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JAMA Netw Open:对台湾地区有2型糖尿病家族史的成人1型糖尿病患者并发症的评估。

2021-12-24 从医路漫漫 MedSci原创

有1型糖尿病(T1D)和2型糖尿病(T2D)家族史的患者发生糖尿病并发症和其他心血管疾病的风险较高。然而,台湾患者个体风险的估计在很大程度上无法得到或不可靠。

背景:有1型糖尿病(T1D)和2型糖尿病(T2D)家族史的患者发生糖尿病并发症和其他心血管疾病的风险较高。然而,台湾患者个体风险的估计在很大程度上无法得到或不可靠。1型糖尿病(T1D)和2型糖尿病(T2D)都与主要不良心血管事件(MACEs)的风险增加有关。1型糖尿病是一种自身免疫性疾病,导致胰腺β细胞破坏,导致绝对胰岛素缺乏。2型糖尿病与胰岛素抵抗相关,导致高胰岛素血症、β细胞功能障碍、高血糖,最终导致胰岛素缺乏。T1D和T2D在病理生理特征和心血管疾病的危险因素方面存在差异。T2D中的MACEs与胰岛素抵抗有关,而T1D中的MACEs与肾脏疾病有关。然而,T1D中的心血管风险是否与T2D阳性家族史的关系尚不清楚。因为这两种疾病的发病机制不同,所以这两种疾病都有可能在一定比例的个体中发生。因此,自发性胰岛素缺乏和遗传性胰岛素抵抗并存可被认为是心血管疾病的危险因素,这可能导致急性心肌梗死的风险增加。为了探讨有T2D家族史的T1D个体患MACEs的风险更高的可能性,T2D阳性家族史已被用作T1D个体MACEs易感性的标志。此外,据报道,T2D个体的一级亲属患有高胰岛素血症,并具有更多的心血管危险因素的动脉粥样硬化模式。本研究的目的是评估有T2D家族史的T1D患者发生糖尿病并发症和主要不良心血管事件(MACEs)的风险。

方法:以人群为基础的队列研究,使用台湾全民健康保险研究资料库。参与者包括2017年12月31日在该数据库中注册的所有个人,并自1995年3月1日以来进行了随访。对2018年12月6日至2019年12月5日的数据进行了分析。受益人登记处包含投保人(缴纳保险费)与其受抚养人之间关系的识别符。只有血亲和配偶才有资格被索赔为被保险人的受抚养人。接生孩子的医疗机构使用出生证明,或者要求对那些不是在医疗机构出生的人进行DNA亲子鉴定,才能将孩子登记为父母的受抚养人。因此,我们可以使用这些标识符和父母、祖父母、子女、孙辈和配偶的独特个人身份来建立家庭关系。一般来说,亲子关系和配偶可以直接识别。一种允许间接识别父母-子女关系的算法也被用来评估可能的家庭联系。如果一个人的完整兄弟姐妹有相同的父母,他们就被识别出来。双胞胎被确认为出生日期相同(±1天)的完全兄弟姐妹。然而,双胞胎合子不能从数据库中得出。为了在同一个家庭的人之间进行分析,每个人都根据他们的关系被分成了不同的家庭。在27370965名健保受益人中(包括在1995年3月1日期间在世和死亡的)。(2017年12月31日),6925954人单独登记,没有任何可识别的亲属。其余20 445 011个个体分为4 145 976个家系。总体而言,21767880对亲子关系,16245232对完全兄弟姐妹,260 844对双胞胎被确认。每个人可能在不同的家庭关系类别中出现过多次。对有T1D和T2D家族史的患者进行评估。分析T1D患者糖尿病、并发症和其他心血管疾病的患病率和危险比(HRs)。MACE由诊断或程序代码识别,遗传率由受益人的登记数据确定。

结果:在纳入数据库的27370965人中,有1237人(平均年龄22.7[14.4]岁,其中54%为女性)患有T1D。T1D的粗患病率为0.04%,男女之比为1.22:1。在确诊时年龄小于20岁、有T2D一级亲属的个体中,调整后的HRs为2.61(95%CI,1.32~5.16)。调整后的HR值分别为糖尿病神经病变1.44(95%CI,1.27~1.64)、视网膜病变1.28(95%CI,1.12~1.47)、神经病变1.24(95%CI,1.06~1.47)。

表1 根据有T2D家族史的T1D患者的预后

表2 根据T2D家族史,男性和女性T1D患者的转归

表3 T2D家族史、诊断年龄对T1D患者预后的影响

表4 单亲或双亲有T2D病史对T1D患者预后的影响

结论:在这项针对台湾T1D患者的研究中,有T2D亲属与个体发生糖尿病并发症的风险增加相关。有T1D家族史和T2D家族史的患者可能会有更多的并发症,需要密切治疗。

原文出处:

Lin CH,  Lo FS,  Huang YY,et al.Evaluation of Disease Complications Among Adults With Type 1 Diabetes and a Family History of Type 2 Diabetes in Taiwan.JAMA Netw Open 2021 Dec 01;4(12)

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    2022-01-06 feather89
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    2022-06-12 canlab
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    2022-09-28 丁鹏鹏
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