中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2012年
6期
521-525
,共5页
王恺隽%康金锁%郭志超%张丽%陈曦
王愷雋%康金鎖%郭誌超%張麗%陳晞
왕개준%강금쇄%곽지초%장려%진희
血红蛋白A%糖基化%冠心病%危险因素
血紅蛋白A%糖基化%冠心病%危險因素
혈홍단백A%당기화%관심병%위험인소
Hemoglobin A glycosylated%Coronary disease%Risk factors
目的 探讨糖尿病和非糖尿病患者糖化血红蛋白( HbA1c)水平与冠心病的关系.方法 对中国医学科学院阜外心血管病医院2009年1至9月收治的1190例患者进行分析,分为糖尿病组(225例)和非糖尿病组(965例),收集性别、年龄及三酰甘油(TG)、总胆固醇(CHO)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FBG)、HbA1c、高敏C反应蛋白(hs-CRP)等资料,分别分析两组人群冠心病发生与各项指标的关系,以协方差分析校正有差异因素后分析各组HbA1c水平差异.然后以HbA1c水平进行分组:4.0％～5.4％(Ⅰ),5.5％～5.9％(Ⅱ),6.0％ ～6.4％(Ⅲ),≥6.5％(Ⅳ),分别分析两组人群冠心病发生与HbA1c水平分布的构成差异.各组间率或比例的比较用person卡方检验,logistic回归分析独立危险因素.结果 (1)在非糖尿病人群中,与非冠心病组相比,冠心病组男性比例(80.5％比62.7％)、年龄[(59±11)岁比(55±11)岁]、FBG[(5.62±1.48) mmol/L比(5.30±0.84) mmol/L]、HbA1c[(5.98±0.92)％比(5.65±0.53)％]相对较高,而CHO[ (4.48±1.01) mmol/L比(4.77±1.04) mmol/L]、LDL-C[(2.59±0.87) mmol/L比(2.79±0.86) mmol/L]、HDL-C[ (1.08±0.26) mmol/L比(1.21±0.32) mmol/L]与前者相比较低,差异均有统计学意义(P均＜0.01),而在糖尿病人群中,两组间仅CHO[ (4.44±0.95) mmol/L比(5.08±1.16) mmol/L]、LDL-C[ (2.56 ±0.81) mmol/L比(3.07 ±0.90) mmol/L]差异有统计学意义(P均＜0.01)；(2)无论是糖尿病人群还是非糖尿病人群,随着HbA1c水平的递增,冠心病风险也逐渐升高,冠心病组高水平HbA1c比例高于非冠心病组,且在校正性别、年龄、HDL-C等因素后HbA1c仍是非糖尿病人群冠心病发生的独立危险因素(OR值:1.935,95％CI:1.356 ～2.762,P＜0.05),而空腹血糖在校正性别、年龄、HDL-C等因素后对非糖尿病人群冠心病发生危险预测价值较前者弱(OR值:1.507,95％ CI:1.082 ～2.098,P＜0.05).结论 HbA1c是非糖尿病人群冠心病发生的独立危险因素,且其预测价值优于空腹血糖.
目的 探討糖尿病和非糖尿病患者糖化血紅蛋白( HbA1c)水平與冠心病的關繫.方法 對中國醫學科學院阜外心血管病醫院2009年1至9月收治的1190例患者進行分析,分為糖尿病組(225例)和非糖尿病組(965例),收集性彆、年齡及三酰甘油(TG)、總膽固醇(CHO)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(FBG)、HbA1c、高敏C反應蛋白(hs-CRP)等資料,分彆分析兩組人群冠心病髮生與各項指標的關繫,以協方差分析校正有差異因素後分析各組HbA1c水平差異.然後以HbA1c水平進行分組:4.0％～5.4％(Ⅰ),5.5％～5.9％(Ⅱ),6.0％ ～6.4％(Ⅲ),≥6.5％(Ⅳ),分彆分析兩組人群冠心病髮生與HbA1c水平分佈的構成差異.各組間率或比例的比較用person卡方檢驗,logistic迴歸分析獨立危險因素.結果 (1)在非糖尿病人群中,與非冠心病組相比,冠心病組男性比例(80.5％比62.7％)、年齡[(59±11)歲比(55±11)歲]、FBG[(5.62±1.48) mmol/L比(5.30±0.84) mmol/L]、HbA1c[(5.98±0.92)％比(5.65±0.53)％]相對較高,而CHO[ (4.48±1.01) mmol/L比(4.77±1.04) mmol/L]、LDL-C[(2.59±0.87) mmol/L比(2.79±0.86) mmol/L]、HDL-C[ (1.08±0.26) mmol/L比(1.21±0.32) mmol/L]與前者相比較低,差異均有統計學意義(P均＜0.01),而在糖尿病人群中,兩組間僅CHO[ (4.44±0.95) mmol/L比(5.08±1.16) mmol/L]、LDL-C[ (2.56 ±0.81) mmol/L比(3.07 ±0.90) mmol/L]差異有統計學意義(P均＜0.01)；(2)無論是糖尿病人群還是非糖尿病人群,隨著HbA1c水平的遞增,冠心病風險也逐漸升高,冠心病組高水平HbA1c比例高于非冠心病組,且在校正性彆、年齡、HDL-C等因素後HbA1c仍是非糖尿病人群冠心病髮生的獨立危險因素(OR值:1.935,95％CI:1.356 ～2.762,P＜0.05),而空腹血糖在校正性彆、年齡、HDL-C等因素後對非糖尿病人群冠心病髮生危險預測價值較前者弱(OR值:1.507,95％ CI:1.082 ～2.098,P＜0.05).結論 HbA1c是非糖尿病人群冠心病髮生的獨立危險因素,且其預測價值優于空腹血糖.
목적 탐토당뇨병화비당뇨병환자당화혈홍단백( HbA1c)수평여관심병적관계.방법 대중국의학과학원부외심혈관병의원2009년1지9월수치적1190례환자진행분석,분위당뇨병조(225례)화비당뇨병조(965례),수집성별、년령급삼선감유(TG)、총담고순(CHO)、고밀도지단백담고순(HDL-C)、저밀도지단백(LDL-C)、공복혈당(FBG)、HbA1c、고민C반응단백(hs-CRP)등자료,분별분석량조인군관심병발생여각항지표적관계,이협방차분석교정유차이인소후분석각조HbA1c수평차이.연후이HbA1c수평진행분조:4.0％～5.4％(Ⅰ),5.5％～5.9％(Ⅱ),6.0％ ～6.4％(Ⅲ),≥6.5％(Ⅳ),분별분석량조인군관심병발생여HbA1c수평분포적구성차이.각조간솔혹비례적비교용person잡방검험,logistic회귀분석독립위험인소.결과 (1)재비당뇨병인군중,여비관심병조상비,관심병조남성비례(80.5％비62.7％)、년령[(59±11)세비(55±11)세]、FBG[(5.62±1.48) mmol/L비(5.30±0.84) mmol/L]、HbA1c[(5.98±0.92)％비(5.65±0.53)％]상대교고,이CHO[ (4.48±1.01) mmol/L비(4.77±1.04) mmol/L]、LDL-C[(2.59±0.87) mmol/L비(2.79±0.86) mmol/L]、HDL-C[ (1.08±0.26) mmol/L비(1.21±0.32) mmol/L]여전자상비교저,차이균유통계학의의(P균＜0.01),이재당뇨병인군중,량조간부CHO[ (4.44±0.95) mmol/L비(5.08±1.16) mmol/L]、LDL-C[ (2.56 ±0.81) mmol/L비(3.07 ±0.90) mmol/L]차이유통계학의의(P균＜0.01)；(2)무론시당뇨병인군환시비당뇨병인군,수착HbA1c수평적체증,관심병풍험야축점승고,관심병조고수평HbA1c비례고우비관심병조,차재교정성별、년령、HDL-C등인소후HbA1c잉시비당뇨병인군관심병발생적독립위험인소(OR치:1.935,95％CI:1.356 ～2.762,P＜0.05),이공복혈당재교정성별、년령、HDL-C등인소후대비당뇨병인군관심병발생위험예측개치교전자약(OR치:1.507,95％ CI:1.082 ～2.098,P＜0.05).결론 HbA1c시비당뇨병인군관심병발생적독립위험인소,차기예측개치우우공복혈당.
Objective To analyze the relation between glycosylated hemoglobin (HbA1c) and coronary heart disease (CHD) among diabetic and non-diabetic individuals.Methods A total of 1190 in patients from January 2009 to September 2009 were selected and divided into two groups:225 patients with diabete mellitus and 965 patients without.We collected the age,sex,triglyceride ( TG),total cholesterol ( CHO),high-density lipoprotein ( HDL-C),low-density lipoprotein ( LDL-C),fasting blood-glucose (FBG),glycosylated hemoglobin (HbA1c),high-sensitivity CRP (hs-CRP) and analyzed the relation between these indexes and CHD in diabetic and non-diabetic individuals respectively,then,analyzed the difference of HbA1c between patients with and without CHD after correcting the differentiating factor with a multivariable-adjusted model.Meanwhile,according the HbA1c level,we divided all participants into four groups:4.0％ -5.4％( Ⅰ),5.5％ -5.9％ ( Ⅱ),6.0％ -6.4％ ( Ⅲ),≥6.5％ ( Ⅳ),and observed the distribution of HbA1c and coronary heart disease in diabetic and non-diabetic individuals respectively.Results ( 1) In non-diabetic individuals,statistically significant difference of male( 80.5％ υs 62.7％),age [ ( 59 ±11) years υs (55 ± 11) years],FBG [(5.62 ± 1.48) mmol/L υs (5.30 ±0.84) mmol/L],HbA1c [(5.98±0.92)％ υs (5.65 ±0.53)％],CHO [(4.48 ±1.01) mmol/L υs (4.77 ±1.04) mmol/L],LDL-C [(2.59±0.87) mmol/L υs (2.79 ±0.86) mmol/L],HDL-C [(1.08 ±0.26) mmol/L υs(1.21 ±0.32) mmol/L] was observed between patients with and without CHD (P ＜0.01),however,in diabetic individuals,only LDL-C [ ( 2.56 ± 0.81) mmol/L υs ( 3.07 ± 0.90) mmol/L],CHO [ (4.44 ±0.95) mmol/L υs ( 5.08 ± 1.16) mmol/L] were observed ( P ＜ 0.0 1).(2) In all participants,the higher of HbA1c,the higher of CHD percent,compared to patients without CHD,the percent of high HbA1c in CHD patients was significantly higher.After adjusting for age,sex,HDL-C,HbA1c was an independent risk marker for CHD in non-diabetic individuals ( OR:1.935,95％ CI:1.356 - 2.762,P ＜ 0.05),however,links between FBG in the non-diabetic range and CHD appeared weaker after controlling indexes listed above( OR:1.507,95％CI:1.082 -2.098,P＜0.05).Conclusion HbA1c is an independent risk factor for CHD in nondiabetic individuals and prior to FBG.
