Niebuhr David W, Chen Ligong, Shao Stephanie, Goldsmith Jonathan, Byrne Celia, Singer Darrell E
Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 4494 North Palmer Road, Bethesda, MD.
Mil Med. 2018 Nov 1;183(11-12):e735-e740. doi: 10.1093/milmed/usy125.
Sickle cell trait (SCT), the heterozygous carrier state for hemoglobin S, is present in an estimated 1.6% of all newborns and 7.3% in black individuals in the USA. SCT has long been considered a benign condition with anticipated normal life expectancy and no increased risk for chronic diseases. The medical literature is inconclusive on the potential association between SCT and chronic medical conditions (CMC) including chronic kidney disease, venous thromboembolism, and stroke. Studies addressing these questions are lacking particularly in non-Black young adults.
We conducted a retrospective cohort study among U.S. active duty, enlisted, service members who entered from 1992 to 2012 using existing Department of Defense (DoD Military Healthcare System databases). SCT positive subjects (1,323) were matched by demographic characteristics to SCT negative subjects (3,136) and followed through 2013 for CMC that included deep vein thrombosis, diabetes mellitus and hematologic, pulmonary, and renal conditions.
The rate of developing any of the included CMC was higher for those with SCT (incidence rate ratio = 1.71 95% CI 1.61-1.81) compared with those who were SCT negative and their healthcare utilization rate for any of CMC studied was higher for SCT positive compared with negative individuals (URR = 2.45 95% CI 2.41-2.50), with the highest rate ratios observed for hematologic and renal conditions. SCT positive compared with negative individuals were more likely to have encounter diagnoses of sickle cell disease and diabetes Type II and were less likely to have encounter diagnoses of other hemoglobinopathies and diabetes type I.
SCT in these racially diverse, young adults increased both the incidence of and healthcare utilization for thromboembolism, diabetes mellitus type II, sickle cell disease, pulmonary, and chronic renal conditions. These findings suggest that clinicians treating young adults with SCT should exercise heightened surveillance for these CMC to ensure both early diagnosis and access to treatments.
镰状细胞性状（SCT）是血红蛋白S的杂合子携带状态，在美国估计所有新生儿中有1.6%存在该性状，黑人个体中有7.3%存在。长期以来，SCT一直被认为是一种良性状况，预期寿命正常，患慢性病的风险也不会增加。医学文献对于SCT与包括慢性肾病、静脉血栓栓塞和中风在内的慢性疾病（CMC）之间的潜在关联尚无定论。尤其在非黑人青年成年人中，缺乏针对这些问题的研究。
我们利用现有的国防部军事医疗系统数据库，对1992年至2012年入伍的美国现役军人进行了一项回顾性队列研究。将SCT阳性受试者（1323名）按人口统计学特征与SCT阴性受试者（3136名）进行匹配，并随访至2013年，观察包括深静脉血栓形成、糖尿病以及血液、肺部和肾脏疾病在内的慢性疾病。
与SCT阴性者相比，SCT阳性者发生任何一种所纳入慢性疾病的几率更高（发病率比=1.71，95%置信区间1.61 - 1.81），且SCT阳性者针对所研究的任何一种慢性疾病的医疗利用率高于阴性个体（利用率比=2.45，95%置信区间2.41 - 2.50），血液和肾脏疾病的发病率比最高。与阴性个体相比，SCT阳性个体更有可能被诊断为镰状细胞病和II型糖尿病，而被诊断为其他血红蛋白病和I型糖尿病的可能性较小。
在这些种族多样的青年成年人中，SCT增加了血栓栓塞、II型糖尿病、镰状细胞病、肺部和慢性肾脏疾病的发病率以及医疗利用率。这些发现表明，治疗患有SCT的青年成年人的临床医生应加强对这些慢性疾病的监测，以确保早期诊断和获得治疗。
