安雅莉：中國(guó)DM患者中風(fēng)發(fā)病率和病死率高
雖然在中國(guó)，中風(fēng)是導(dǎo)致死亡的主要原因之一，且中國(guó)糖尿病和糖耐量異常（IGT）人群數(shù)量龐大，并日漸增加。但在中國(guó)糖尿病和IGT成年人，由中風(fēng)引起的死亡風(fēng)險(xiǎn)尚未被量化。來(lái)自中國(guó)醫(yī)學(xué)科學(xué)院阜外醫(yī)院的安雅莉博士及其團(tuán)隊(duì)進(jìn)行了一項(xiàng)研究，該研究發(fā)現(xiàn)在中國(guó)，糖尿病和IGT導(dǎo)致相當(dāng)大的額外中風(fēng)風(fēng)險(xiǎn)，以及相當(dāng)大的由中風(fēng)引起的超額死亡率。糖尿病或IGT患者面對(duì)中風(fēng)發(fā)病率較高和中風(fēng)后病死率較高的雙重危險(xiǎn)。
該研究在1986年中國(guó)大慶篩查50%年齡25歲及其以上社區(qū)居民中最初被確認(rèn)的630例新診斷糖尿病（NDM）、576例IGT和519例正常糖耐量（NGT）組成的隊(duì)列中，在長(zhǎng)達(dá)23年隨訪期間，調(diào)查中風(fēng)發(fā)病率及相關(guān)的死亡率。直到2009年12月31日，在大約95%的隊(duì)列中發(fā)現(xiàn)中風(fēng)發(fā)病率及相關(guān)死亡率。
在218例（36.8%）NDM、177例（32.7）IGT、以及121例（24.6%）NGT中出現(xiàn)致命性中風(fēng)和非致命性中風(fēng)。在NDM（29.0 vs 18.5/1000人年）和IGT（22.1 vs 13.7/1000人年），而不是NGT（12.9 vs 11.4/1000人年），男性的中風(fēng)發(fā)病率高于女性。NDM對(duì)NGT的年齡校正風(fēng)險(xiǎn)比在男性為2.15（95%CI 1.67-3.69），在女性為1.47（95%CI 1.05-2.08）。
在這些發(fā)生中風(fēng)的人群中，145例（66.5%）NDM患者、82例（46.3%）IGT、和36例（29.8%）NGT發(fā)生中風(fēng)死亡。NDM的中風(fēng)病死率（每1000人年）在男性為130.6，在女性為153.9；IGT的中風(fēng)病死率在男性為95.5，在女性為56.7，NGT的中風(fēng)病死率在男性為56.4，在女性為46.6。NDM對(duì)NGT的年齡和性別校正病死率為2.42（95%CI 1.67-3.69），而IGT對(duì)NGT的年齡和性別校正病死率為1.54（95%CI 1.04-2.39）。
該研究發(fā)現(xiàn)，在中國(guó)，糖尿病和IGT導(dǎo)致相當(dāng)大的額外中風(fēng)風(fēng)險(xiǎn)，以及相當(dāng)大的由中風(fēng)引起的超額死亡率。糖尿病或IGT患者面對(duì)中風(fēng)發(fā)病率較高和中風(fēng)后病死率較高的雙重危險(xiǎn)。
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While stroke is a leading cause of death in China and the numbers of persons with diabetes and impaired glucose tolerance (IGT) are large and growing the incidence and risk of death attributable to stroke among Chinese adults with these conditions have not previously been quantified.
We examined incidence of stroke and related mortality over a 23 year period in a cohort of 630 persons with newly diagnosed diabetes (NDM) 576 with IGT and 519 with normal glucose tolerance (NGT) who were identified initially in 1986 by screening 50% of the community aged 25 years and over in Da Qing China. Stroke incidence and related mortality were ascertained up to December 31st 2009 in some 95% of the cohort.
Stroke fatal or non-fatal occurred in 218 (36.8%) persons with NDM 177 (32.7%) with IGT and 121 (24.6%) with NGT. Stroke incidence was higher in men than in women with NDM (29.0 vs. 18.5/1000 person-years) and IGT (22.1 vs. 13.7/1000 person-years) but not with NGT (12.9 vs. 11.4/1000 person-years). The age-adjusted hazard ratios for NDM vs. NGT were 2.15 (95% CI 1.59-2.92) in men and 1.47(95% CI 1.05-2.08) in women.
Among those who developed a stroke death occurred in 145 (66.5%) with NDM 82 (46.3%) with IGT and 36 (29.8%) with NGT. Case-fatality rates from stroke (per 1000 person-years) were 130.6 in men and 153.9 in women with NDM 95.5 and 56.7 in men and women with IGT and 56.4 and 46.6 in men and women with NGT. Age- and sex- adjusted case-fatality rate ratios were 2.42 (95% CI 1.67-3.69) for NDM vs. NGT and 1.54 (95% CI 1.04-2.29) for IGT vs. NGT.
In Chinadiabetes and IGT lead to considerable excess risk for strokeand excess mortality due to stroke. Persons with diabetes or IGT face double jeopardy by having both a higher stroke incidence and a higher case-fatality rate after a stroke.
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ADA是美國(guó)糖尿病學(xué)會(huì) (Americn Diabetos Association)的縮寫，美國(guó)糖尿病協(xié)會(huì)縣美國(guó)重要的非贏利性衛(wèi)生姐織，旨在提供有關(guān)糖尿病的研究進(jìn)展和信息，促進(jìn)糖尿病的科研、教育、診療等，關(guān)注一切與糖尿病有關(guān)的事務(wù)。