Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes.
Lower-extremity amputation as a marker for renal and cardiovascular events and mortality in patients with long standing type 1 diabetes.
复制标题
DOI：
10.1186/s12933-015-0322-0
复制
发表时间：
2016-01-07
影响因子：
9.3
通讯作者：
Velho G
中科院分区：
文献类型：
--
作者：
Mohammedi K;Potier L;Belhatem N;Matallah N;Hadjadj S;Roussel R;Marre M;Velho G
我们评估了1型糖尿病患者发生肾脏和心血管并发症的风险，以及与下肢截肢(LEA)相关的死亡率。我们研究了两组长期患有1型糖尿病的人：GENEDIAB(n=456)和Genesis(n=611)。队列的子集(n=1260，n=544)分别被跟踪9年和5年。结果是终末期肾病(ESRD)、心肌梗死、中风的发生率和随访期间的死亡率。分析是在汇集的队列中进行的。基线时LEA患病率为9.3%(n=999)。低密度脂蛋白阳性史与已有糖尿病肾病(OR4.50，95%可信区间2.33-8.91，P<0.0001)和晚期糖尿病肾病(OR 5.5，95%可信区间2.89-10.78，P<0.05)的基线患病率相关；(0.0001)、终末期肾病(OR2.86，95%可信区间1.43-5.5，P=0.004)、心肌梗死(OR 3.25，95%可信区间1.68-6.15，P=0.0006)和中风(OR 3.88，95%可信区间1.67-8.72，P=0.002，调整了性别、年龄和队列成员)。基线时LEA阳性史与终末期肾病(HR 2.69，95%CI 1.17~6.20，P=0.02)和心肌梗死(HR 3.53，95%CI 1.79~6.97，P=0.0001)的发生率相关。LEA病史还与全因(HR 3.55，95%CI 2.05-6.16，P=0.0001)、心血管(HR 3.30，95%CI 1.36-8.02，P=0.008)、感染性疾病(HR 5.18，95%CI 1.13-23.84，P=0.03)和其他原因死亡率(HR 2.81，95%CI 1.09-7.26，P=0.03)的风险增加有关。基线时的LEA病史与在随访期间死亡的患者子集的生存时间减少40%有关。随访期间总死亡率基线时LEA病史的人群归因危险度为0.31。患有LEA的患者患ESRD、心肌梗死以及心血管和非心血管死亡的风险更高。我们的结果强调了LEA作为主要血管事件和1型糖尿病患者过早死亡的关键预测因子的重要性。本文的在线版本(doi：10.1186/s12933-0150322-0)包含补充材料，授权用户可以使用。
We evaluated the risks of renal and cardiovascular complications, and mortality associated with lower extremity amputation (LEA) in patients with type 1 diabetes. We studied two cohorts of people with long standing type 1 diabetes: GENEDIAB (n = 456) and GENESIS (n = 611). Subsets of the cohorts (n = 260, n = 544) were followed for 9 and 5 years, respectively. Outcomes were the incidence of end stage renal disease (ESRD), myocardial infarction, stroke and mortality during follow-up. Analyses were performed in pooled cohorts. The prevalence of LEA at baseline was 9.3 % (n = 99). A positive history of LEA was associated with the baseline prevalence of established (OR 4.50, 95 % CI 2.33–8.91, p < 0.0001) and advanced diabetic nephropathy (OR 5.50, 95 % CI 2.89–10.78, p < 0.0001), ESRD (OR 2.86, 95 % CI 1.43–5.50, p = 0.004), myocardial infarction (OR 3.25, 95 % CI 1.68–6.15, p = 0.0006) and stroke (OR 3.88, 95 % CI 1.67–8.72, p = 0.002, adjusted for sex, age, and cohort membership). A positive history of LEA at baseline was associated with the incidence during follow-up of ESRD (HR 2.69, 95 % CI 1.17–6.20, p = 0.02), and myocardial infarction (HR 3.53, 95 % CI 1.79–6.97, p = 0.0001). History of LEA was also associated with increased risk for all-cause (HR 3.55, 95 % CI 2.05–6.16, p < 0.0001), cardiovascular (HR 3.30, 95 % CI 1.36–8.02, p = 0.008), infectious disease (HR 5.18, 95 % CI 1.13–23.84, p = 0.03) and other-cause mortality (HR 2.81, 95 % CI 1.09–7.26, p = 0.03). History of LEA at baseline was associated with a 40 % reduction in the duration of survival in the subset of patients who died during follow-up. Population attributable risk of the history of LEA at baseline for total mortality during follow-up was 0.31. Patients with LEA have a higher risk of ESRD, myocardial infarction and cardiovascular and non-cardiovascular mortality. Our results highlight the importance of LEA as a key-predictor for major vascular events and premature death in type 1 diabetic patients. The online version of this article (doi:10.1186/s12933-015-0322-0) contains supplementary material, which is available to authorized users.