Sasaki A, Uehara M, Horiuchi N, Hasegawa K, Shimizu T
Osaka Seijinbyo Center, A Medical Institute for Noncommunicable Diseases, Japan.
Diabetes Res Clin Pract. 1996 Sep;34(1):47-55. doi: 10.1016/s0168-8227(96)01329-0.
A 15 year follow-up study of diabetic patients was performed in Osaka, Japan. The subjects studied were 1939 patients with non-insulin dependent diabetes mellitus (NIDDM), of whom 1000 (51.5%) were alive, 880 (45.4%) had died and 59 (3.0%) were untraceable at the end of 1993. The mortality rate per 1000 person-years of the subjects increased from 28.94 in 1960-1984 to 35.74 in 1985-1993, but the ratio of numbers of observed to expected deaths (O/E ratio) declined from 1.77 to 1.52 for the corresponding periods, suggesting an improvement in the prognosis for diabetic patients, with the exception of patients 65 years or over at the time of entry. Cerebro-cardiovascular and renal diseases were major causes of death, accounting for 48.4% of all deaths. In particular, disease of the heart was the cause of death in 20.5% of all deaths, cerebrovascular disease in 14.5% and renal disease in 12.0%. The O/E ratio was 11.30 for renal disease, which was remarkably high. The O/E ratios were 1.48 for malignant neoplasms, 3.02 for cancer of the liver and 2.15 for cancer of the pancreas. In the subjects less than 65 years of age at entry, a significant decrease in the O/E ratio for overall deaths, malignant neoplasms, disease of the heart, cerebrovascular disease and renal disease was observed, but no notable difference in the O/E ratio for ischemic heart disease was found between the periods 1960-1984 and 1985-1993. By contrast, in the case of subjects 65 years or more at entry, the O/E ratios for overall deaths, malignant neoplasms, disease of the heart, ischemic heart disease and cerebrovascular disease increased markedly in the later period, while there was a considerable decline in renal disease indicated during this period. The analysis suggested a structural change in causes of death of Japanese diabetic patients in recent years, with a relative increase in ischemic heart disease and a relative decrease in renal disease.
在日本大阪对糖尿病患者进行了一项为期15年的随访研究。研究对象为1939例非胰岛素依赖型糖尿病（NIDDM）患者，截至1993年底，其中1000例（51.5%）存活，880例（45.4%）死亡，59例（3.0%）失访。研究对象每1000人年的死亡率从1960 - 1984年的28.94上升至1985 - 1993年的35.74，但相应时期的观察死亡数与预期死亡数之比（O/E比）从1.77降至1.52，这表明糖尿病患者的预后有所改善，但入组时年龄在65岁及以上的患者除外。心脑血管疾病和肾脏疾病是主要死因，占所有死亡人数的48.4%。特别是，心脏疾病导致所有死亡人数的20.5%，脑血管疾病导致14.5%，肾脏疾病导致12.0%。肾脏疾病的O/E比为11.30，显著高于其他疾病。恶性肿瘤的O/E比为1.48，肝癌为3.02，胰腺癌为2.15。在入组时年龄小于65岁的研究对象中，观察到总体死亡、恶性肿瘤、心脏疾病、脑血管疾病和肾脏疾病的O/E比显著下降，但1960 - 1984年和1985 - 1993年期间缺血性心脏病的O/E比没有显著差异。相比之下，对于入组时年龄在65岁及以上的研究对象，后期总体死亡、恶性肿瘤、心脏疾病、缺血性心脏病和脑血管疾病的O/E比显著上升，而在此期间肾脏疾病的O/E比则大幅下降。分析表明，近年来日本糖尿病患者死因结构发生变化，缺血性心脏病相对增加，肾脏疾病相对减少。
