贫血及慢性肾脏病对糖尿病人群心脑血管事件发生与死亡的影响  

Impact of anemia and chronic kidney disease on the risk of cardiovascular disease and all-cause mortality among diabetic patients

作　　者：杨超 王晋伟[1] 杨尧政 白坤昊[1] 高碧霞[1] 赵明辉[1] 张路霞[1,2] 吴寿岭[3] 王芳[1] YANG Chao1 , WANG Jin-wei1 , YANG Yao-zheng1 , BAI Kun-hao1 , GAO Bi-xia1 , ZHAO Ming-hui1 , ZHANG Lu-xia1,2 , WU Shou-ling3 , WANG Fang1(1. Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; 2. Peking University, Center for Data Science in Health and Medicine, Beijing 100191, China; 3. Department of Cardiology, Kailuan Hospital Affiliated to Hebei United University, Tangshan 063000, Hebei, Chin)

机构地区：[1]北京大学第一医院肾内科,北京大学肾脏病研究所,北京100034 [2]北京大学健康医疗大数据研究中心,北京100191 [3]河北联合大学附属开深医院心内科,河北唐山063000

出　　处：《北京大学学报（医学版）》2018年第3期495-500,共6页Journal of Peking University:Health Sciences

基　　金：“十三五”国家重点研发计划(2016YFC1305400); 中国贫血临床诊疗青年医师科研基金资助

摘　　要：目的:探讨糖尿病人群中贫血与心脑血管事件发生和死亡风险的关系,并评价其关联是否受慢性肾脏病(chronic kidney disease,CKD)的影响。方法:基于开滦研究的前瞻性队列数据,收集2010—2011年符合纳入和排除标准的8 563例糖尿病患者的体检资料。末次随访时间为2015年12月31日,终点事件包括全因死亡和发生心脑血管疾病。采用Kaplan-Meier法进行生存分析,构建Cox比例风险回归模型,评估调整混杂因素后贫血及CKD与心脑血管事件发生和全因死亡的关联强度。结果:研究对象的平均年龄为(57.3±10.3)岁,其中贫血患者占5.2%。贫血患者合并CKD的比例高于非贫血患者(27.2%vs.20.8%,P=0.001)。研究对象的中位随访时间为4.9年(四分位数间距4.6~5.2年),随访期间死亡559人,发生心脑血管事件434人。贫血患者的全因死亡率高于非贫血患者(3 220.3/10万人年vs.1 257.9/10万人年,P<0.001),而贫血与非贫血两组的心脑血管疾病发病率差异无统计学意义(999.8/10万人年vs.1081.2/10万人年,P>0.05)。CKD患者的全因死亡率和心脑血管疾病的发病率都要高于非CKD患者(2 558.3/10万人年vs.1 044.0/10万人年,P<0.001;1 605.9/10万人年vs.941.6/10万人年,P<0.001)。Cox回归模型结果显示,调整混杂因素后,贫血使糖尿病患者的死亡风险增加95%(HR=1.95,95%CI:1.50~2.54),贫血合并CKD则会显著增加死亡风险(HR=3.61,95%CI:2.48~5.26),非贫血但合并CKD会使糖尿病患者发生心脑血管疾病的风险增加(HR=1.41,95%CI:1.13~1.74)。结论:中国糖尿病人群中,贫血会增加患者的死亡风险,CKD会增加患者心脑血管疾病发生和死亡的风险,贫血合并CKD则会使死亡风险显著增加,应重点加强对贫血合并CKD的糖尿病患者的防治。Objective： To explore the association between anemia and cardiovascular disease and allcause mortality among diabetic patients,and whether the association is modified by the presence of chronic kidney disease（ CKD）. Methods： Physical examination data of 8 563 patients with diabetes who met the inclusion and exclusion criteria between 2010 and 2011 were collected,based on the prospective cohort data of Kailuan study. The deadline of the follow-up was December 31,2015,and the endpoints comprised all-cause mortality and cardiovascular disease. Survival analysis was performed by KaplanMeier method. Cox proportional hazards regression model was used to assess the association between anemia with or without CKD,and cardiovascular events and all-cause mortality after adjustment for confounding factors. Results： The average age of the subjects was（ 57. 3 ± 10. 3） years,of whom the patients with anemia accounted for 5. 2%. The proportion of the patients with anemia combined with CKD was higher than that of the patients without anemia（ 27. 2% vs. 20. 8%,P = 0. 001）. The median follow-up time was 4. 9 years（ interquartile range： 4. 6-5. 2 years）. During the follow-up period,559 patients died,and 434 patients had cardiovascular disease. Compared with the patients without anemia,the allcause mortality rate of the patients with anemia was higher（ 3 220. 3/100 000 person-years vs. 1 257. 9/100 000 person-years,P〈0. 001）. There was no statistically significant difference in the incidence of cardiovascular disease between the above two groups（ 999. 8/100 000 person-years vs. 1 081. 2/100 000 person-years,P〈0. 05）. The mortality and incidence of cardiovascular disease among the patients with CKD were higher than those of the patients without CKD（ 2 558. 3/100 000 person-years vs. 1 044. 0/100 000 person-years,P〈0. 001; 1 605. 9/100 000 person-years vs. 941. 6/100 000 person-years,P〈0. 001）. Results of Cox regression model showed that,after adjustment for confounding factors,the allcause

关 键 词：贫血 糖尿病 慢性肾脏病 心脑血管疾病 死亡 

分 类 号：R587.1[医药卫生—内分泌]