MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK.
Diabetes Care. 2010 Feb;33(2):311-6. doi: 10.2337/dc09-1215. Epub 2009 Nov 16.
Diabetes is increasingly common in cystic fibrosis, but little information describing its influence on mortality exists. Using national U.K. data, in this study we document diabetes-specific mortality rates, estimate the impact of diabetes on survival, and estimate population-attributable fractions.
This retrospective cohort study identified 8,029 individuals aged 0-65 years from the U.K. Cystic Fibrosis Registry (1996-2005). A total of 5,892 patients were included in analyses of mortality rates, and 4,234 were included in analyses of risk factors. We calculated age-adjusted mortality rates using Poisson regression, standardized mortality ratios using the population of England and Wales, and relative risks using proportional hazards modeling.
During 17,672 person-years of follow-up, 393 subjects died. The age-adjusted mortality rate was 1.8 per 100 person-years (95% CI 1.6-2.0). The age-adjusted mortality rates per 100 person-years were 2.0 (1.8-2.4) in female subjects and 1.6 (1.4-1.9) in male subjects, and 4.2 (3.4-5.1) in individuals with diabetes vs. 1.5 (1.3-1.7) in those without diabetes. Independent risk factors for death included diabetes (hazard ratio 1.31 [95% CI 1.03-1.67], female sex (1.71 [1.36-2.14]) plus poorer pulmonary function, lower BMI, Burkholderia cepacia infection, absence of Staphylococcus aureus infection, allergic bronchopulmonary aspergillosis, liver disease, prior organ transplantation, and corticosteroid use.
Individuals with cystic fibrosis die earlier if they have diabetes, which, if delayed or better treated, might reasonably extend survival; this hypothesis merits testing.
糖尿病在囊性纤维化中越来越常见，但关于其对死亡率影响的信息很少。使用英国全国数据，本研究记录了糖尿病特异性死亡率，估计了糖尿病对生存的影响，并估计了人群归因分数。
这是一项回顾性队列研究，从英国囊性纤维化登记处（1996-2005 年）中确定了 8029 名 0-65 岁的个体。共有 5892 名患者纳入死亡率分析，4234 名患者纳入危险因素分析。我们使用泊松回归计算年龄调整死亡率，使用英格兰和威尔士人口计算标准化死亡率比，使用比例风险模型计算相对风险。
在 17672 人年的随访期间，有 393 名患者死亡。年龄调整死亡率为 1.8/100 人年（95%CI 1.6-2.0）。年龄调整死亡率/100 人年分别为女性患者 2.0（1.8-2.4）和男性患者 1.6（1.4-1.9），糖尿病患者 4.2（3.4-5.1），无糖尿病患者 1.5（1.3-1.7）。死亡的独立危险因素包括糖尿病（危险比 1.31[95%CI 1.03-1.67]）、女性（1.71[1.36-2.14]）、加上更差的肺功能、较低的 BMI、洋葱伯克霍尔德菌感染、无金黄色葡萄球菌感染、过敏性支气管曲霉病、肝病、既往器官移植和皮质类固醇使用。
如果囊性纤维化患者患有糖尿病，他们会更早死亡，如果糖尿病得到延迟或更好的治疗，可能会合理地延长生存时间；这一假设值得进一步验证。
