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JAMA Netw Open:百万亚洲糖尿病分析:亚洲患者早死风险较高,中国农村尤甚,需严格管理

2019-05-16 朱柳媛 中国循环杂志

4月19日,JAMA子刊在线发表了一项覆盖亚洲22项前瞻性队列研究、100多万受试者的汇总分析结果,发现亚洲2型糖尿病患者的死亡风险高,较无糖尿病人群增加89%。

4月19日,JAMA子刊在线发表了一项覆盖亚洲22项前瞻性队列研究、100多万受试者的汇总分析结果,发现亚洲2型糖尿病患者的死亡风险高,较无糖尿病人群增加89%。

研究指出,中国有1.1亿糖尿病患者,其死亡风险是无糖尿病者的两倍。中国农村,糖尿病患者的死亡风险增加1.6倍。

《中国血管病报告2018》指出,糖尿病患者中血管病死亡风险的增加尤为突出,且农村高于城市。

中国疾病负担报告也表明,糖尿病仍是影响我国居民生命质量的主要疾病之一。

该汇总分析显示,在各种病因死亡中,亚洲2型糖尿病患者肾脏病死亡风险最高(HR=3.08),其次是冠心病死亡(HR=2.57)、结核病死亡(HR=2.28)、肝病死亡(HR=2.24)、缺血性脑卒中死亡(HR=2.15)。

另外,女性2型糖尿病患者因糖尿病死亡的风险高于男性患者(HR:2.09 vs 1.74),心血管病死亡(HR,2.30 vs 1.82)和肾脏病死亡(HR,3.44 vs 2.85)风险尤其高。研究者认为,这与男女患者中治疗不平衡有关。

在各年龄段中,30~49岁的糖尿病患者中全因死亡风险最高,较无糖尿病人群增加1.43倍。此后随着年龄增长,全因死亡风险逐渐降低。

除外有心血管病或癌症病史受试者的敏感性分析也得出了类似的结果。

作者指出,与西方国家相比,亚洲糖尿病患者的糖尿病死亡风险格外高。与西方患者相比,亚洲患者的糖尿病控制较差,与缺医少药、糖尿病教育不足等因素有关。

另外,亚洲人本身更易受可导致糖尿病相关死亡的因素影响。例如,亚洲人死于肾脏病的风险较高,更容易出现胰岛素抵抗,合并高血压、血脂代谢异常、腹型肥胖的比例更高。

而且,亚洲人往往在相对年轻、偏瘦时患糖尿病。这些亚洲人特异的糖尿病表型与糖尿病预后不佳以及酮症酸中毒、肾衰竭等并发症发生风险高有关。

因此,亚洲人群亟需开展并严格实施“量体裁衣式”的糖尿病管理项目,根据多因素综合干预,着重关注女性、年轻、偏瘦的糖尿病患者。

该研究纳入的22项亚洲前瞻性队列研究均加入亚洲队列联盟,至少随访3年,覆盖中国(包括中国大陆和台湾地区)、日本、朝鲜、韩国、新加坡、印度、孟加拉国。受试者平均年龄为54岁。中位随访12.6年期间,近15万人死亡。

原始出处:Yang JJ, Yu D, Wen W, et al. Association of Diabetes With All-Cause and Cause-Specific Mortality in Asia: A Pooled Analysis of More Than 1 Million Participants. JAMA Netw Open. 2019 Apr 5;2(4):e192696. 

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    2019-11-26 feather89
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    2019-11-27 canlab
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    2019-05-17 daviiliu
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    2019-05-16 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2019-05-16 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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