血红蛋白糖化指数作为2型糖尿病患者对二肽基肽酶-4抑制剂治疗反应的有用预测指标。
Hemoglobin glycation index as a useful predictor of therapeutic responses to dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes.
作者信息
Chen Yu-Wei, Wang Jun-Sing, Sheu Wayne H-H, Lin Shih-Yi, Lee I-Te, Song Yuh-Min, Fu Chia-Po, Lee Chia-Lin
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
School of Medicine, National Yang Ming University, Taipei, Taiwan.
出版信息
PLoS One. 2017 Feb 9;12(2):e0171753. doi: 10.1371/journal.pone.0171753. eCollection 2017.
INTRODUCTION
A high hemoglobin glycation index (HGI) and glycated hemoglobin (HbA1c) level are associated with greater inflammatory status, and dipeptidyl peptidase-4 (DPP-4) inhibitors can suppress inflammation. We aimed to evaluate the relationship between HGI and the therapeutic effect of DPP-4 inhibitors.
METHODS
This retrospective cohort study followed 468 patients with type 2 diabetes receiving DPP-4 inhibitor treatment for 1 year. Estimated HbA1c was calculated using a linear regression equation derived from another 2969 randomly extracted patients with type 2 diabetes based on fasting plasma glucose (FPG) level. The subjects were divided into two groups based on HGI (HGI = observed HbA1c - estimated HbA1c). Mixed model repeated measures were used to compare the treatment efficacy after 1 year in patients with a low (HGI<0, n = 199) and high HGI (HGI≧0, n = 269).
RESULTS
There were no significant group differences in mean changes of FPG after 1 year (-12.8 and -13.4 mg/dL in the low and high HGI groups, respectively). However, the patients with a high HGI had a significantly greater reduction in HbA1c from baseline compared to those with a low HGI (-1.9 versus -0.3% [-20.8 versus -3.3 mmol/mol]). Improvements in glycemic control were statistically significantly associated with the tested DPP-4 inhibitors in the high HGI group (-2.4, -1.4, -1.2 and -2.2% [-26.2, -15.3, -13.1 and -24.0 mmol/mol] for vildagliptin, linagliptin, saxagliptin and sitagliptin, respectively) but not in the low HGI group.
CONCLUSIONS
The HGI index derived from FPG and HbA1c may be able to identify who will have a better response to DPP-4 inhibitors.
引言
高血红蛋白糖化指数（HGI）和糖化血红蛋白（HbA1c）水平与更高的炎症状态相关，而二肽基肽酶-4（DPP-4）抑制剂可抑制炎症。我们旨在评估HGI与DPP-4抑制剂治疗效果之间的关系。
方法
这项回顾性队列研究对468例接受DPP-4抑制剂治疗1年的2型糖尿病患者进行了随访。根据空腹血糖（FPG）水平，使用从另外2969例随机抽取的2型糖尿病患者中得出的线性回归方程计算估计的HbA1c。根据HGI（HGI = 观察到的HbA1c - 估计的HbA1c）将受试者分为两组。采用混合模型重复测量法比较1年后低HGI组（HGI<0，n = 199）和高HGI组（HGI≧0，n = 269）患者的治疗效果。
结果
1年后FPG的平均变化在两组之间无显著差异（低HGI组和高HGI组分别为-12.8和-13.4 mg/dL）。然而，与低HGI患者相比，高HGI患者的HbA1c从基线的降低幅度明显更大（-1.9%对-0.3% [-20.8对-3.3 mmol/mol]）。在高HGI组中，血糖控制的改善与所测试的DPP-4抑制剂在统计学上显著相关（维格列汀、利格列汀、沙格列汀和西格列汀分别为-2.4%、-1.4%、-1.2%和-2.2% [-26.2、-15.3、-13.1和-24.0 mmol/mol]），而在低HGI组中则不然。
结论
由FPG和HbA1c得出的HGI指数可能能够识别出谁对DPP-4抑制剂的反应更好。
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