摘要
目的探讨2型糖尿病患者糖化血红蛋白指数(HGI)与糖尿病心脏自主神经病变(DCAN)的相关性及HGI在DCAN发病风险预测中的作用。方法本研究为回顾性研究。选取2017年10月至2020 年5月在重庆医科大学附属第一医院内分泌科住院的993例2型糖尿病患者作为研究对象。收集所有患者的性别、年龄、糖尿病家族史、糖尿病病程、收缩压及舒张压、体质指数(BMI)等资料,检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血脂、血肌酐、高敏C反应蛋白(hs-CRP)等指标,并计算预估肾小球滤过率(eGFR)。留取24 h晨尿测定尿微量白蛋白/肌酐(UACR)。根据FPG与HbA1c建立线性回归方程并计算HGI。根据HGI 数值,采用三分位法将患者分为低HGI组、中HGI组及高HGI组三组,使用单因素方差分析及χ^(2)检验分析各组间基线资料差异,多因素logistic回归分析法分析DCAN患病的危险因素。结果 993例2型糖尿病患者中,DCAN组293例,非DCAN组700例,DCAN的发病率为29.5%(293/993),低HGI组(331例)、中HGI组(331例)及高HGI组(331例)三组DCAN的发病率分别为15.1%(50/331)、28.7%(95/331)、44.7%(148/331),随着HGI水平的增高,DCAN的发生率随之增加,三组间差异有统计学意义(χ^(2)=69.50,P<0.01)。多因素logistic回归分析原始模型显示,随着HGI的增加,DCAN的患病率也随之增加[优势比1.445,95%可信区间(CI)1.281~1.629),P<0.01]。在校正年龄、糖尿病家族史、FPG、HbA1c、hs-CRP、UACR>30 mg/g、eGFR、BMI、高血压、血脂异常等混杂因素后,HGI为DCAN的独立危险因素[优势比1.578(95%CI 1.378~1.808),P<0.01]。高HGI 组患者发生DCAN的风险是低HGI 组的4.545倍(95%CI 3.137~6.585,P<0.05),中HGI组发生DCAN的风险是低HGI 的2.262倍(95%CI 1.541~3.320,P<0.05)。结论 HGI与2型糖尿病患者DCAN发病密切相关,HGI检测有望用于临床上糖尿病患者并发心脏自主神经病变等并发症的个性化风险评估和预测。
Objective To explore the correlation between hemoglobin glycosylation index(HGI)and diabetic cardiovascular autonomic neuropathy(DCAN)in patients with type 2 diabetes and the role of HGI in predicting the risk of DCAN.Methods This study was a retrospective study.The clinical data of 993 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from October 2017 to May 2020 were selected.The patients′gender,age,family history of diabetes,diabetes duration,systolic blood pressure and diastolic blood pressure,body mass index(BMI),and other data were collected,and fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),blood lipids,serum creatinine,hypersensitive C-reactive protein(hs-CRP),and other indicators were detected,and the estimated glomerular filtration rate(eGFR)was calculated.The 24-hour morning urine was collected for determination of urinary albumin creatinine ratio(UACR).Based on FPG and HbA1c,a linear regression equation was established and HGI was calculated.According to the HGI value,the patients were divided into three groups:low-HGI(L-HGI)group,medium-HGI(M-HGI)group,and high-HGI(H-HGI)group using the three-quantile method.One-way analysis of variance(ANOVA)and chi-square test were employed to analyze the differences of baseline data among three groups,multivariate logistic regression was used to analyze the risk factors of DCAN.Results Among the 993 patients with type 2 diabetes,there were 293 patients in the DCAN group and 700 patients in the non-DCAN(N-DCAN)group,and the incidence of DCAN was 29.5%(293/993).The incidence of DCAN in L-HGI group(331 cases),M-HGI group(331 cases),and H-HGI group(331 cases)was 15.1%(50/331),28.7%(95/331)and 44.7%(148/331),respectively.The incidence of DCAN increased with the increase of HGI level,and the difference between the three groups was statistically significant(χ²=69.50,P<0.01).The risk of DCAN in H-HGI group was 4.545 times higher than that in L-HGI group[95%confidence interval(CI)3.137 to 6.585,P<0.05],and the risk of DCAN in M-HGI group was 2.262 times higher than that in L-HGI(95%CI 1.541 to 3.320,P<0.05).Logistic regression analysis showed that the incidence of DCAN increased with the increase of HGI[odds ratio was 1.445(95%CI 1.281 to 1.629),P<0.01].After adjusting for age,family history of diabetes,FPG,HbA1c,hs-CRP,UACR>30 mg/g,eGFR,BMI,hypertension,and dyslipidemia confounding factors,HGI was an independent risk factor for DCAN(odds ratio was 1.578(95%CI 1.378 to 1.808),P<0.01].Conclusions HGI is closely related to the onset of the type 2 diabetes with DCAN.HGI testing is expected to be used for clinically personalized risk assessment and prediction of complications such as cardiovascular autonomic neuropathy in diabetic patients.
作者
陈崇鑫
余萌
杨征
李蓉
Chen Chongxin;Yu Meng;Yang Zheng;Li Rong(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2021年第3期238-244,共7页
CHINESE JOURNAL OF DIABETES MELLITUS
关键词
糖尿病
2型
糖尿病神经病变
糖化血红蛋白指数
危险因素
糖基化
Diabetes mellitus,type 2
Diabetic neuropathies
hemoglobin glycation index
Risk factors
Glycosylation
作者简介
通信作者:李蓉,Email:rongli232006@163.com。
