糖尿病与痛风发病的竞争风险研究  

Incidence of diabetes mellitus and gout: a study of competitive risk

作　　者：董晓梅[1] 张加仪 张思恒[1] 吴雪霁[2] 潘冰莹[2] 庞敏慧 杨建卫[1] 张洁[1] 陈雄飞[1] DONG Xiao-mei;ZHANG Jia-yi;ZHANG Si-heng;WU Xue-ji;PAN Bing-ying;PANG Min-hui;YANG Jian-wei;ZHANG Jie;CHEN Xiong-fei(Department of Epidemiology,Medical College of Jinan University,Guangzhou,Guangdong 510632,China;Department of Basic Public Health,Guangzhou Municipal Center for Disease Control and Prevention,Guangzhou,Guangdong 510440,China)

机构地区：[1]暨南大学医学院流行病教研室,广东广州510632 [2]广州市疾病预防控制中心基层公共卫生科,广东广州510440

出　　处：《实用预防医学》2019年第4期430-433,509,共5页Practical Preventive Medicine

基　　金：广东省医学科研基金项目(A2013538)

摘　　要：目的探讨糖尿病与痛风发病风险随年龄变化的趋势,以及一种疾病先发病对另一种发生的影响。方法采取分层整群抽样方法,抽取35岁及以上户籍常住居民14 752人,采用面对面调查及调阅健康档案建立糖尿病、痛风发生的历史性队列。采用具有竞争风险的多状态Markov模型来估计糖尿病和痛风在不同年龄下、不同状态下的经验发病风险。采用参数法,利用6种常见的发病风险函数,对经验发病风险数据拟合分布曲线,并从中选择最合适的分布曲线。结果 logistic分布为最合适的发病风险分布曲线。人群从健康到患糖尿病、健康到患痛风、患糖尿病到同时患有糖尿病和痛风、患痛风到同时患有糖尿病和痛风的累积发病率分别为0.314 8、0.163 9、0.172 8、0.420 4。人群从健康到患糖尿病、健康到患痛风、患糖尿病到同时患有糖尿病和痛风、患痛风到同时患有糖尿病和痛风的瞬时发病率的最大值时的年龄分别为70.8、79.0、60.4、68.1岁。结论糖尿病与痛风互为危险因素。痛风和糖尿病将对方发病率发峰值提前10年,发病曲线更高、更陡。样本年龄范围以及年龄构成比的差异,可能是导致目前研究结论不一致的重要原因。在研究慢性病相互作用时,应进一步探讨样本年龄对结果的影响。Objective To survey the changing tendency of risk of diabetes mellitus and gout incidence with the increasing age, and to explore how the two diseases mutually influence each other in their incidence. Methods A stratified cluster sampling method was used to select 14,752 permanent residents aged 35 years and above in Guangzhou City. The historical cohort about diabetes mellitus and gout onset was established based on a face-to-face interview and a retrospective survey of the residents’ health records. Multistate Markov model with competitive risk was introduced to estimate the risk of empirical onset of diabetes mellitus and gout at different ages and in different state. The risk curves of the diseases were fitted by parametric method. Using six common risk-of-risk functions, the distribution curve was fitted to the empirical risk data, and the most appropriate distribution curve was selected. Results Logistic distribution was the most suitable distribution curve. The cumulative incidence rates of populations from health to suffering from diabetes mellitus, from health to suffering from gout, from suffering from diabetes mellitus to suffering from both diabetes mellitus and gout, and from suffering from gout to suffering from both diabetes mellitus and gout were 0.314,8, 0.163,9, 0.172,8 and 0.420,4 respectively. The instantaneous incidence rates of populations from health to suffering from diabetes mellitus, from health to suffering from gout, from suffering from diabetes mellitus to suffering from both diabetes mellitus and gout, and from suffering from gout to suffering from both diabetes mellitus and gout were found to reach the maximum values at the ages of 70.8, 79.0, 60.4 and 68.1 years respectively. Conclusions Diabetes mellitus and gout are risk factors for each other. Gout and diabetes mellitus make the peak incidence of the counterpart happen 10 years earlier, and the incidence curve is higher and steeper. Differences in sample age range and age composition may be the important reasons for the incons

关 键 词：糖尿病 痛风 多状态 竞争风险 

分 类 号：R587.1[医药卫生—内分泌]