Chen Yin-Huei, Lin Cheng-Li, Bau Da-Tian, Hung Yi-Chih
Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
BMJ Open. 2017 Jun 19;7(6):e015795. doi: 10.1136/bmjopen-2016-015795.
In accordance with the dichotomy between T helper type 1(Th1) and T helper type 2 (Th2) responses, the occurrence of allergic conjunctivitis (AC) and type 1 diabetes mellitus (T1DM) is, in theory, inversely related in the individual. However, recent studies investigating the association between the two diseases are controversial.
Population-based cohort study.
We used claims data of the National Health Insurance Research Database of Taiwan.
We identified 4160 patients aged 1-30 years with newly diagnosed T1DM and no history of AC at baseline. For each patient with T1DM, four non-T1DM controls (n=16,640) were matched by sex. The mean follow-up time was 6 years.
Multivariate Cox proportional hazards regression analysis was used to evaluate the risk of AC. We additionally evaluated the association between risk of AC and T1DM progression by examining Diabetes Complications Severity Index (aDCSI) changes from the date of diagnosis until the end of follow-up.
The overall incidence of allergic conjunctivitis (AC) was higher in the type 1 diabetes mellitus (T1DM) cohort than in the control cohort (23.0 vs 13.5 per 1000 person-years, adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.47 to 1.71). Relative to that in patients with mildly progressive T1DM, the risk of AC increased as the adapted Diabetes Complications Severity Index (aDCSI) increased (aIRR: 1.68, 3.78 and 18.8, with yearly changes in aDCSI score: 0.51 to 1.00, 1.01 to 2.00, and >2.00 vs <0.51, respectively; for trend <0.001).
Patients with T1DM are at an elevated risk of developing AC; this risk increases with T1DM progression. The T helper type 1/T helper type 2 hypothesis is an overly simplistic explanation for this association.
根据1型辅助性T细胞（Th1）和2型辅助性T细胞（Th2）反应之间的二分法，理论上，过敏性结膜炎（AC）和1型糖尿病（T1DM）在个体中的发生呈负相关。然而，最近关于这两种疾病之间关联的研究存在争议。
基于人群的队列研究。
我们使用了台湾国民健康保险研究数据库的理赔数据。
我们确定了4160名年龄在1至30岁之间、新诊断为T1DM且基线时无AC病史的患者。对于每例T1DM患者，按性别匹配4名非T1DM对照（n = 16640）。平均随访时间为6年。
采用多变量Cox比例风险回归分析评估AC风险。我们还通过检查从诊断日期到随访结束时糖尿病并发症严重程度指数（aDCSI）的变化，评估了AC风险与T1DM进展之间的关联。
1型糖尿病（T1DM）队列中过敏性结膜炎（AC）的总体发病率高于对照队列（每1000人年分别为23.0和13.5，调整发病率比（aIRR）：1.59，95%可信区间1.47至1.71）。相对于轻度进展性T1DM患者，随着适应性糖尿病并发症严重程度指数（aDCSI）增加，AC风险升高（aIRR分别为1.68、3.78和18.8，aDCSI评分年变化分别为0.51至1.00、1.01至2.00和>2.00，对比<0.51；趋势P<0.001）。
T1DM患者发生AC的风险升高；该风险随T1DM进展而增加。Th1/Th2假说对这种关联的解释过于简单。
