Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO multinational study of vascular disease in diabetes
Risk factors, ethnic differences and mortality associated with lower-extremity gangrene and amputation in diabetes. The WHO multinational study of vascular disease in diabetes
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DOI：
10.1007/pl00002941
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发表时间：
2001-09-01
期刊：
影响因子：
8.2
通讯作者：
Lu, M
中科院分区：
文献类型：
--
作者：
Chaturvedi, N;Stevens, LK;Lu, M
目的/假设。我们的目的是研究与截肢相关的地理差异、危险因素和死亡率。使用了来自WHO糖尿病血管疾病多国研究最初14个中心中10个中心的数据。这包括3443名男性和女性，年龄在35至55岁的基线。在美洲印第安人、古巴、欧洲和东亚中心，根据I型（胰岛素依赖型）糖尿病患者的性别和持续时间校正的截肢发生率分别为31.0、8.2、3.5和1.0/1000人年。在II型（非胰岛素依赖型）糖尿病中，美洲印第安人、古巴、欧洲和东亚中心的截肢发生率分别为9.7、2.0、2.5和0.7/1000人年。截肢的关键危险因素包括葡萄糖、甘油三酯和视网膜病变，美洲印第安人和欧洲人的情况相似。与欧洲人相比，美洲印第安人的年龄、病程和性别校正截肢相对风险在I型糖尿病中为11.48（95% CI 3.56，36.98），在II型糖尿病中为3.86（95% CI 2.36，6.32）。调整心脏病、视网膜病变、蛋白尿、血糖、血压和甘油三酯后，I型和II型糖尿病的相对危险度分别为10.83（95%CI 3.20，36.65）和3.15（1.91，5.20）。截肢使所有组的死亡率加倍。结论/解释。血管并发症及其风险因素本身就是I型和II型糖尿病截肢的风险因素，在全球几个地理区域很常见。然而，地理区域之间的差异以及不同医疗保健系统的责任程度的原因尚不清楚。
Aims/hypothesis. We aimed to examine geographic differences, risk factors and mortality associated with amputation.Methods. Data from 10 of the original 14 centres of the WHO Multinational Study of Vascular Disease in Diabetes were used. This included 3443 men and women aged 35 to 55 years at baseline.Results. Incidences of amputation, adjusted for sex and duration in Type I (insulin-dependent) diabetes mellitus, were 31.0, 8.2, 3.5 and 1.0 per 1000 person years in the American Indian, Cuban, European and East Asian centres respectively. In Type II (non-insulin-dependent) diabetes mellitus, incidences of amputation were 9.7, 2.0, 2.5 and 0.7 per 1000 person years in the American Indian, Cuban, European and East Asian centres respectively. Key risk factors for amputation included glucose, triglyceride, and retinopathy, and were similar for American Indians and Europeans. The age, duration and sex adjusted relative risk for amputation in American Indians compared with Europeans was 11.48 (95% CI 3.56, 36.98) in Type I diabetes and 3.86 (95% CI 2.36, 6.32) in Type II diabetes. Adjusting for heart disease, retinopathy, proteinuria, glucose, blood pressure and triglyceride attenuated these relative risks to 10.83 (95% CI 3.20, 36.65) and 3.15 (1.91, 5.20) in Type I and Type II diabetes respectively. Amputation doubled mortality rates in all groups.Conclusion/interpretation. Vascular complications and their risk factors are themselves risk factors for amputation in both Type I and Type II diabetes and are common to several geographical regions worldwide. However, reasons for differences between geographical regions and the degree to which different health care systems could be responsible is not clear.