糖尿病与腹主动脉瘤患者破裂风险无关——来自 1996 年至 2016 年丹麦大型基于登记的匹配病例对照研究的结果。
Diabetes Is Not Associated with the Risk of Rupture Among Patients with Abdominal Aortic Aneurysms - Results From a Large Danish Register Based Matched Case Control Study From 1996 to 2016.
机构信息
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense University Hospital, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; The Danish Diabetes Academy, Odense University Hospital, Odense C, Denmark.
Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense University Hospital, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
出版信息
Eur J Vasc Endovasc Surg. 2020 Jul;60(1):36-42. doi: 10.1016/j.ejvs.2020.02.020. Epub 2020 Apr 3.
OBJECTIVE
Numerous studies have shown a paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysm (AAA). The aim of this study was to investigate whether the protective role of diabetes on AAA extends to rupture, given the presence of an AAA.
METHODS
This was a register based case control study. Patients with ruptured AAA (RAAA) were matched 1:1 with patients undergoing elective surgery for AAA by sex, age, and year of diagnosis. Multiple conditional logistic regression was performed to estimate the odds ratio (OR) associating a diagnosis of diabetes with RAAA. No protocol was registered.
RESULTS
From 1996 to 2016, there were 6293 potential people with RAAA. A total of 898 people with a RAAA were excluded since no matching controls existed. This left 5 395 cases in the study. The cases had a median age of 75, and 85.4% were men. Diabetes was defined by hospital diagnosis or the redemption of antidiabetic prescriptions within one year. Comparing cases with controls and the presence of diabetes, a significant crude OR of 0.82 (95% confidence interval [CI] 0.71-0.95) was found. When adjusting for confounders OR increased to 0.97 (CI 0.83-1.14). Stratifying by age and year of diagnosis did not change the results markedly. OR associating RAAA with diabetes was significantly elevated in women (adjusted OR 1.82 [CI 1.17-2.81]). Of the 5395 cases, the overall 30 days mortality was 58% (n = 3145). Using Cox regression, a crude hazard ratio (HR) of 1.06 (CI 0.93-1.22) was found for the 30 day mortality and having diabetes compared with not having diabetes. Adjusting for index year, male sex, and age had little effect on this estimate (HR 1.11 [CI 0.97-1.28]).
CONCLUSION
Diabetes was not found to protect against RAAA, given the presence of an AAA. Furthermore, diabetes did not increase the risk of dying within 30 days of RAAA.
目的
大量研究表明糖尿病对腹主动脉瘤（AAA）的发展和进展具有矛盾的保护作用。本研究旨在探讨在存在 AAA 的情况下，糖尿病对 AAA 破裂的保护作用是否延伸。
方法
这是一项基于登记的病例对照研究。通过性别、年龄和诊断年份，将破裂性腹主动脉瘤（RAAA）患者与接受择期 AAA 手术的患者 1:1 匹配。采用多条件逻辑回归估计诊断为糖尿病与 RAAA 相关的优势比（OR）。本研究未注册协议。
结果
1996 年至 2016 年期间，共有 6293 名 RAAA 的潜在患者。由于没有匹配的对照，共有 898 名 RAAA 患者被排除在外，因此本研究共有 5395 例病例。病例的中位年龄为 75 岁，85.4%为男性。糖尿病通过医院诊断或一年内抗糖尿病处方的使用来定义。与对照组相比，患有糖尿病的患者的未校正 OR 为 0.82（95%置信区间 [CI] 0.71-0.95）。调整混杂因素后，OR 增加到 0.97（CI 0.83-1.14）。按年龄和诊断年份分层并没有显著改变结果。在女性中，与 RAAA 相关的糖尿病的 OR 明显升高（调整后的 OR 为 1.82 [CI 1.17-2.81]）。在 5395 例病例中，总体 30 天死亡率为 58%（n=3145）。使用 Cox 回归，与无糖尿病相比，30 天死亡率和患有糖尿病的患者的未校正危险比（HR）为 1.06（CI 0.93-1.22）。调整指数年、男性性别和年龄对该估计值的影响很小（HR 为 1.11 [CI 0.97-1.28]）。
结论
在存在 AAA 的情况下，糖尿病并未发现可预防 RAAA。此外，糖尿病并未增加 RAAA 后 30 天内死亡的风险。
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