二甲双胍使用与糖尿病患者新发听力损失风险：一项英国生物银行队列研究

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中文摘要

目的： 探讨英国生物银行中糖尿病患者基线二甲双胍使用与新发听力损失之间的关联。
材料与方法： 本研究纳入英国生物银行中在基线前已诊断为糖尿病且无听力损失证据的参与者（N = 24 981）。二甲双胍使用根据基线评估时自我报告的药物使用情况确定。新发听力损失采用复合定义确定，该定义基于言语接受阈估计值、助听器使用、人工耳蜗植入以及随访期间相关ICD-10诊断。使用Cox比例风险模型，分析按性别分层，并调整人口学、生活方式、社会经济、临床因素、噪声暴露、抗糖尿病药物使用和肾功能。
结果： 在约12年的随访期间，男性参与者和女性参与者中分别观察到725例和385例新发听力损失事件。按性别分层的分析显示，在男性糖尿病患者中，基线二甲双胍使用与新发听力损失风险较低相关（完全调整模型：风险比[95%置信区间]，0.846 [0.725-0.987]，p = 0.0339），且该关联在多项敏感性分析中总体保持稳定。相比之下，在女性糖尿病患者中，未观察到二甲双胍使用与新发听力损失风险之间存在统计学显著关联（完全调整模型：风险比[95%置信区间]，0.977 [0.790-1.208]，p = 0.8290）。进一步的交互作用分析显示，二甲双胍使用与性别之间的交互项无统计学显著性（交互作用p = 0.260）。
结论： 在英国生物银行的糖尿病患者中，基线二甲双胍使用与男性新发听力损失风险较低相关，而在女性中未观察到显著关联。然而，二甲双胍使用与性别之间的交互项无统计学显著性；因此，尚不能得出该关联因性别而异的结论。

英文摘要

AIMS: To investigate the association between baseline metformin use and incident hearing loss among participants with diabetes in the UK Biobank.
MATERIALS AND METHODS: This study included participants from the UK Biobank who had been diagnosed with diabetes before baseline and had no evidence of hearing loss (N = 24 981). Metformin use was determined based on self-reported medication use at the baseline assessment. Incident hearing loss was ascertained using a composite definition based on speech-reception-threshold estimate, hearing aid use, cochlear implantation and relevant ICD-10 diagnoses during follow-up. Cox proportional hazards models were used, with analyses stratified by sex and adjusted for demographic, lifestyle, socioeconomic, clinical factors, noise exposure, use of antidiabetic medications and renal function.
RESULTS: During approximately 12 years of follow-up, 725 and 385 incident hearing loss events were observed among male and female participants, respectively. Sex-stratified analyses showed that, among men with diabetes, baseline metformin use was associated with a lower risk of incident hearing loss (fully adjusted model: hazard ratio [95% confidence interval], 0.846 [0.725-0.987], p = 0.0339), and this association remained generally stable across multiple sensitivity analyses. In contrast, among women with diabetes, no statistically significant association was observed between metformin use and the risk of incident hearing loss (fully adjusted model: hazard ratio [95% confidence interval], 0.977 [0.790-1.208], p = 0.8290). Further interaction analysis showed that the interaction term between metformin use and sex was not statistically significant (p for interaction = 0.260).
CONCLUSIONS: In participants with diabetes from the UK Biobank, baseline metformin use was associated with a lower risk of incident hearing loss among men, whereas no significant association was observed among women. However, the interaction term between metformin use and sex was not statistically significant; therefore, it cannot yet be concluded that this association differed by sex.