2型糖尿病患者发病年龄、病程、糖化血红蛋白与缺血性脑卒中发病风险的前瞻性队列研究

Associations of onset age,diabetes duration and glycated hemoglobin level with ischemic stroke risk in type 2 diabetes patients:a prospective cohort study

目的分析江苏省2型糖尿病患者发病年龄、病程和糖化血红蛋白(HbA1c)与缺血性脑卒中(IS)发病风险的关联。方法研究对象来自江苏省社区糖尿病综合干预及应用研究,2013年12月至2014年1月开展基线调查,本研究随访数据截至2021年12月31日,剔除基线诊断为脑卒中以及发病年龄、病程和HbA1c信息缺失的参与者后,最终共纳入17576名研究对象。采用Cox比例风险回归模型计算发病年龄、病程、HbA1c与IS发病的风险比(HR)值及其95%CI。结果研究对象中位随访时间8.02年,期间共登记IS新发病例2622名。多因素Cox比例风险回归分析显示,糖尿病发病年龄每延迟5年,IS发病风险降低5%(HR=0.95,95%CI:0.92~0.99),糖尿病病程每增加5年,IS发病风险增加5%(HR=1.05,95%CI:1.02~1.10),较高的HbA1c(每增加1个标准差:HR=1.17,95%CI:1.13~1.21)与IS发病风险增加相关。结论2型糖尿病患者较早的发病年龄、更长的病程和较高水平的HbA1c均与IS发病风险增加相关。

Objective To investigate the associations of onset age,diabetes duration,and glycated hemoglobin(HbA1c)levels with ischemic stroke risk in type 2 diabetes patients.Methods The participants were from Comprehensive Research on the Prevention and Control of the Diabetes in Jiangsu Province.The study used data from baseline survey from December 2013 to January 2014 and follow-up until December 31,2021.After excluding the participants who had been diagnosed with stroke at baseline survey and those with incomplete information on onset age,diabetes duration,and HbA1c level,a total of 17576 type 2 diabetes patients were included.Cox proportional hazard model was used to calculate the hazard ratio(HR)and 95%CI of onset age,diabetes duration,and HbA1c level for ischemic stroke.Results During the median follow-up time of 8.02 years,2622 ischemic stroke cases were registered.Multivariate Cox proportional risk regression model showed that a 5-year increase in type 2 diabetes onset age was significantly associated with a 5%decreased risk for ischemic stroke(HR=0.95,95%CI:0.92-0.99).A 5-year increase in diabetes duration was associated with a 5%increased risk for ischemic stroke(HR=1.05,95%CI:1.02-1.10).Higher HbA1c(per 1 standard deviation increase:HR=1.17,95%CI:1.13-1.21)was associated with an increased risk for ischemic stroke.Conclusion The earlier onset age of diabetes,longer diabetes duration,and high levels of HbA1c are associated with an increased risk for ischemic stroke in type 2 diabetes patients.