Mühlhauser I, Bender R, Bott U, Jörgens V, Grüsser M, Wagener W, Overmann H, Berger M
Department of Nutrition and Metabolic Diseases, Heinrich-Heine University, Düsseldorf, Germany.
Diabet Med. 1996 Jun;13(6):536-43. doi: 10.1002/(SICI)1096-9136(199606)13:6<536::AID-DIA110>3.0.CO;2-J.
The objective of the present study was to analyse the association between cigarette smoking and progression of retinopathy and nephropathy, respectively, in a prospective multicentre study including 636 people with Type 1 diabetes: 81% of the original cohort of consecutively referred patients, aged 15 to 40 years and free of severe late diabetic complications. At baseline, all patients had participated in a 5-day in-patient group treatment and teaching programme for intensification of insulin therapy. Patients were examined at recruitment, and after 1, 2, 3 and 6 years including assessment of smoking status, blood pressure, metabolic control, and degree of nephropathy. Degree of retinopathy was assessed by ophthalmoscopy or fundus photography at baseline and after 6 years. Several logistic regression analyses were performed by describing the responses retinopathy and nephropathy, respectively, either as progression yes/no or as actual status at the 6-year follow-up and by using different measures for smoking. Adjustments for important covariables were made. While significant associations between smoking, and retinopathy and nephropathy respectively, were found, the relations were variable depending on the statistical model used. The results show that the real associations between smoking and retinopathy and nephropathy are complex and that more emphasis should be put on the complete description of the response variables and the statistical models used in clinical and epidemiological research.
本研究的目的是在一项前瞻性多中心研究中，分析吸烟与视网膜病变和肾病进展之间的关联。该研究纳入了636例1型糖尿病患者，占连续转诊患者原队列的81%，年龄在15至40岁之间，且无严重的晚期糖尿病并发症。在基线时，所有患者都参加了为期5天的住院小组治疗和强化胰岛素治疗教学计划。患者在招募时以及1、2、3和6年后接受检查，包括评估吸烟状况、血压、代谢控制和肾病程度。在基线和6年后通过检眼镜检查或眼底摄影评估视网膜病变程度。通过分别将视网膜病变和肾病的反应描述为进展/无进展或6年随访时的实际状况，并使用不同的吸烟测量方法，进行了多项逻辑回归分析。对重要的协变量进行了调整。虽然分别发现了吸烟与视网膜病变和肾病之间的显著关联，但这些关系因所使用的统计模型而异。结果表明，吸烟与视网膜病变和肾病之间的实际关联很复杂，临床和流行病学研究应更加强调对反应变量和所使用统计模型的完整描述。
