Wang Jing, Huang Yifang, Zhu Qiuli, Huang Chen, Lin Ruilang, Peng Yuwei, Jiang Zixuan, Tang Dongxu, Yao Ye, Zheng Xueying, Qin Guoyou, Chen Jiaohua
Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032 China; Department of Biostatistics, NHC Key Laboratory for Health Technology Assessment, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032 China.
Healthcare-associated Infection Prevention and Control Office, Shanghai General Hospital, Address: No. 100 Haining Road, Hongkou District, Shanghai, China.
Brain Behav Immun. 2025 May;126:30-37. doi: 10.1016/j.bbi.2025.01.027. Epub 2025 Feb 4.
Previous evidence suggests that infectious diseases may contribute to the development of neurodegenerative diseases (NDDs) while individuals with hyperglycemia may be at increased risk for both infection and NDDs due to dysregulated inflammation levels. This study aimed to examine the association between hospital-treated infectious diseases and the risk of NDDs among patients with prediabetes and diabetes and whether the associations differed by the number of infections and potential effect modifiers.
Using data from the UK Biobank, we conducted a prospective study involving 69,731 individuals, consisting of 48,149 participants with prediabetes and 21,582 participants with diabetes. Hospital-treated infectious diseases and NDDs were identified through record linkage to Health Episode Statistics and the Scottish Morbidity Records. Cox regression models were applied to assess the association between hospital-treated infectious diseases and the risk of developing NDDs, and to evaluate the trend of this association in relation to the number of infections. The modification effects by age, sex, smoking status, alcohol consumption, sleep duration, body mass index (BMI), glycated hemoglobin (HbA) levels, comorbidities, and diabetes medication use were investigated.
Over a median follow-up of 10.75 years, 1,867 participants (2.57 per 1,000 person-years) were diagnosed with NDDs. We found hospital-treated infectious diseases were significantly associated with an increased risk of NDDs among both individuals with prediabetes or diabetes (adjusted HR [aHR] 3.11, 95 % CI 2.83-3.42). Specifically, hospital-treated infectious diseases were associated with a higher risk of developing Alzheimer's disease, vascular dementia, all-cause dementia, Parkinson's disease, and multiple sclerosis. Moreover, a greater number of infection diagnoses was associated with a higher risk of NDDs. Consistent associations between infection and an increased risk of NDDs were observed, regardless of factors representing age, sex, lifestyle, and diabetes severity.
Hospital-treated infectious diseases were significantly associated with the risk of NDDs in individuals with diabetes and prediabetes, with similar associations observed for bacterial and viral infections. These findings emphasize the importance of implementing infection prevention strategies and monitoring of infectious comorbidities in the management of NDDs among patients with prediabetes and diabetes.
先前的证据表明，传染病可能会促使神经退行性疾病（NDDs）的发展，而高血糖个体可能因炎症水平失调而增加感染和患神经退行性疾病的风险。本研究旨在探讨医院治疗的传染病与糖尿病前期和糖尿病患者患神经退行性疾病风险之间的关联，以及这种关联是否因感染次数和潜在效应修饰因素而异。
利用英国生物银行的数据，我们进行了一项前瞻性研究，涉及69731名个体，其中包括48149名糖尿病前期参与者和21582名糖尿病参与者。通过与健康事件统计数据和苏格兰发病率记录的记录链接来确定医院治疗的传染病和神经退行性疾病。应用Cox回归模型评估医院治疗的传染病与患神经退行性疾病风险之间的关联，并评估这种关联与感染次数的趋势。研究了年龄、性别、吸烟状况、饮酒、睡眠时间、体重指数（BMI）、糖化血红蛋白（HbA）水平、合并症和糖尿病药物使用的修饰作用。
在中位随访10.75年期间，1867名参与者（每1000人年2.57人）被诊断患有神经退行性疾病。我们发现，医院治疗的传染病与糖尿病前期或糖尿病个体患神经退行性疾病的风险显著增加相关（调整后风险比[aHR] 3.11，95%置信区间2.83-3.42）。具体而言，医院治疗的传染病与患阿尔茨海默病、血管性痴呆、全因痴呆、帕金森病和多发性硬化症的风险较高相关。此外，更多的感染诊断与患神经退行性疾病的风险较高相关。无论代表年龄、性别、生活方式和糖尿病严重程度的因素如何，均观察到感染与神经退行性疾病风险增加之间存在一致的关联。
医院治疗的传染病与糖尿病前期和糖尿病个体患神经退行性疾病的风险显著相关，细菌和病毒感染的关联相似。这些发现强调了在糖尿病前期和糖尿病患者的神经退行性疾病管理中实施感染预防策略和监测感染合并症的重要性。
