糖化血红蛋白（HbA1c）升高是冠状动脉搭桥手术中的一个风险标志物。
Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery.
作者信息
Alserius Thomas, Anderson Russell E, Hammar Niklas, Nordqvist Tobias, Ivert Torbjörn
机构信息
Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
出版信息
Scand Cardiovasc J. 2008 Dec;42(6):392-8. doi: 10.1080/14017430801942393.
OBJECTIVE
To evaluate if glycosylated haemoglobin 1 (HbA1c) was associated with increased risk of infection and mortality after coronary artery bypass grafting (CABG).
DESIGN
Prospective observational study. Preoperative HbA1c concentrations were correlated to outcome in patients followed for an average of 3.5 years after CABG.
RESULTS
HbA1c was > or =6% in 68% of 161 patients with diabetes mellitus (DM) and in 3% of 444 patients without DM. Superficial sternal wound infection was observed in 13.9% if HbA1c > or =6% versus in 5.5% if <6% (p=0.007). Mediastinitis occurred in 4.9% if HbA1c > or =6% and in 2.1% if HbA1c <6% (p=0.20) (Hazard ratio (HR) 1.9, 95% CI 0.6-5.9). Follow-up mortality was 18.9% in patients with HbA1c > or =6% compared to 4.1% if HbA1c <6% (p<0.001) with HR 5.4, (95% CI 3.0-10.0) after multivariable adjustment. The risk of death was similar regardless of DM diagnosis.
CONCLUSIONS
HbA1c > or =6% was associated with an increased risk of postoperative superficial sternal wound infections and a trend for higher mediastinitis rate and significantly higher mortality three years after CABG.
目的
评估糖化血红蛋白1（HbA1c）是否与冠状动脉旁路移植术（CABG）后感染风险及死亡率增加相关。
设计
前瞻性观察性研究。将术前HbA1c浓度与CABG后平均随访3.5年的患者的结局进行关联分析。
结果
161例糖尿病（DM）患者中有68%的HbA1c≥6%，444例非DM患者中有3%的HbA1c≥6%。若HbA1c≥6%，浅表胸骨伤口感染发生率为13.9%；若HbA1c＜6%，则为5.5%（p = 0.007）。若HbA1c≥6%，纵隔炎发生率为4.9%；若HbA1c＜6%，则为2.1%（p = 0.20）（风险比（HR）1.9，95%置信区间0.6 - 5.9）。HbA1c≥6%的患者随访死亡率为18.9%，而HbA1c＜6%的患者为4.1%（p＜0.001），多变量调整后HR为5.4（95%置信区间3.0 - 10.0）。无论DM诊断情况如何，死亡风险相似。
结论
HbA1c≥6%与术后浅表胸骨伤口感染风险增加、纵隔炎发生率升高趋势以及CABG三年后死亡率显著升高相关。
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