Mukai Naoko, Ninomiya Toshiharu, Hata Jun, Hirakawa Yoichiro, Ikeda Fumie, Fukuhara Masayo, Hotta Taeko, Koga Masafumi, Nakamura Udai, Kang Dongchon, Kitazono Takanari, Kiyohara Yutaka
Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Cardiovasc Diabetol. 2015 Jun 24;14:84. doi: 10.1186/s12933-015-0247-7.
It is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects.
A total of 2702 subjects aged 40-79 years underwent a 75-g oral glucose tolerance test and measurements of HbA1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007-2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT.
The crude average of the maximum IMT increased significantly with rising quartiles of HbA1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors.
In community-dwelling Japanese subjects with GI, elevated HbA1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA1c and GA are useful for assessing carotid atherosclerosis.
目前尚不清楚哪种血糖指标在动脉粥样硬化评估中更有用。我们在社区居住的日本受试者中研究了糖化血红蛋白（HbA1c）、糖化白蛋白（GA）、1,5-脱水葡萄糖醇（1,5-AG）、空腹血糖（FPG）和餐后2小时血糖（PG）与颈动脉内膜中层厚度（IMT）之间的关联。
2007年至2008年，共有2702名40 - 79岁的受试者接受了75克口服葡萄糖耐量试验，并通过超声检查测量了HbA1c、GA、1,5-AG和颈动脉IMT。颈动脉壁增厚定义为最大IMT>1.0毫米。采用粗线性和多变量调整线性及逻辑回归模型分析血糖指标水平与颈动脉IMT之间的横断面关联。
在有和无葡萄糖不耐受（GI）的受试者中，最大IMT的粗平均值均随HbA1c、GA、FPG和餐后2小时PG水平四分位数的升高而显著增加，而1,5-AG未观察到明显关联。在调整其他混杂因素后，HbA1c、GA和FPG的阳性趋势（所有趋势p<0.05）在有GI的受试者中仍然显著，但餐后2小时PG（p = 0.07）并非如此，而在无GI的受试者中未发现此类关联。在估计有GI的受试者中血糖指标1个标准差变化与最大IMT关联的多变量调整β值时，HbA1c（β = 0.021）、GA（β = 0.024）和FPG（β = 0.024）的影响程度大于餐后2小时PG（β = 0.014）和1,5-AG（β = 0.003）。仅在有GI的受试者中，颈动脉壁增厚的多变量调整比值比随HbA1c、GA和FPG水平的升高而显著增加（所有趋势p<0.001）。在有GI的受试者中，在包含其他心血管危险因素的模型中加入HbA1c（p = 0.04）或GA（p = 0.04），而非1,5-AG、FPG或餐后2小时PG时，受试者工作特征曲线下面积显著增加。
在社区居住的有GI的日本受试者中，HbA1c、GA和FPG水平升高与颈动脉IMT增加显著相关，并且与1,5-AG、FPG和餐后2小时PG相比，HbA1c和GA对颈动脉壁增厚具有更好的辨别能力，这表明HbA1c和GA可用于评估颈动脉粥样硬化。
