糖化血红蛋白（HbA1c）在肺动脉高压中的作用：是否是一个预后相关的标志物？

HbA1c in pulmonary arterial hypertension: a marker of prognostic relevance?

机构信息

Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany.

出版信息

J Heart Lung Transplant. 2012 Oct;31(10):1109-14. doi: 10.1016/j.healun.2012.08.014.

DOI:10.1016/j.healun.2012.08.014

PMID:22975101

Abstract

BACKGROUND

Patients with pulmonary arterial hypertension (PAH) exhibit impaired glucose metabolism and increased insulin resistance. The clinical consequences of these metabolic changes are not known.

METHODS

We assessed HbA1c levels in 115 patients newly diagnosed with PAH (79 females and 36 males; mean age 49.2 years; idiopathic n = 67, collagen vascular disease n = 16, congenital heart defect n = 19, pulmonary veno-occlusive disease n = 8, portopulmonary n = 5). No patients had diabetes or were receiving anti-diabetic medication or systemic steroids. After initiation of pulmonary vasoactive treatment, patients remained in long-term follow-up.

RESULTS

Initially, patients were in an advanced stage of disease (mean pulmonary arterial pressure 53 ± 18 mm Hg, cardiac index 2.3 ± 0.8 liters/min/m2) with a 6-minute-walk distance of 337 ± 123 meters, and in NYHA Functional Class 3.0 ± 0.7. The HbA1c was 5.73 ± 0.75%. A moderate but statistically significant positive correlation was observed between HbA1c levels and BNP (r(p) = 0.41, p = 0.014), but no correlation was found with hemodynamics or 6-minute-walk distance. The 5-year survival rate for the entire group was 68%. Kaplan-Meier analysis and multivariate Cox proportional hazard models correcting for demographic and clinical covariates revealed that patients with HbA1c < 5.7% had a significantly better 5-year survival compared with those having higher initial values (85.1% vs. 55.9%; log rank p = 0.002). HbA1c was a predictor of all-cause mortality with a hazard ratio of 2.23 (95% CI 1.06 to 4.70; p = 0.034) per 1-unit increase of HbA1c.

CONCLUSIONS

In patients with pulmonary arterial hypertension, the HbA1c level at time of diagnosis is an independent predictor of long-term prognosis.

摘要

背景

肺动脉高压（PAH）患者表现出葡萄糖代谢受损和胰岛素抵抗增加。这些代谢变化的临床后果尚不清楚。

方法

我们评估了 115 例新诊断为 PAH 的患者的糖化血红蛋白（HbA1c）水平（79 名女性和 36 名男性；平均年龄 49.2 岁；特发性 n = 67，结缔组织疾病 n = 16，先天性心脏病 n = 19，肺静脉闭塞病 n = 8，门脉高压性肺病 n = 5）。无患者患有糖尿病或正在接受抗糖尿病药物或全身类固醇治疗。在开始肺动脉血管活性治疗后，患者接受了长期随访。

结果

最初，患者处于疾病晚期（平均肺动脉压 53 ± 18 mmHg，心指数 2.3 ± 0.8 L/min/m2），6 分钟步行距离为 337 ± 123 米，NYHA 功能分级 3.0 ± 0.7。HbA1c 为 5.73 ± 0.75%。HbA1c 水平与 BNP 之间存在中度但具有统计学意义的正相关（r（p）= 0.41，p = 0.014），但与血液动力学或 6 分钟步行距离无相关性。整个队列的 5 年生存率为 68%。Kaplan-Meier 分析和多元 Cox 比例风险模型校正人口统计学和临床协变量后显示，HbA1c < 5.7%的患者 5 年生存率明显高于初始值较高的患者（85.1% vs. 55.9%；对数秩检验 p = 0.002）。HbA1c 是全因死亡率的预测因子，风险比为 2.23（95%CI 1.06 至 4.70；p = 0.034），HbA1c 每增加 1 单位。