Araki Atsushi, Murotani Yukari, Kamimiya Fumi, Ito Hideki
Department of Endocrinology, Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan.
J Am Geriatr Soc. 2004 Feb;52(2):205-10. doi: 10.1111/j.1532-5415.2004.52055.x.
To examine whether psychological factors are risk factors for the development of stroke in elderly diabetic patients.
Prospective cohort study.
Outpatient clinic.
Three hundred seventy-six diabetic outpatients free of stroke; mean age 75.
Well-being and diabetes-specific burden were assessed at baseline using the Philadelphia Geriatric Center morale scale and the Elderly Diabetes Burden Scale (EDBS), respectively. Symptomatic stroke was defined as a focal neurological deficit with rapid onset that persists for more than 24 hours, supported by brain computed tomography or magnetic resonance imaging.
During the 3-year follow-up period, 25 symptomatic strokes (24 ischemic strokes and 1 cerebral hemorrhage) occurred. Low scores on the morale scale (</=7) were significant predictors for stroke after adjustment for age; sex; body mass index; hemoglobin A1c level; systolic blood pressure; serum levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol; smoking; and previous ischemic heart disease (IHD) (hazard ratio (HR)=3.0, 95% confidence interval (CI)=1.2-7.3, P=.017). The relationship between low morale scores and future stroke remained significant after adjusting for socioeconomic factors and microalbuminuria. Increased symptom burden and social burden, but not dietary restrictions, worry about diabetes mellitus (DM), treatment satisfaction, and burden by tablets or insulin of EDBS, were also significant predictors for stroke after adjustment for age, sex, duration of DM, previous IHD, and microalbuminuria (HR=2.6, 95% CI=1.1-6.5, P=.039).
Low well-being and symptom burden were predictors of stroke in elderly patients with diabetes mellitus (DM), although the causal relationship remains unknown.
探讨心理因素是否为老年糖尿病患者发生中风的危险因素。
前瞻性队列研究。
门诊诊所。
376名无中风的糖尿病门诊患者；平均年龄75岁。
分别使用费城老年中心精神量表和老年糖尿病负担量表（EDBS）在基线时评估幸福感和糖尿病特异性负担。有症状性中风定义为局灶性神经功能缺损，起病迅速，持续超过24小时，并经脑部计算机断层扫描或磁共振成像证实。
在3年随访期间，发生了25例有症状性中风（24例缺血性中风和1例脑出血）。在调整年龄、性别、体重指数、糖化血红蛋白水平、收缩压、总胆固醇、甘油三酯和高密度脂蛋白胆固醇血清水平、吸烟及既往缺血性心脏病（IHD）后，精神量表得分低（≤7分）是中风的显著预测因素（风险比（HR）=3.0，95%置信区间（CI）=1.2 - 7.3，P = 0.017）。在调整社会经济因素和微量白蛋白尿后，低精神得分与未来中风之间的关系仍然显著。在调整年龄、性别、糖尿病病程、既往IHD和微量白蛋白尿后，症状负担和社会负担增加，但不是饮食限制、对糖尿病（DM）的担忧、治疗满意度以及EDBS中的片剂或胰岛素负担，也是中风的显著预测因素（HR = 2.6，95% CI = 1.1 - 6.5，P = 0.039）。
幸福感低和症状负担是老年糖尿病患者中风的预测因素，尽管因果关系尚不清楚。
