脊髓损伤会增加患2型糖尿病的风险：一项基于人群的队列研究。
Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study.
作者信息
Lai Yun-Ju, Lin Cheng-Li, Chang Yen-Jung, Lin Ming-Chia, Lee Shih-Tan, Sung Fung-Chang, Lee Wen-Yuan, Kao Chia-Hung
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County 545, Taiwan.
Management Office for Health Data, China Medical University Hospital, No. 2, Yuh-Der Rd, Taichung 404, Taiwan.
出版信息
Spine J. 2014 Sep 1;14(9):1957-64. doi: 10.1016/j.spinee.2013.12.011. Epub 2013 Dec 18.
BACKGROUND CONTEXT
Previous studies on the risk and prevalence of diabetes among spinal cord injury (SCI) patients are limited and controversial.
PURPOSE
To compare the risk and incidence rate (IR) of Type 2 diabetes in SCI and non-SCI patients.
STUDY DESIGN
This is a population-based retrospective cohort study.
PATIENT SAMPLE
Data from Taiwan's National Health Insurance Research Database for the period 1997 to 2010 were analyzed. Patients aged 20 years and older newly identified with SCIs during this period were included in the SCI cohort. A non-SCI comparison cohort was randomly selected from National Health Insurance beneficiaries and matched with the SCI cohort based on age, sex, and index date.
OUTCOME MEASURES
Both cohorts were followed until the first of the following occurred: the diagnosis of Type 2 diabetes (International Classification of Disease, Ninth Revision, Clinical Modification codes 250), withdrawal from the insurance system, the end of 2010, or death.
METHODS
A Cox proportional hazards regression analysis was used to estimate the risk of developing diabetes.
RESULTS
Taiwan possesses an older SCI population, with a mean age of 51.6 years. The IR for diabetes in patients with and without SCIs was 22.1 per 10,000 person-years and 17.2 per 10,000 person-years, respectively. The adjusted hazard ratio (HR) for diabetes was 1.33 times higher in patients with SCIs than in those without SCIs. In patients with SCIs, men (adjusted HR=1.23, 95% confidence interval (CI)=1.04-1.44), older people (adjusted HR=4.26 in patients older than 65 years, 95% CI=3.16-5.74), patients with comorbidity (adjusted HR=1.36, 95% CI=1.14-1.62), and patients with a complete thoracic SCI (T-spine injury) (adjusted HR=2.13, 95% CI=0.95-4.79) were more likely to be diagnosed with diabetes than other patient subgroups.
CONCLUSIONS
Our findings may facilitate the prioritizing of preventive health strategies and planning of long-term care for SCI patients.
背景信息
先前关于脊髓损伤（SCI）患者中糖尿病风险和患病率的研究有限且存在争议。
目的
比较SCI患者和非SCI患者患2型糖尿病的风险和发病率（IR）。
研究设计
这是一项基于人群的回顾性队列研究。
患者样本
分析了台湾国民健康保险研究数据库1997年至2010年期间的数据。在此期间新确诊为SCI的20岁及以上患者被纳入SCI队列。从国民健康保险受益人中随机选取一个非SCI对照队列，并根据年龄、性别和索引日期与SCI队列进行匹配。
观察指标
两个队列均随访至以下情况首次出现：2型糖尿病诊断（国际疾病分类第九版临床修订本编码250）、退出保险系统、2010年底或死亡。
方法
采用Cox比例风险回归分析来估计患糖尿病的风险。
结果
台湾SCI患者群体年龄较大，平均年龄为51.6岁。有和没有SCI的患者糖尿病发病率分别为每10000人年22.1例和每10000人年17.2例。SCI患者患糖尿病的调整后风险比（HR）比非SCI患者高1.33倍。在SCI患者中，男性（调整后HR = 1.23，95%置信区间（CI）= 1.04 - 1.44）、老年人（65岁以上患者调整后HR = 4.26，95% CI = 3.16 - 5.74）、合并症患者（调整后HR = 1.36，95% CI = 1.14 - 1.62）以及完全性胸段SCI（胸椎损伤）患者（调整后HR = 2.13，95% CI = 0.95 - 4.79）比其他患者亚组更易被诊断为糖尿病。
结论
我们的研究结果可能有助于确定脊髓损伤患者预防性健康策略的优先级并规划长期护理。
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