective To investigate the correlation between cumulative exposure to diabetes on new-onset acute myocardial infarction.Methods A total of fifty-two thousand five hundred and sixty-eight participants who participated three health examinations in 2006-2007,2008-2009,2010-2011 and without history of myocardial infarction,history of stroke,history of cancertest were enrolled.The participants were divided into three groups according to the different years of cumulative exposure to diabetes:the cumulative exposure to diabetes was 0 years in the 0-year group,the cumulative exposure to diabetes was 2 years in the 2 years group,and the cumulative exposure to diabetes was 4 years or 6 years in the 4 years group.Multivariate COX regressionmodel was used to analyze the effect of cumulative exposure years of diabetes on new-onset AMI.After removing the lipid-lowering drugs,antihypertensive drugs,and hypoglycemic agents,the COX regression model was repeated for sensitivity analysis.Results Among 52,568 participants,the incidence of AMI in cumulative 0-year,2-year,and 4-years of diabetes was 9.82 per 10,000 person-year,19.10 per 10,000 person-year,and 26.51 per 10,000 person-year,the cumulative incidence rates of each group were:0.79%,1.49%and 1.95%(χ^(2)=66.57,P<0.01).Multi Cox regression analysis presented that with adjusted confounding factors,compared with the participants in cumulative exposure with diabetes 0 years group,HR(95%CI)of the other groups of AMI were 1.32(1.03~1.70)and 1.66(1.19~2.33).After adjusted the FBG measured value at 2006 health examination,HR(95%CI)of the other groups of AMI were1.30(1.01~1.66)and 1.54(1.09~2.19).The above results were not changed after removing the lipid-lowering drugs,antihypertensive drugs,and hypoglycemic agents in the sensitivity analysis.Conclusion The long-term change of FBG shows"cumulative exposure"effect,and cumulative exposure to diabetes was a risk factor for AMI,independent of single FBG measurement.