安雅莉：中国DM患者中风发病率和病死率高

虽然在中国，中风是导致死亡的主要原因之一，且中国糖尿病和糖耐量异常（IGT）人群数量庞大，并日渐增加。但在中国糖尿病和IGT成年人，由中风引起的死亡风险尚未被量化。来自中国医学科学院阜外医院的安雅莉博士及其团队进行了一项研究，该研究发现在中国，糖尿病和IGT导致相当大的额外中风风险，以及相当大的由中风引起的超额死亡率。糖尿病或IGT患者面对中风发病率较高和中风后病死率较高的双重危险。

该研究在1986年中国大庆筛查50%年龄25岁及其以上社区居民中最初被确认的630例新诊断糖尿病（NDM）、576例IGT和519例正常糖耐量（NGT）组成的队列中，在长达23年随访期间，调查中风发病率及相关的死亡率。直到2009年12月31日，在大约95%的队列中发现中风发病率及相关死亡率。

在218例（36.8%）NDM、177例（32.7）IGT、以及121例（24.6%）NGT中出现致命性中风和非致命性中风。在NDM（29.0 vs 18.5/1000人年）和IGT（22.1 vs 13.7/1000人年），而不是NGT（12.9 vs 11.4/1000人年），男性的中风发病率高于女性。NDM对NGT的年龄校正风险比在男性为2.15（95%CI 1.67-3.69），在女性为1.47（95%CI 1.05-2.08）。

在这些发生中风的人群中，145例（66.5%）NDM患者、82例（46.3%）IGT、和36例（29.8%）NGT发生中风死亡。NDM的中风病死率（每1000人年）在男性为130.6，在女性为153.9；IGT的中风病死率在男性为95.5，在女性为56.7，NGT的中风病死率在男性为56.4，在女性为46.6。NDM对NGT的年龄和性别校正病死率为2.42（95%CI 1.67-3.69），而IGT对NGT的年龄和性别校正病死率为1.54（95%CI 1.04-2.39）。

该研究发现，在中国，糖尿病和IGT导致相当大的额外中风风险，以及相当大的由中风引起的超额死亡率。糖尿病或IGT患者面对中风发病率较高和中风后病死率较高的双重危险。

While stroke is a leading cause of death in China and the numbers of persons with diabetes and impaired glucose tolerance (IGT) are large and growing the incidence and risk of death attributable to stroke among Chinese adults with these conditions have not previously been quantified.

We examined incidence of stroke and related mortality over a 23 year period in a cohort of 630 persons with newly diagnosed diabetes (NDM) 576 with IGT and 519 with normal glucose tolerance (NGT) who were identified initially in 1986 by screening 50% of the community aged 25 years and over in Da Qing China. Stroke incidence and related mortality were ascertained up to December 31st 2009 in some 95% of the cohort.

Stroke fatal or non-fatal occurred in 218 (36.8%) persons with NDM 177 (32.7%) with IGT and 121 (24.6%) with NGT. Stroke incidence was higher in men than in women with NDM (29.0 vs. 18.5/1000 person-years) and IGT (22.1 vs. 13.7/1000 person-years) but not with NGT (12.9 vs. 11.4/1000 person-years). The age-adjusted hazard ratios for NDM vs. NGT were 2.15 (95% CI 1.59-2.92) in men and 1.47(95% CI 1.05-2.08) in women.

Among those who developed a stroke death occurred in 145 (66.5%) with NDM 82 (46.3%) with IGT and 36 (29.8%) with NGT. Case-fatality rates from stroke (per 1000 person-years) were 130.6 in men and 153.9 in women with NDM 95.5 and 56.7 in men and women with IGT and 56.4 and 46.6 in men and women with NGT. Age- and sex- adjusted case-fatality rate ratios were 2.42 (95% CI 1.67-3.69) for NDM vs. NGT and 1.54 (95% CI 1.04-2.29) for IGT vs. NGT.

In Chinadiabetes and IGT lead to considerable excess risk for strokeand excess mortality due to stroke. Persons with diabetes or IGT face double jeopardy by having both a higher stroke incidence and a higher case-fatality rate after a stroke.

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