Tuomilehto J, Borch-Johnsen K, Molarius A, Jormanainen V, Lounamaa R, Grönhagen-Riska C, Reunanen A, Sarti C
Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
Diabetes Care. 1997 Jul;20(7):1081-6. doi: 10.2337/diacare.20.7.1081.
Finland has the highest documented incidence of childhood IDDM in the world, but the incidence of diabetic nephropathy in Finland is unknown. The aim of the present study was to determine the incidence of hospitalization for diabetic nephropathy in a population-based cohort of Finnish IDDM patients and to analyze the prognostic effect of sex, age at diagnosis, and calendar year of diagnosis of IDDM.
We included all Finnish patients who had onset of IDDM before age 18 years, were diagnosed between January 1965 and December 1979 (n = 5,149), and were traced for hospitalizations between January 1970 and the end of December 1989 in the Hospital Discharge Register, using the unique personal identification code given to all Finnish citizens. The development of diabetic nephropathy was defined as the first hospitalization with a diagnosis of nephropathy (International Classification of Diseases-8th Revision [ICD-8] 250.04, or 9th Revision [ICD-9] 2503B/2503X).
Among the 5,149 patients included, we identified 446 cases of diabetic nephropathy. The incidence of hospitalization for diabetic nephropathy was very low during the first 8 years of diabetes duration, and after that increased to a maximum of 1.6-2.0% per year. Female subjects developed nephropathy slightly earlier than male subjects, but the cumulative risk was independent of sex. Patients diagnosed at ages 5-14 years had the highest risk of hospitalization for diabetic nephropathy. We observed no effect of calendar year of diagnosis.
We found a 20% cumulative incidence of hospitalization for diabetic nephropathy during a total 24 years of IDDM duration. This finding is compatible with the cumulative incidence of hospitalization for diabetic nephropathy found in other European populations. The incidence of hospitalization for diabetic nephropathy did not decrease during the 20-year observation period.
芬兰是世界上儿童期胰岛素依赖型糖尿病（IDDM）发病率记录最高的国家，但芬兰糖尿病肾病的发病率尚不清楚。本研究的目的是确定以人群为基础的芬兰IDDM患者队列中糖尿病肾病的住院发病率，并分析性别、诊断时年龄和IDDM诊断年份的预后影响。
我们纳入了所有18岁之前发病、在1965年1月至1979年12月期间被诊断为IDDM的芬兰患者（n = 5149），并利用赋予所有芬兰公民的唯一个人识别码，在医院出院登记处追踪他们在1970年1月至1989年12月底期间的住院情况。糖尿病肾病的发生被定义为首次因肾病诊断而住院（国际疾病分类第8版[ICD-8] 250.04，或第9版[ICD-9] 2503B/2503X）。
在纳入的5149例患者中，我们确定了446例糖尿病肾病病例。糖尿病肾病住院发病率在糖尿病病程的前8年非常低，之后每年增加到最高1.6 - 2.0%。女性患者发生肾病的时间略早于男性患者，但累积风险与性别无关。5 - 14岁诊断的患者糖尿病肾病住院风险最高。我们未观察到诊断年份的影响。
我们发现在IDDM总病程24年期间，糖尿病肾病住院的累积发病率为20%。这一发现与其他欧洲人群中发现的糖尿病肾病住院累积发病率相符。在20年的观察期内，糖尿病肾病住院发病率没有下降。
