BMJ：酒精摄入与糖尿病年轻患者死亡率增加有关
2012-02-25 MedSci MedSci原创
糖尿病（Diabetes）是由遗传因素、免疫功能紊乱、微生物感染等等各种致病因子作用于机体导致胰岛功能减退、胰岛素抵抗等而引发的糖、蛋白质、脂肪、水和电解质等一系列代谢紊乱综合征，临床上以高血糖为主要特点，典型病例可出现多尿、多饮、多食、消瘦等表现，即“三多一少”症状，糖尿病（血糖）一旦控制不好会引发并发症，导致肾、眼、足等部位的衰竭病变，且无法治愈。 1型糖尿病人主要是青少年。1型糖尿病患者的
糖尿病（Diabetes）是由遗传因素、免疫功能紊乱、微生物感染等等各种致病因子作用于机体导致胰岛功能减退、胰岛素抵抗等而引发的糖、蛋白质、脂肪、水和电解质等一系列代谢紊乱综合征，临床上以高血糖为主要特点，典型病例可出现多尿、多饮、多食、消瘦等表现，即“三多一少”症状，糖尿病（血糖）一旦控制不好会引发并发症，导致肾、眼、足等部位的衰竭病变，且无法治愈。
1型糖尿病人主要是青少年。1型糖尿病患者的死亡率是逐年增长，若不能得到有效治疗，死亡率还会大有增长的空间。从1980年代开始，酒精成为导致1型糖尿病患者死亡的重要原因之一。
近日，刊登在英格兰医学杂志上的一项研究表明：1980年代以来，虽然糖尿病发病较早的患者的幸存率随着时间推移有所改善，但糖尿病发病较晚患者的生存率仍不容乐观。
虽然糖尿病患者接受治疗后，病情能得到显著改善，但由于糖尿病伴发的急慢性疾病，1型糖尿病患者仍有较高的死亡率。一直以来，我们都认为糖尿病发病较晚的患者长期幸存率较糖尿病发病较早的患者要好。这项研究纳入在1970至1990年间出生的年龄在30岁以下的1型糖尿病患者共17,306名，对患者平均随访研究了21年，比较了糖尿病发病较晚的患者和糖尿病发病较早患者在死亡率的差异。
结果发现糖尿病发病较早患者的生存时间从1970年延长到2007年，这些人生存时间延长的原因是在糖尿病发病的早期20年内，糖尿病慢性并发症减少了。对于糖尿病发病较晚的患者来说，由于摄入酒精以及服用药物的缘由，患者死亡率较高。
研究人员强调：摄入酒精以及药物导致糖尿病患者死亡的人数占糖尿病发病较晚患者头20年内死亡总人数的39%，这表明酒精有可能是导致1型糖尿病年轻患者死亡的一大危险因素。
doi:10.1136/bmj.d5364
Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study
Valma Harjutsalo, senior scientist, Carol Forsblom, senior scientist, Per-Henrik Groop, professor of nephrology
Objective To examine short and long term time trends in mortality among patients with early onset (age 0-14 years) and late onset (15-29 years) type 1 diabetes and causes of deaths over time.
Design Population based nationwide cohort study.
Setting Finland.
Participants All Finnish patients diagnosed as having type 1 diabetes below age 30 years between 1970 and 1999 (n=17306).
Main outcome measures Crude mortality, standardised mortality ratios, time trends, and cumulative mortality.
Results A total of 1338 deaths occurred during 370733 person years of follow-up, giving an all cause mortality rate of 361/100000 person years. The standardised mortality ratio was 3.6 in the early onset cohort and 2.8 in the late onset cohort. Women had higher standardised mortality ratios than did men in both cohorts (5.5 v 3.0 in the early onset cohort; 3.6 v 2.6 in the late onset cohort). The standardised mortality ratio at 20 years’ duration of diabetes in the early onset cohort decreased from 3.5 in the patients diagnosed in 1970-4 to 1.9 in those diagnosed in 1985-9. In contrast, the standardised mortality ratio in the late onset cohort increased from 1.4 in those diagnosed in 1970-4 to 2.9 in those diagnosed in 1985-9. Mortality due to chronic complications of diabetes decreased with time in the early onset cohort but not in the late onset cohort. Mortality due to alcohol related and drug related causes increased in the late onset cohort and accounted for 39% of the deaths during the first 20 years of diabetes. Accordingly, mortality due to acute diabetic complications increased significantly in the late onset cohort.
Conclusion Survival of people with early onset type 1 diabetes has improved over time, whereas survival of people with late onset type 1 diabetes has deteriorated since the 1980s. Alcohol has become an important cause of death in patients with type 1 diabetes, and the proportion of deaths caused by acute complications of diabetes has increased in patients with late onset type 1 diabetes.
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