Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Clalit Health Services, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Diabetes Care. 2019 Apr;42(4):682-688. doi: 10.2337/dc18-2472. Epub 2019 Feb 6.
To examine the association of diabetes and glycated hemoglobin (HbA) with the risk of intracerebral hemorrhage (ICH) in a large population-based cohort.
The computerized database of the largest health care provider in Israel was used to identify adult members aged 40 years or older and alive at 1 January 2010 (297,486 with diabetes and 1,167,585 without diabetes). The cohort was followed until 31 December 2017 for incidence of ICH. Multivariable Cox proportional hazards regression models, adjusted for baseline disease risk score, were applied to estimate the hazard ratio (HR) of ICH.
Overall 4,170 ICH cases occurred during 10,730,915 person-years of follow-up. Diabetes was independently associated with increased ICH risk, with hazard ratio (HR) 1.36 (95% CI 1.27-1.45), and increased with longer diabetes duration: 1.23 (1.12-1.35) and 1.44 (1.34-1.56) for diabetes duration ≤5 years and >5 years, respectively. The increased ICH risk associated with diabetes was more pronounced in patients ≤60 years old ( <0.001). Among patients with diabetes, HbA had a nonlinear J-shaped relationship with ICH ( for nonlinearity = 0.0186). Compared to the fourth HbA decile, 6.5-6.7% (48-50 mmol/mol), the HR for ICH was 1.27 (1.01-1.59) and 2.19 (1.75-2.73) in the lowest HbA decile, ≤6.0% (≤42 mmol/mol), and highest HbA decile, >9.3% (>78 mmol/mol), respectively.
Diabetes is associated with increased risk of ICH that is directly associated with diabetes duration. ICH and HbA appear to have a J-shaped relationship, suggesting that both poor control as well as extreme intensive diabetes control might be associated with increased risk.
在一个大型基于人群的队列中，研究糖尿病和糖化血红蛋白（HbA）与脑出血（ICH）风险的相关性。
利用以色列最大医疗服务提供商的计算机数据库，确定 2010 年 1 月 1 日年龄在 40 岁或以上且存活的成年成员（297486 例糖尿病患者和 1167585 例非糖尿病患者）。该队列在 2017 年 12 月 31 日前随访ICH 的发病情况。应用多变量 Cox 比例风险回归模型，根据基线疾病风险评分进行调整，以估计 ICH 的风险比（HR）。
在 10730915 人年的随访中，共发生 4170 例 ICH 病例。糖尿病与 ICH 风险增加独立相关，HR 为 1.36（95%CI 1.27-1.45），且随着糖尿病病程的延长而增加：病程≤5 年和>5 年时，HR 分别为 1.23（1.12-1.35）和 1.44（1.34-1.56）。糖尿病患者中，HbA 与 ICH 呈非线性 J 型关系（非线性性=0.0186）。与第 4 个 HbA 百分位相比，HbA 为 6.5-6.7%（48-50mmol/mol）时，ICH 的 HR 为 1.27（1.01-1.59），最低 HbA 百分位（≤6.0%，≤42mmol/mol）和最高 HbA 百分位（>9.3%，>78mmol/mol）时，HR 分别为 2.19（1.75-2.73）。
糖尿病与 ICH 风险增加相关，ICH 与糖尿病病程直接相关。ICH 和 HbA 之间似乎存在 J 型关系，提示血糖控制不佳和血糖控制过度强化都可能与风险增加有关。
