Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Diabet Med. 2019 Oct;36(10):1287-1293. doi: 10.1111/dme.13936. Epub 2019 Mar 13.
To test the hypothesis that delayed menarche is associated with an increased microvascular complication risk among women with Type 1 diabetes.
We studied the female participants of an ongoing prospective study of childhood-onset Type 1 diabetes diagnosed during the period 1950-1980. Of 325 women, we included data from 315 who had reached menarche by the study baseline (1986-1988) and who self-reported their age at menarche. Both cross-sectional and prospective analyses over the 25-year follow-up were used to assess the relationship of age at menarche with the prevalence, incidence and cumulative incidence of microvascular complications, comprising overt nephropathy, proliferative retinopathy and confirmed distal symmetric polyneuropathy.
In cross-sectional analyses at baseline, the odds of overt nephropathy increased 1.24 times (P=0.02) with each annual increase in age at menarche, and 3.2 times (P=0.009) in those with delayed menarche compared with women with normal menarche onset, after adjustment. Similarly, the cumulative incidence of overt nephropathy increased 1.16 times (P=0.01) with each older year of menarche and women with delayed menarche were at twofold increased risk of overt nephropathy (hazard ratio 2.30, P=0.001) compared with women with normal menarche onset. However, age at menarche was not significantly associated with either proliferative retinopathy or confirmed distal symmetric polyneuropathy after adjusting for covariates.
Age at menarche was significantly associated with the prevalence and cumulative incidence of overt nephropathy, but not with proliferative retinopathy or confirmed distal symmetric polyneuropathy in Type 1 diabetes. Women with delayed menarche may therefore be targeted for early screening and timely interventions to prevent the development of nephropathy.
检验以下假说，即初潮延迟与 1 型糖尿病女性微血管并发症风险增加相关。
我们研究了一项正在进行的、针对儿童期发病的 1 型糖尿病女性患者的前瞻性研究中的参与者。在 325 名女性中，我们纳入了 315 名在研究基线（1986-1988 年）前已初潮且报告了初潮年龄的女性的数据。我们采用了 25 年随访期间的横断面和前瞻性分析，以评估初潮年龄与微血管并发症（包括显性肾病、增殖性视网膜病变和已确诊的远端对称性多发性神经病）的患病率、发病率和累积发病率之间的关系。
在基线的横断面分析中，经过调整后，与正常初潮年龄的女性相比，初潮年龄每增加 1 年，显性肾病的患病风险增加 1.24 倍（P=0.02），初潮延迟的女性患病风险增加 3.2 倍（P=0.009）。同样，显性肾病的累积发病率随着初潮年龄每增加 1 岁而增加 1.16 倍（P=0.01），初潮延迟的女性发生显性肾病的风险增加两倍（风险比 2.30，P=0.001），与正常初潮年龄的女性相比。然而，在调整了协变量后，初潮年龄与增殖性视网膜病变或已确诊的远端对称性多发性神经病均无显著相关性。
初潮年龄与 1 型糖尿病女性显性肾病的患病率和累积发病率显著相关，但与增殖性视网膜病变或已确诊的远端对称性多发性神经病无关。因此，初潮延迟的女性可能需要进行早期筛查和及时干预，以预防肾病的发生。
