2型糖尿病患者长期血糖变异性与持续性慢性高血糖和心率校正QT间期的关联。
The association of long-term glycaemic variability versus sustained chronic hyperglycaemia with heart rate-corrected QT interval in patients with type 2 diabetes.
作者信息
Su Jian-Bin, Yang Xiao-Hua, Zhang Xiu-Lin, Cai Hong-Li, Huang Hai-Yan, Zhao Li-Hua, Xu Feng, Chen Tong, Cheng Xing-Bo, Wang Xue-Qin, Lu Yan
机构信息
Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China.
出版信息
PLoS One. 2017 Aug 28;12(8):e0183055. doi: 10.1371/journal.pone.0183055. eCollection 2017.
OBJECTIVES
Prolonged heart rate-corrected QT(QTc) interval is related to ventricular arrhythmia and cardiovascular mortality, with considerably high prevalence of type 2 diabetes. Additionally, long-term glycaemic variability could be a significant risk factor for diabetic complications in addition to chronic hyperglycaemia. We compared the associations of long-term glycaemic variability versus sustained chronic hyperglycaemia with the QTc interval among type 2 diabetes patients.
METHODS
In this cross-sectional study, 2904 type 2 diabetes patients were recruited who had undergone at least four fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPG) measurements (at least once for every 3 months, respectively) during the preceding year. Long-term glycaemic variabilities of FPG and 2-hour PPG were assessed by their standard deviations (SD-FPG and SD-PPG, respectively), and chronic fasting and postprandial hyperglycaemia were assessed by their means (M-FPG and M-PPG, respectively). HbA1c was also determined upon enrolment to assess current overall glycaemic control. QTc interval was estimated from resting 12-lead electrocardiograms, and more than 440 ms was considered abnormally prolonged.
RESULTS
Patients with prolonged QTc interval (≥440 ms) had greater M-FPG, M-PPG, SD-PPG and HbA1c than those with normal QTc interval but comparable SD-FPG. QTc interval was correlated with M-FPG, M-PPG, SD-PPG and HbA1c (r = 0.133, 0.153, 0.245 and 0.207, respectively, p = 0.000) but not with SD-FPG (r = 0.024, p = 0.189). After adjusting for metabolic risk factors via multiple linear regression analysis, SD-PPG, M-PPG and HbA1c (t = 12.16, 2.69 and 10.16, respectively, p = 0.000) were the major independent contributors to the increased QTc interval. The proportion of prolonged QTc interval increased significantly from 10.9% to 14.2% to 26.6% for the first (T1) to second (T2) to third (T3) tertiles of SD-PPG. After adjusting via multiple logistic regression analysis, the odd ratios of prolonged QTc interval of the T2 and T3 versus the T1 of SD-PPG were 1.15 (95% CI, 0.82-1.60) and 2.62 (1.92-3.57), respectively.
CONCLUSIONS
Increased long-term variability of PPG is a strong independent risk factor for prolonged QTc interval in type 2 diabetes patients, in addition to long-term postprandial hyperglycaemia and current HbA1c.
目的
校正心率后的QT（QTc）间期延长与室性心律失常及心血管死亡率相关，2型糖尿病的患病率相当高。此外，除慢性高血糖外，长期血糖变异性可能是糖尿病并发症的一个重要危险因素。我们比较了2型糖尿病患者中长期血糖变异性与持续性慢性高血糖与QTc间期的关联。
方法
在这项横断面研究中，招募了2904例2型糖尿病患者，他们在前一年至少进行了4次空腹血糖（FPG）和餐后2小时血糖（PPG）测量（分别每3个月至少测量一次）。通过标准差（分别为SD-FPG和SD-PPG）评估FPG和餐后2小时PPG的长期血糖变异性，通过均值（分别为M-FPG和M-PPG）评估慢性空腹和餐后高血糖。入组时还测定了糖化血红蛋白（HbA1c）以评估当前的总体血糖控制情况。从静息12导联心电图估计QTc间期，超过440 ms被认为是异常延长。
结果
QTc间期延长（≥440 ms）的患者比QTc间期正常的患者有更高的M-FPG、M-PPG、SD-PPG和HbA1c，但SD-FPG相当。QTc间期与M-FPG、M-PPG、SD-PPG和HbA1c相关（r分别为0.133、0.153、0.245和0.207，p = 0.000），但与SD-FPG无关（r = 0.024，p = 0.189）。通过多元线性回归分析调整代谢危险因素后，SD-PPG、M-PPG和HbA1c（t分别为12.16、2.69和10.16，p = 0.000）是QTc间期延长的主要独立影响因素。对于SD-PPG的第一个（T1）到第二个（T2）到第三个（T3）三分位数，QTc间期延长的比例从10.9%显著增加到14.2%再到26.6%。通过多元逻辑回归分析调整后，SD-PPG的T2和T3与T1相比，QTc间期延长的比值比分别为1.15（95%CI，0.82 - 1.60）和2.62（1.92 - 3.57）。
结论
除了长期餐后高血糖和当前的HbA1c外，餐后血糖长期变异性增加是2型糖尿病患者QTc间期延长的一个强大独立危险因素。
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