文章摘要
樊 垚,顾刘宝,唐 伟,杨 俊,窦 毓.他汀类药物对老年2型糖尿病患者死亡风险影响的巢式病例对照研究[J].南京医科大学学报,2020,(12):1820~1823
他汀类药物对老年2型糖尿病患者死亡风险影响的巢式病例对照研究
A nested case⁃control study on effects of statin on mortality risk of the elderly with type 2 diabetes mellitus
投稿时间:2020-03-29  
DOI:10.7655/NYDXBNS20201215
中文关键词: 他汀  老年  T2DM  死亡风险  巢式病例对照研究
英文关键词: statin  old people  type 2 diabetes mellitus  risk of mortality  nested case⁃control study
基金项目:南京医科大学科技发展基金(NMUB2019256)
作者单位
樊 垚 南京医科大学附属老年医院临床流行病学研究室江苏 南京 210024 
顾刘宝 南京医科大学附属老年医院临床流行病学研究室江苏 南京 210024 
唐 伟 南京医科大学附属老年医院内分泌科江苏 南京 210024 
杨 俊 南京医科大学附属老年医院内分泌科江苏 南京 210024 
窦 毓 南京医科大学附属老年医院心血管科江苏 南京 210024 
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中文摘要:
      目的:因他汀类药物在年龄≥75岁老年人群中的心血管一级预防的应用仍然存在较大争议,本研究关注他汀用药对老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者死亡风险的影响。方法:研究对象为自2010年起于南京医科大学附属老年医院自愿参与糖尿病分阶段达标管理(China Staged Diabetes Targeting Management,SDTM)的T2DM患者。截止2017年12月对4 285例T2DM患者随访7.4年,随访期间基线年龄≥75岁患者共发生死亡事件172例。按照性别、年龄进行1∶1匹配,选择165例随访期间未死亡T2DM患者为对照。一般人口学信息、疾病史和用药史由护士采用面对面访谈的形式收集。采用单因素和多因素Logistic回归模型分析他汀用药与死亡风险的关联。结果:多因素Logistic回归结果表明,在总人群中他汀与死亡关联无统计学意义;在校正年龄、性别等影响因素后,他汀用药未降低T2DM患者总体死亡风险(OR 0.61,95%CI 0.36~1.01)。进一步按性别、冠心病疾病史及低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL?C)达标情况进行分层分析发现,仅在女性人群中,他汀用药与死亡风险降低有关,OR和95% CI分别为0.538和0.256~1.131,校正影响因素后OR(95%CI)为0.36(0.15~0.85),P < 0.05。结论:在老年T2DM人群中他汀药物的使用并没有明显降低死亡风险,但是可能由于女性人群激素的影响,他汀类药物的使用降低该人群的死亡风险。
英文摘要:
      Objective:Effects of statin for reducing mortality is controversial in individuals aged 75 years or older. We undertook this study to investigate whether there is an association between statin therapy and the risk of mortality in patients over the 75 years with type 2 diabetes mellitus (T2DM). Methods:The present study was conducted using the data taken from the Staged Diabetes Targeting Management Study(SDTM),which was started since 2010. A total of 4 285 diabetic patients were enrolled in the SDTM study until September 2017. There were 172 T2DM patients dead for the final analysis. There were 165 age and gender?matched individuals who remained survival during the median follow?up of 7.4 years selected as controls. Details on personal information,history of disease and use of medications were obtained through interviews by the nurses. Results:Logistic regression results showed that there was no statistically significant association between statin and mortality in the total population. After adjusting for age and gender,statins did not reduce the overall risk of death in patients with type 2 diabetes(OR 0.61,95%CI 0.36~1.01). Further stratified analysis was carried out according to gender,CHD disease history and LDL?c levels. Statin use was associated with a reduced risk of death in female. Odds ratio and 95% confidence interval was 0.538 and(0.256~1.131),respectively. After further adjustment for age,gender and all potential confounders,OR(95%CI) was 0.36(0.15~0.85),P < 0.05. Conclusion:Statin use did not significantly reduce the risk of death in old people with T2DM. However,statin use may reduce the risk of death in women because of hormonal effects.
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