Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Stroke Vasc Neurol. 2021 Sep;6(3):402-409. doi: 10.1136/svn-2020-000601. Epub 2021 Feb 1.
Diabetes mellitus (DM) is a common metabolic disorder with increased risk of cardiovascular and cerebrovascular complications. However, its relationship with risk of subarachnoid haemorrhage (SAH), the most devastating form of stroke, remains controversial.
To evaluate the relationship between DM and risk of SAH, we performed a retrospective cohort study using a nationwide, population-based, health screening database in Korea. We included participants without history of stroke who underwent a nationwide health screening programme between 2003 and 2004. Primary outcome was occurrence of SAH. Participants were followed up until development of SAH or December 2015. Multivariate Cox proportional hazards regression analysis was performed with adjustments for age, sex, systolic blood pressure, total cholesterol, body mass index, physical activity, smoking status, alcohol habit, household income and treatment with antihypertensive agents and statins.
Among 421 768 study participants, prevalence of DM was 9.6%. During a mean follow-up period of 11.6±1.9 years, 1039 patients developed SAH. Presence of DM was significantly associated with decreased risk of SAH (adjusted HR 0.68; 95% CI 0.53 to 0.86; p<0.001). Elevated level of fasting blood glucose was also negatively associated with risk of SAH (adjusted HR per 1 mmol/L increase 0.90; 95% CI 0.86 to 0.95; p<0.001).
DM and elevated level of fasting blood glucose were inversely associated with risk of SAH. Further studies may elucidate the possibly protective, pathophysiological role played by hyperglycaemia in patients at risk of SAH.
糖尿病（DM）是一种常见的代谢紊乱疾病，增加了心血管和脑血管并发症的风险。然而，它与蛛网膜下腔出血（SAH）的风险之间的关系，SAH 是最具破坏性的中风形式，仍然存在争议。
为了评估 DM 与 SAH 风险之间的关系，我们使用韩国全国性的基于人群的健康筛查数据库进行了一项回顾性队列研究。我们纳入了 2003 年至 2004 年间没有中风病史且参加了全国性健康筛查计划的参与者。主要结局是发生 SAH。参与者的随访时间为发生 SAH 或 2015 年 12 月。采用多变量 Cox 比例风险回归分析，调整了年龄、性别、收缩压、总胆固醇、体重指数、身体活动、吸烟状况、饮酒习惯、家庭收入以及抗高血压药物和他汀类药物的治疗情况。
在 421768 名研究参与者中，DM 的患病率为 9.6%。在平均 11.6±1.9 年的随访期间，有 1039 名患者发生了 SAH。存在 DM 与 SAH 风险降低显著相关（调整后的 HR 为 0.68；95%CI 为 0.53 至 0.86；p<0.001）。空腹血糖水平升高也与 SAH 风险呈负相关（每增加 1mmol/L，调整后的 HR 为 0.90；95%CI 为 0.86 至 0.95；p<0.001）。
DM 和空腹血糖水平升高与 SAH 风险呈负相关。进一步的研究可能阐明高血糖在处于 SAH 风险中的患者中发挥的可能具有保护作用的病理生理作用。
