Silverstein J H, Gordon G, Pollock B H, Rosenbloom A L
Department of Pediatrics, University of Florida, Gainesville 32610, USA.
J Pediatr. 1998 Jun;132(6):944-7. doi: 10.1016/s0022-3476(98)70388-9.
Limited joint mobility (LJM) in childhood insulin-dependent (type 1) diabetes is associated with a substantially increased risk of microvascular complications. Cross-sectional studies have not demonstrated a relationship between LJM and metabolic control. This study was designed to determine whether glycemic control, as measured by glycohemoglobin (hgbA1C) levels from the onset of diabetes, is associated with the occurrence of LJM.
Probands (n = 18) had hgbA1C values and recorded observation of joint function from soon after onset of their diabetes. Controls (n = 40) were matched to probands for gender and age at diagnosis and had follow-up beyond the age at which the proband was found to have LJM.
The odds ratio for occurrence of LJM for the mean hgbA1C from diabetes onset was 1.46, 95% confidence limits 1.07 to 2.00. Thus, for every unit increase in average hgbA1C, there was approximately a 46% increase in the risk of LJM. When hgbA1C was dichotomized, the OR for hgbA1C of more than 8% was 2.55, and the OR was 4.54 if the hgbA1C was greater than 12%. Age at diagnosis and duration of diabetes were not independent prognostic factors for LJM.
Glycemic control from onset of diabetes is strongly associated with occurrence of LJM.
儿童胰岛素依赖型（1型）糖尿病患者的关节活动受限（LJM）与微血管并发症风险大幅增加相关。横断面研究未证实LJM与代谢控制之间存在关联。本研究旨在确定自糖尿病发病起通过糖化血红蛋白（hgbA1C）水平衡量的血糖控制是否与LJM的发生有关。
先证者（n = 18）有hgbA1C值，并记录了糖尿病发病后不久的关节功能观察情况。对照组（n = 40）在诊断时按性别和年龄与先证者匹配，并在发现先证者出现LJM的年龄之后进行随访。
糖尿病发病时平均hgbA1C水平发生LJM的比值比为1.46，95%置信区间为1.07至2.00。因此，平均hgbA1C每升高一个单位，LJM风险大约增加46%。当将hgbA1C进行二分法划分时，hgbA1C大于8%的比值比为2.55，若hgbA1C大于12%，比值比为4.54。诊断时的年龄和糖尿病病程并非LJM的独立预后因素。
糖尿病发病起的血糖控制与LJM的发生密切相关。
