Lo Sui-Foon, Chen Wei-Liang, Muo Chih-Hsin, Chen Pei-Chun, Chen Shih-Yin, Kuo Chih Lan, Sung Fung-Chang
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
Department of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
Front Neurol. 2018 Aug 29;9:719. doi: 10.3389/fneur.2018.00719. eCollection 2018.
Intensive glycemic control has not shown consistent findings in stroke prevention for diabetes patients, particularly for those with microvascular complications. This case-control study evaluates the risks of stroke in Asian diabetic population with microvascular complications. From the insurance claims of Taiwan, we identified 67,426 type 2 diabetic mellitus (DM) patients with newly diagnosed stroke in 2000-2011 and 134,852 randomly selected controls with DM but without stroke, matched by sex, age, and number of years since diagnosis of DM. Conditional logistic regression analysis measured crude odds ratios (OR) and adjusted odds ratio (aOR) of stroke and 95% confidence intervals (CI) for associations with demographic status, comorbidities, and microvascular complications: retinopathy (RetP), neuropathy (NeuP) or nephropathy (NepP). The aOR of stroke increased significantly associated with each complication: 1.47 with RetP, 1.73 with NeuP and 1.23 with NepP. The risk increased further when there was a combination of complications. The overall aOR of stroke was 2.83 (95% CI 2.58-3.09) for stroke patients with 3 microvascular complications. The corresponding aOR of ischemic stroke was 2.64 (95% CI 2.39-2.91) and that of hemorrhagic stroke was 4.12 (95% CI 3.25-5.22). The number of microvascular complications positively correlated to the prevalence of comorbidity ( < 0.01). This study suggests that microvascular complications are significant stroke predictors, with a greater involvement for ischemic stroke than for hemorrhagic stroke. Multiple microvascular complications interactively increase the stroke risk. Our study contributes to the identification of high-risk subjects for stroke prevention and adequate glycemic control.
强化血糖控制在糖尿病患者预防中风方面尚未显示出一致的结果，尤其是对于那些有微血管并发症的患者。本病例对照研究评估了亚洲有微血管并发症的糖尿病患者中风的风险。从台湾的保险理赔记录中，我们识别出2000年至2011年新诊断为中风的67426例2型糖尿病（DM）患者以及134852例随机选取的患有DM但未中风的对照者，这些对照者按性别、年龄和DM诊断后的年数进行匹配。条件逻辑回归分析测量了中风的粗比值比（OR）和调整后的比值比（aOR）以及与人口统计学状况、合并症和微血管并发症（视网膜病变（RetP）、神经病变（NeuP）或肾病（NepP））相关的95%置信区间（CI）。中风的aOR与每种并发症显著相关：RetP为1.47，NeuP为1.73，NepP为1.23。当出现并发症组合时，风险进一步增加。对于有3种微血管并发症的中风患者，中风的总体aOR为2.83（95%CI 2.58 - 3.09）。缺血性中风的相应aOR为2.64（95%CI 2.39 - 2.91），出血性中风的相应aOR为4.12（95%CI 3.25 - 5.22）。微血管并发症的数量与合并症的患病率呈正相关（<0.01）。本研究表明，微血管并发症是中风的重要预测因素，缺血性中风比出血性中风受累程度更大。多种微血管并发症相互作用会增加中风风险。我们的研究有助于识别中风预防的高危人群并进行适当的血糖控制。
