Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2650, USA.
J Heart Lung Transplant. 2011 Aug;30(8):904-11. doi: 10.1016/j.healun.2011.02.016. Epub 2011 Apr 13.
Animal and human data suggest insulin resistance is common in pulmonary arterial hypertension (PAH). Although routine assessment of insulin resistance is difficult, hemoglobin A(1c) (HbA(1c)) is a sensitive test to detect diabetes mellitus (DM) and those at high risk for DM. We aimed to define the prevalence of elevated HbA(1c) in PAH patients and to correlate HbA(1c) levels with functional assessment.
HbA(1c) was measured in 41 PAH patients without a diagnosis of DM, along with demographic, functional, and hemodynamic data. Using published criteria, HbA(1c) ≤ 5.9% defined normal, 6.0% to 6.4% was glucose intolerance, and ≥ 6.5% was DM.
Twenty-three patients (56%) had HbA(1c) ≥ 6.0%, and 6 (15%) had unrecognized DM (HbA(1c) ≥ 6.5%). Age and body mass index were similar in patients with HbA(1c) ≥ 6.0% vs < 6.0%. There was a trend towards lower mean 6-minute walk distance in patients with elevated HbA(1c) (331.0 ± 126.6 vs 413.6 ± 74.9 meters, p = 0.07). The 6-month event-free survival was not significantly different in patients with elevated HbA(1c).
Unrecognized glucose intolerance as assessed by HbA(1c) is common in PAH. Further studies are needed to discern if glucose or insulin dysregulation mediates PAH pathogenesis or is secondary to advanced PAH.
动物和人体数据表明，胰岛素抵抗在肺动脉高压（PAH）中很常见。尽管常规评估胰岛素抵抗较为困难，但血红蛋白 A1c（HbA1c）是检测糖尿病（DM）和高风险 DM 的敏感测试。我们旨在确定 PAH 患者中 HbA1c 升高的患病率，并将 HbA1c 水平与功能评估相关联。
我们测量了 41 名无 DM 诊断的 PAH 患者的 HbA1c，并同时记录了人口统计学、功能和血流动力学数据。使用已发表的标准，HbA1c≤5.9%定义为正常，6.0%至 6.4%为葡萄糖耐量受损，≥6.5%为 DM。
23 名患者（56%）的 HbA1c≥6.0%，6 名患者（15%）患有未被识别的 DM（HbA1c≥6.5%）。HbA1c≥6.0%与<6.0%的患者年龄和体重指数相似。HbA1c 升高的患者平均 6 分钟步行距离有降低趋势（331.0±126.6 与 413.6±74.9 米，p=0.07）。HbA1c 升高的患者 6 个月无事件生存率无显著差异。
通过 HbA1c 评估，未被识别的葡萄糖耐量受损在 PAH 中很常见。需要进一步研究以确定葡萄糖或胰岛素失调是否介导 PAH 发病机制或继发于晚期 PAH。
