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糖尿病、糖尿病前期和糖尿病病程与慢性阻塞性肺疾病风险的关联:一项英国生物银行的前瞻性研究。

Associations of diabetes, prediabetes and diabetes duration with the risk of chronic obstructive pulmonary disease: A prospective UK Biobank study.

机构信息

Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.

Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.

出版信息

Diabetes Obes Metab. 2023 Sep;25(9):2575-2585. doi: 10.1111/dom.15142. Epub 2023 May 29.

Abstract

AIM

To investigate the associations of diabetes, prediabetes and diabetes duration with chronic obstructive pulmonary disease (COPD) risk and survival in the UK Biobank.

MATERIALS AND METHODS

We conducted a prospective analysis among 452 680 participants without COPD at baseline using UK Biobank data. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. The dose-response relationship was explored using restricted cubic splines. A separate survival analysis was conducted for 12 595 patients with incident COPD.

RESULTS

Over a median follow-up of 12.3 years, 12 595 cases of COPD were documented. Compared with the reference group, those with prediabetes and diabetes were associated with an 18% (HR 1.18 [95% CI: 1.13-1.24]) and 35% (HR 1.35 [95% CI: 1.24-1.47]) higher risk of COPD, respectively. Diabetes duration was associated with COPD risk, with multivariable HRs (95% CIs) of 1.23 (1.05-1.44), 1.20 (1.04-1.39) and 1.18 (1.01-1.37) for diabetes duration of 7 years or longer, 3 to less than 7 years, and 1 to less than 3 years versus less than 1 year, respectively. Dose-response analysis revealed a non-linear relationship between diabetes duration and COPD risk. Regarding COPD survival, COPD patients with prediabetes and diabetes had a 9% (HR 1.09 [95% CI: 1.00-1.19]) and 21% (HR 1.21 [95% CI: 1.05-1.41]) higher risk of overall death, respectively. Compared with the cases with a diabetes duration of less than 1 year, those with a diabetes duration of 7 years or longer were associated with a 46% higher risk of overall death (HR 1.46 [95% CI: 1.11-1.92]).

CONCLUSIONS

Our findings indicate that diabetes, prediabetes and a longer diabetes duration are associated with a higher risk of and worse survival for COPD. Future studies are warranted to determine the optimal way of diabetes control that might reduce COPD risk.

摘要

目的

在英国生物库中,研究糖尿病、糖尿病前期和糖尿病病程与慢性阻塞性肺疾病(COPD)风险和生存的关系。

材料与方法

我们使用英国生物库的数据,对基线时无 COPD 的 452680 名参与者进行了前瞻性分析。采用 Cox 回归模型估计多变量调整后的风险比(HR)和 95%置信区间(CI)。采用限制性立方样条法探讨剂量-反应关系。对 12595 例新发 COPD 患者进行了单独的生存分析。

结果

在中位随访 12.3 年期间,共记录了 12595 例 COPD 病例。与参考组相比,糖尿病前期和糖尿病患者患 COPD 的风险分别增加了 18%(HR 1.18 [95%CI:1.13-1.24])和 35%(HR 1.35 [95%CI:1.24-1.47])。糖尿病病程与 COPD 风险相关,病程 7 年或以上、3 至少于 7 年和 1 至少于 3 年的多变量 HR(95%CI)分别为 1.23(1.05-1.44)、1.20(1.04-1.39)和 1.18(1.01-1.37),而病程少于 1 年的 HR 为 1.00。与病程少于 1 年的患者相比,病程 7 年或更长的患者全因死亡风险增加 46%(HR 1.46 [95%CI:1.11-1.92])。

结论

我们的研究结果表明,糖尿病、糖尿病前期和较长的糖尿病病程与 COPD 的风险增加和预后较差相关。需要进一步的研究来确定可能降低 COPD 风险的糖尿病控制的最佳方法。

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