糖尿病与脑卒中发病风险的前瞻性研究

陈亚荣; 尹春; 黄佩瑶; 李娜; 许璐璐; 黄文雅; 柳念; 李思宇; 李靖; 胡雨佳; 白亚娜

doi:10.16462/j.cnki.zhjbkz.2022.01.013

糖尿病与脑卒中发病风险的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2022.01.013

1.
730000 兰州，兰州大学公共卫生学院流行病与卫生统计学系
2.
737100 金昌，金川集团职工医院心血管内科
3.
737100 金昌，金川集团职工医院体检中心

基金项目:

金川集团公司职工代谢性疾病全程管理体系建设 Jinkezong 2020-02

详细信息

通讯作者:
白亚娜，E-mail: baiyana@lzu.edu.cn

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-03
- 修回日期: 2021-05-26
- 网络出版日期: 2022-01-16
- 刊出日期: 2022-01-10

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

1.
Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
2.
Department of Cardiovascular Medicine, Workers' Hospital of Jinchuan Group, Jinchang 737100, China
3.
Physical Examination Center, Workers' Hospital of Jinchuan Group, Jinchang 737100, China

Funds:

Construction of the Whole-process Management System for Metabolic Diseases Among Staffs in Jinchuan Group Co Ltd Jinkezong 2020-02

More Information

Corresponding author: BAI Ya-na, E-mail: baiyana@lzu.edu.cn

摘要

摘要: 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。
- 金昌队列 /
- 脑卒中 /
- 糖尿病 /
- 剂量-反应关系 /
- 前瞻性研究
Abstract: 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.
- Jinchang Cohort /
- Stroke /
- Diabetes /
- Dose-response relationship /
- Prospective study

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图 1 总人群、男性、女性基线FPG与脑卒中发病风险间的剂量反应关系(A：总人群; B：男性; C：女性)

Figure 1. The dose-response relationship of baseline FPG with the risk of stroke in the total population, men and women (A: total population; B: male; C: female)

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表 1 2011年6月22日―2013年12月30日金昌队列基线情况[n(%)]

Table 1. Baseline situation of Jinchang Cohort from June 22, 2011 to December 30, 2013 [n(%)]

变量	脑卒中组(n=287)	非脑卒中组(n=32 449)	t/χ²值	P值
年龄[(x±s)，岁]	62.67±9.64	45.96±12.57	22.465	< 0.001
性别			13.017	< 0.001
男	204(71.08)	19 675(60.63)
女	83(28.92)	12 774(39.37)
家庭人均月收入(元)			13.981	< 0.001
< 1 000	8(2.79)	1470(4.53)
1 000~＜2 000	165(57.49)	15 126(46.62)
≥2 000	114(39.72)	15 852(48.85)
吸烟			21.999	< 0.001
否	119(41.46)	17 942(55.29)
是	168(58.54)	14 507(44.71)
饮酒			3.082	0.079
否	209(72.82)	25 048(77.19)
是	78(27.18)	7 401(22.81)
脑卒中家族史			0.630	0.427
无	269(93.73)	28 768(94.78)
有	18(6.27)	1 573(5.22)
糖尿病			78.484	< 0.001
无	167(58.19)	24 896(76.72)
IFG	64(22.30)	5 214(16.07)
糖尿病	56(9.51)	2 339(7.21)

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表 2 糖尿病对脑卒中的发病风险分析

Table 2. Analysis of diabetes on the risk of stroke

组别	N ^a	n ^b	Inc ^c值(‰)	随访时间(人年)	发病密度(/10万人年)	模型1 ^d		模型2 ^e
组别	N ^a	n ^b	Inc ^c值(‰)	随访时间(人年)	发病密度(/10万人年)	HR(95% CI)值	P值	HR(95% CI)值	P值
对照组	25 063	167	6.67	55 139	30.29	1.000		1.000
IFG组	5 278	64	12.13	11 611	55.12	1.452(1.088~1.938)	0.011	1.396(1.039~1.877)	0.027
糖尿病	2 395	56	23.38	5 269	1 062.28	2.289(1.690~3.101)	< 0.001	2.257(1.658~3.072)	< 0.001
注：^a为总人数; ^b为脑卒中新发病例数; ^c为脑卒中发病率; ^d采用单因素分析; ^e为调整年龄、性别、收入、吸烟、饮酒、SBP、DBP、脑卒中家族史、体育锻炼后的模型。

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表 3 总人群基线FPG与脑卒中发病风险分析

Table 3. Analysis of baseline FPG on the risk of stroke in the total population

基线FPG值(mmol/L)	N ^a	n ^b	Inc(%)值	模型1		模型2
基线FPG值(mmol/L)	N ^a	n ^b	Inc(%)值	HR(95% CI)值	P值	HR(95% CI)值	P值
< 5.6	25 036	171	0.68	1.000		1.000
5.6~ < 6.1	3 153	39	1.24	1.503(1.061~2.129)	0.022	1.481(1.040~2.108)	0.030
6.1~ < 7.0	2 658	39	1.47	1.551(1.095~2.197)	0.014	1.493(1.044~2.136)	0.028
≥7.0	1 889	38	2.01	1.984(1.396~2.822)	< 0.001	1.939(1.358~2.768)	< 0.001
注：^a为总人数; ^b为脑卒中新发病例数。

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表 4 不同性别人群基线FPG与脑卒中发病风险分析

Table 4. Analysis of baseline FPG on the risk of stroke among different gender population

基线FPG值(mmol/L)	男性					女性
	N ^a	n ^b	Inc(%)值	模型1	模型2	N ^a	n ^b	Inc(%)值	模型1 ^c	模型2 ^d
	N ^a	n ^b	Inc(%)值	HR(95% CI)值	HR(95% CI)值	N ^a	n ^b	Inc(%)值	HR(95% CI)值	HR(95% CI)值
< 5.6	14 540	114	0.78	1.000	1.000	10 496	57	0.54	1.000	1.000
5.6~ < 6.1	2 107	29	1.38	1.307(0.869~1.967)	1.370(0.903~2.077)	1 046	10	0.96	1.629(0.832~3.189)	1.597(0.815~3.129)
6.1~ < 7.0	1 853	32	1.73	1.421(0.959~2.106)	1.445(0.962~2.170)	805	7	0.87	1.333(0.608~2.923)	1.283(0.585~2.815)
≥7.0	1 379	29	2.10	1.515(1.007~2.280)	1.614(1.068~2.438)	510	9	1.76	2.825(1.397~5.711)	2.742(1.355~5.547)
P_趋势			< 0.001	0.015	0.008		0.003	0.006		0.008
注：^a为总人数; ^b为脑卒中新发病例数; ^c采用单因素分析; ^d为调整年龄、收入、吸烟、饮酒、SBP、DBP、脑卒中家族史、体育锻炼、降糖药物使用情况后的模型。

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