2 型糖尿病与心肾综合征。一项全国性的法国医院队列研究。

Type 2 diabetes and cardiorenal syndromes. A nationwide French hospital cohort study.

机构信息

Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.

Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; EA4245, T2I, Université de Tours, Tours, France; INI-CRCT, France.

出版信息

Diabetes Metab. 2023 May;49(3):101441. doi: 10.1016/j.diabet.2023.101441. Epub 2023 Mar 15.

DOI:10.1016/j.diabet.2023.101441

PMID:36931430

Abstract

AIM

Type 2 diabetes mellitus (T2DM) is a risk factor for cardiac and renal complications; its effect on cardiorenal syndromes is unknown.

METHODS

In a French nationwide cohort of 5,123,193 patients hospitalized in 2012 with ≥5 years of follow-up, we assessed the effect of T2DM on cardiorenal syndrome (CRS) (using cardiorenal, renocardiac, and simultaneous subtypes) incidence and outcomes using 1:1 propensity matching.

RESULTS

Among 4,605,236 adults without cardiorenal syndrome, 380,581 (8.5%) with T2DM were matched to 380,581 adults without T2DM. During follow-up, CRS occurred in 104,788 patients: simultaneous n = 25,225 (24.0%); cardiorenal n = 51,745 (49.4%); renocardiac n = 27,818 (26.5%). T2DM doubled the risk of incident CRS (1.30% versus 0.65%/year; adjusted hazard ratio (HR) for any cardiorenal syndrome: 2.14 [95% confidence interval 2.10;2.19]; renocardiac: 2.43 [2.34;2.53]; cardiorenal: 2.09 [2.03;2.15]; simultaneous: 1.94 [1.86;2.03]. Among the 26,396 adults with CRS in 2012, 11,355 (43.0%) had T2DM and were younger than non-diabetic adults (77.4 ± 9.5 versus 82.3 ± 10.0); 8,314 patients with T2DM were matched to 8,314 patients without. T2DM increased risk of: end-stage kidney disease, adjusted HR 1.50 [1.39;1.62]; myocardial infarction 1.35 [1.19;1.53]; cardiovascular death 1.20 [1.13;1.27]; heart failure 1.17 [1.12;1.21]; and all-cause death 1.09 [1.06;1.13], but not ischemic stroke.

CONCLUSION

Patients with T2DM represent almost half of patients with CRS and are younger than their non-diabetic counterparts. T2DM doubles the risk of CRS and increases the risk of death, cardiovascular outcome, and end-stage kidney disease but not ischemic stroke after CRS.

摘要

目的

2 型糖尿病（T2DM）是心脏和肾脏并发症的危险因素；其对心肾综合征的影响尚不清楚。

方法

在 2012 年法国全国范围内对 5123193 名至少随访 5 年的住院患者进行研究，我们使用 1:1 倾向匹配评估 T2DM 对心肾综合征（CRS）（使用心肾、肾心和同时性亚类）发病率和结局的影响。

结果

在 4605236 名无心肾综合征的成年人中，380581 名（8.5%）患有 T2DM 的患者与 380581 名无 T2DM 的成年人相匹配。在随访期间，有 104788 名患者发生 CRS：同时性 n=25225（24.0%）；心肾性 n=51745（49.4%）；肾心型 n=27818（26.5%）。T2DM 使 CRS 的发病风险增加了一倍（1.30% vs. 0.65%/年；任何心肾综合征的调整后的危险比（HR）为 2.14[95%置信区间 2.10；2.19]；肾心型：2.43[2.34；2.53]；心肾型：2.09[2.03；2.15]；同时性：1.94[1.86；2.03]）。在 2012 年有 CRS 的 26396 名成年人中，11355 名（43.0%）患有 T2DM，且比非糖尿病成年人年轻（77.4±9.5 岁 vs. 82.3±10.0 岁）；8314 名 T2DM 患者与 8314 名非 T2DM 患者相匹配。T2DM 增加了：终末期肾病的风险，调整后的 HR 为 1.50[1.39；1.62]；心肌梗死的风险 1.35[1.19；1.53]；心血管死亡的风险 1.20[1.13；1.27]；心力衰竭的风险 1.17[1.12；1.21]；全因死亡的风险 1.09[1.06；1.13]，但不包括缺血性中风。