Ikeda Nobutaka, Hara Hisao, Hiroi Yukio
Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
J Cardiol. 2014 Oct;64(4):297-301. doi: 10.1016/j.jjcc.2014.02.014. Epub 2014 Mar 26.
The relationship between hemoglobin A1c (HbA1c) levels and coronary artery disease (CAD) has previously been confirmed. Serum 1,5-anhydro-D-glucitol (1,5-AG) levels are a useful clinical marker for short-term glycemic status that reflect glycemic excursions with greater sensitivity compared with HbA1c, specifically in the postprandial state. Postprandial hyperglycemia is an important CAD risk factor. Thus, the aim of this study was to compare HbA1c with 1,5-AG as a CAD predictor.
The subjects consisted of 336 consecutive patients who underwent their first coronary angiography between July 2011 and March 2013. The relationship between CAD prevalence and HbA1c as well as CAD prevalence and 1,5-AG levels was evaluated. The correlation between CAD complexity and HbA1c or 1,5-AG was also assessed. CAD complexity was evaluated by the SYNTAX score.
CAD patients presented with significantly lower 1,5-AG and higher HbA1c values than patients without CAD (11.6 μg/ml [6.1, 19.1] vs. 17.6 μg/ml [11.9, 25.0], p<0.001, and 6.0% [5.6, 7.1] vs. 5.7% [5.4, 6.2], p<0.001, respectively) (median [25th, 75th percentiles]). According to logistic regression analysis, 1,5-AG was a predictor of CAD prevalence (odds ratio 0.94, 95% confidence interval 0.90-0.97). However, HbA1c levels did not present a predictive value for CAD. Levels of 1,5-AG and HbA1c were significantly correlated with SYNTAX scores (ρ=-0.27, p<0.001; and ρ=0.23, p<0.001, respectively).
The use of 1,5-AG, may be superior to HbA1c in predicting CAD prevalence. Both 1,5-AG and HbA1c correlate with CAD complexity.
血红蛋白A1c（HbA1c）水平与冠状动脉疾病（CAD）之间的关系此前已得到证实。血清1,5-脱水-D-葡萄糖醇（1,5-AG）水平是反映短期血糖状态的有用临床标志物，与HbA1c相比，它能更敏感地反映血糖波动，尤其是在餐后状态。餐后高血糖是CAD的重要危险因素。因此，本研究的目的是比较HbA1c与1,5-AG作为CAD预测指标的效果。
研究对象为2011年7月至2013年3月期间连续接受首次冠状动脉造影的336例患者。评估CAD患病率与HbA1c之间的关系以及CAD患病率与1,5-AG水平之间的关系。还评估了CAD复杂性与HbA1c或1,5-AG之间的相关性。CAD复杂性通过SYNTAX评分进行评估。
与无CAD的患者相比，CAD患者的1,5-AG水平显著降低，HbA1c值显著升高（分别为11.6μg/ml[6.1,19.1]对17.6μg/ml[11.9,25.0]，p<0.001；以及6.0%[5.6,7.1]对5.7%[5.4,6.2]，p<0.001）（中位数[第25,75百分位数]）。根据逻辑回归分析，1,5-AG是CAD患病率的预测指标（比值比0.94，95%置信区间0.90-0.97）。然而，HbA1c水平对CAD没有预测价值。1,5-AG水平和HbA1c水平与SYNTAX评分显著相关（分别为ρ=-0.27，p<0.001；以及ρ=0.23，p<0.001）。
在预测CAD患病率方面，使用1,5-AG可能优于HbA1c。1,5-AG和HbA1c均与CAD复杂性相关。
