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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (2): 249-254. doi: 10.19723/j.issn.1671-167X.2022.02.008

• 论著 • 上一篇    下一篇

北京城镇职工2型糖尿病患者缺血性脑卒中发病率及主要危险因素

吴俊慧,武轶群,吴瑶,王紫荆,吴涛,秦雪英,王梦莹,王小文,王伽婷,胡永华()   

  1. 北京大学公共卫生学院流行病与卫生统计学系,北京 100191
  • 收稿日期:2020-04-27 出版日期:2022-04-18 发布日期:2022-04-13
  • 通讯作者: 胡永华 E-mail:yhhu@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81230066);国家自然科学基金(81473043);国家自然科学基金(81703291);国家自然科学基金(81872695)

Incidence and risk factors of ischemic stroke in patients with type 2 diabetes among urban workers in Beijing, China

WU Jun-hui,WU Yi-qun,WU Yao,WANG Zi-jing,WU Tao,QIN Xue-ying,WANG Meng-ying,WANG Xiao-wen,WANG Jia-ting,HU Yong-hua()   

  1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
  • Received:2020-04-27 Online:2022-04-18 Published:2022-04-13
  • Contact: Yong-hua HU E-mail:yhhu@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81230066);National Natural Science Foundation of China(81473043);National Natural Science Foundation of China(81703291);National Natural Science Foundation of China(81872695)

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摘要：

目的: 通过对新发2型糖尿病患者进行前瞻性观察,探究2型糖尿病发病后缺血性脑卒中的发病特点,并进一步分析2型糖尿病患者缺血性脑卒中发病的危险因素。方法: 数据资料来源于北京市城镇职工基本医疗保险信息系统数据库。研究采用前瞻性设计,对2010年新诊断为2型糖尿病的患者在2010—2017年缺血性脑卒中的发病情况进行描述,采用Logistic回归模型分析2型糖尿病患者缺血性脑卒中发病的危险因素。结果: 共纳入185 813例新发2型糖尿病患者,平均年龄(58.5±13.2)岁,男性占49.0%。随访7年内出现新发缺血性脑卒中患者10 393例,累积发病率为5.6%,发病密度为8.1/1 000人年。2型糖尿病患者缺血性脑卒中在各个年龄段均有发生,不同年龄组累积发病率分别为:≤44岁组1.5%(95%CI:1.3%~1.6%),45~54岁组3.6%(95%CI:3.4%~3.7%),55~64岁组5.4%(95%CI:5.2%~5.5%),≥65岁组9.2%(95%CI:9.0%~9.4%),累积发病率随年龄升高而增加(P<0.05)。男性累积发病率(6.8%,95%CI: 6.7%~7.0%)高于女性(4.4%,95%CI: 4.3%~4.6%);<80岁的患者中,男性在各年龄段累积发病率均高于女性;≥80岁的患者中,女性累积发病率(9.2%)高于男性(7.9%)。进一步分析2型糖尿病患者缺血性脑卒中发病的危险因素,发现患有冠心病(OR=3.18,95%CI:2.72~3.72)、心力衰竭(OR=1.53,95%CI:1.32~1.79)、肾衰竭(OR=1.45, 95%CI:1.20~1.75)等合并症与2型糖尿病患者缺血性脑卒中的发病有关。结论: 2型糖尿病患者缺血性脑卒中发病率仍处于较高水平,应针对老年患者加强危险因素管理,尽早筛查2型糖尿病患者的合并症情况并采取针对性的预防控制措施。

关键词: 糖尿病, 2型, 卒中, 糖尿病并发症, 发病率

Abstract:

Objective: To explore the incidence of ischemic stroke after the onset of type 2 diabetes, and further analyze the risk factors, so as to provide a basis for further research. Methods: The data were obtained from the database of the Beijing Urban Employee Basic Medical Insurance Database. The study used a prospective design to describe the incidence of ischemic stroke in patients with type 2 diabetes. In our study, these patients were followed up for seven years. Multivariate Logistic regression models were used to analyze the risk factors of ischemic stroke in patients with type 2 diabetes. Results: A total of 185 813 newly diagnosed type 2 diabetes patients were enrolled, with an average age of (58.5±13.2) years, and 49.0% of them were males. A total of 10 393 patients with newly diagnosed ischemic stroke occurred in 7 years, with a cumulative incidence of 5.6% and an incidence density of 8.1/1 000 person-years. Ischemic stroke occurred in all age groups in patients with type 2 diabetes. The cumulative incidence was 1.5% (95%CI: 1.3%-1.6%) in group ≤44 years old, 3.6% (95%CI: 3.4%-3.7%) in group 45-54 years old, 5.4% (95%CI: 5.2%-5.5%) in group 55-64 years old, and 9.2% (95%CI: 9.0%-9.4%) in group ≥65 years old, and the cumulative incidence increased with age (P<0.05). Cumulative incidence rate of the males (6.8%, 95%CI: 6.7%-7.0%) was higher than the females (4.4%, 95%CI: 4.3%-4.6%). Among the patients <80 years old, the cumulative incidence rate of the males was higher than that of the females in all the age groups. In the patients ≥80 years of age, the cumulative incidence was higher in the females (9.2%) than in the males (7.9%). Further analysis revealed that complications, such as coronary heart disease (OR=3.18, 95%CI: 2.72-3.72), heart failure (OR=1.53, 95%CI: 1.32-1.79) and kidney failure (OR=1.45, 95%CI: 1.20-1.75) were associated with ischemic stroke in the patients with type 2 diabetes. Conclusion: The incidence level of ischemic stroke in patients with type 2 diabetes is high. It is necessary to strengthen the management of risk factors in elderly patients, screen the complications of type 2 diabetes as early as possible, and take active preventive and control measures.

Key words: Diabetes mellitus, type 2, Stroke, Diabetes complication, Incidence

中图分类号: 

  • R181.32

表1

北京市成年2型糖尿病患者的一般情况"

Characteristics Male (n=90 948) Female (n=94 865) χ2 P Total (n=185 813)
Age group, n(%) 2 318.82 <0.01
≤44 years 11 572 (12.72) 10 177 (10.73) 21 749 (11.71)
45-54 years 21 208 (23.32) 31 568 (33.28) 52 776 (13.91)
55-64 years 27 241 (29.95) 25 984 (27.39) 53 225 (28.40)
≥65 years 30 927 (34.01) 27 136 (28.60) 58 063 (28.64)
Comorbidity, n(%)
Coronary heart disease 2 710 (2.98) 2 261 (2.38) 63.42 <0.01 4 971 (2.67)
Heart failure 1 103 (1.21) 794 (0.84) 64.89 <0.01 1 897 (1.02)
Kidney failure 917 (1.01) 591 (0.62) 85.62 <0.01 1 508 (0.81)

表2

北京市成年2型糖尿病患者缺血性脑卒中的累积发病率"

Follow-up Male Female Total
n Cumulative
incidence/%		 95%CI n Cumulative
incidence/%		 95%CI n Cumulative
incidence/%		 95%CI
1 year 1 069 1.18 1.11-1.25 637 0.67 0.62-0.72 1 706 0.92 0.87-0.96
2 years 1 809 1.99 1.90-2.08 1 092 1.15 1.08-1.22 2 901 1.56 1.50-1.62
3 years 2 672 2.94 2.83-3.05 1 668 1.76 1.67-1.84 4 340 2.34 2.27-2.40
4 years 3 565 3.92 3.79-4.05 2 222 2.34 2.25-2.44 5 787 3.11 3.04-3.19
5 years 4 472 4.92 4.78-5.06 2 888 3.04 2.93-3.15 7 360 3.96 3.87-4.05
6 years 5 337 5.87 5.72-6.02 3 563 3.73 3.63-3.88 8 900 4.79 4.69-4.89
7 years 6 201 6.82 6.65-6.98 4 195 4.42 4.29-4.55 10 396 5.59 5.49-5.70

表3

北京市成年2型糖尿病患者各年龄段缺血性脑卒中的累积发病率"

Follow-up ≤44 years 45-54 years
n Cumulative incidence(95%CI) n Cumulative incidence(95%CI)
1 year 34 0.16 (0.10-0.21) 279 0.53 (0.47-0.59)
2 years 65 0.30 (0.23-0.37) 469 0.89 (0.81-0.97)
3 years 109 0.50 (0.41-0.60) 716 1.36 (1.26-1.46)
4 years 152 0.70 (0.59-0.81) 958 1.82 (1.70-1.93)
5 years 213 0.98 (0.85-1.11) 1 282 2.43 (2.30-2.56)
6 years 263 1.21 (1.06-1.35) 1 575 2.98 (2.84-3.13)
7 years 319 1.48 (1.31-1.63) 1 880 3.56 (3.40-3.72)
Follow-up 55-64 years ≥65 years
n Cumulative incidence(95%CI) n Cumulative incidence(95%CI)
1 year 425 0.80 (0.72-0.87) 968 1.67 (1.56-1.77)
2 years 737 1.38 (1.29-1.48) 1 630 2.81 (2.67-2.94)
3 years 1 092 2.05 (1.93-2.17) 2 423 4.17 (4.01-4.34)
4 years 1 517 2.85 (2.71-2.99) 3 160 5.54 (5.26-5.63)
5 years 1 955 3.67 (3.51-3.83) 3 910 6.73 (6.53-6.94)
6 years 2 394 4.50 (4.32-4.67) 4 668 8.04 (7.82-8.26)
7 years 2 847 5.35 (5.16-5.54) 5 347 9.21 (8.97-9.44)

图1

北京市不同性别和年龄段成年2型糖尿病患者缺血性脑卒中的累积发病率"

表4

北京市不同性别成年2型糖尿病患者缺血性脑卒中的发病密度"

Items Male patients with ischemic stroke Female patients with ischemic stroke Total
n Incidence
densitya		 95%CI n Incidence
densitya		 95%CI n Incidence
densitya		 95%CI
Total 6 021 9.94 9.69-10.19 4 195 6.39 6.20-6.59 10 393 8.12 7.97-8.28
Age group
≤44 years 238 2.94 2.57-3.31 81 1.14 0.89-1.38 319 2.10 1.87-2.33
45-54 years 1 113 7.50 7.06-7.94 767 3.47 3.23-3.72 1 880 5.09 4.86-5.32
55-64 years 1 882 9.87 9.43-10.31 965 5.31 4.97-5.64 2 847 7.64 7.36-7.92
≥65 years 2 962 13.68 13.19-14.17 2 385 12.56 12.06-13.06 5 347 12.97 12.50-13.43

表5

2型糖尿病患者发生缺血性脑卒中危险因素的多因素 Logistic 回归分析"

Variable Model 1 Model 2 Model 3
OR 95%CI P OR 95%CI P OR 95%CI P
Male 1.48 1.42-1.54 <0.01 1.40 1.34-1.46 <0.01 1.39 1.33-1.45 <0.01
Age 1.04 1.04-1.04 <0.01 1.04 1.04-1.04 <0.01 1.04 1.04-1.04 <0.01
Use of insulin 0.50 0.48-0.53 <0.01 0.51 0.49-0.54 <0.01
Use of metformin 0.56 0.54-0.59 <0.01 0.57 0.54-0.59 <0.01
Coronary heart disease 3.18 2.72-3.72 <0.01
Heart failure 1.53 1.32-1.79 <0.01
Kidney failure 1.45 1.20-1.75 <0.01
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CN 11-4691/R
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