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长期血糖变异性对2型糖尿病患者房颤发生的影响。

Impact of long-term glycemic variability on development of atrial fibrillation in type 2 diabetic patients.

作者信息

Gu Jun, Fan Yu Qi, Zhang Jun Feng, Wang Chang Qian

机构信息

Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai-People's Republic of China.

出版信息

Anatol J Cardiol. 2017 Dec;18(6):410-416. doi: 10.14744/AnatolJCardiol.2017.7938.

DOI:10.14744/AnatolJCardiol.2017.7938
PMID:29256876
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6282889/
Abstract

OBJECTIVE

It is well known that patients with type 2 diabetes mellitus (T2DM) have a high risk of atrial fibrillation (AF). The current study was designed to determine the relationship between long-term glycemic variability and incidence of new-onset AF in T2DM patients.

METHODS

Between January 2008 and December 2009, we conducted a retrospective cohort study in patients with T2DM referred to our hospital. In 505 consecutive patients without any medical history of AF at baseline, the relationship between hemoglobin A1c (HbA1c) variability and future AF incidence was evaluated, with adjustments for other possible confounding factors. HbA1c variability was determined by standard deviation (SD) and coefficient of variation (CV).

RESULTS

Over a median of 6.9-year follow-up period, 48 patients (9.5%) developed incident AF. Multiple cox regression revealed that higher HbA1c-SD (HR: 1.726, 95% CI: 1.104-1.830, p=0.001) or HbA1c-CV (HR: 1.241, 95% CI: 1.029-1.497, p=0.024) remained the remarkable predictor of new-onset AF after adjusting for age, body mass index, left ventricular mass index, and left atrium diameter. Receiver operating curve analysis identified thresholds for HbA1c-SD (0.665%, sensitivity 71.4%, specificity 54.9%) and HbA1c-CV (8.970%, sensitivity 73.8%, specificity 47.1%) to detect new-onset AF development.

CONCLUSION

In patients with T2DM, higher HbA1c variability is significantly associated with future AF development.

摘要

目的

众所周知，2型糖尿病（T2DM）患者发生心房颤动（AF）的风险很高。本研究旨在确定T2DM患者长期血糖变异性与新发AF发生率之间的关系。

方法

2008年1月至2009年12月，我们对转诊至我院的T2DM患者进行了一项回顾性队列研究。在505例基线时无AF病史的连续患者中，评估糖化血红蛋白（HbA1c）变异性与未来AF发生率之间的关系，并对其他可能的混杂因素进行校正。HbA1c变异性通过标准差（SD）和变异系数（CV）来确定。

结果

在中位6.9年的随访期内，48例患者（9.5%）发生了新发AF。多因素Cox回归显示，在调整年龄、体重指数、左心室质量指数和左心房直径后，较高的HbA1c-SD（HR：1.726，95%CI：1.104-1.830，p=0.001）或HbA1c-CV（HR：1.241，95%CI：1.029-1.497，p=0.024）仍然是新发AF的显著预测因素。受试者工作特征曲线分析确定了HbA1c-SD（0.665%，敏感性71.4%，特异性54.9%）和HbA1c-CV（8.970%，敏感性73.8%，特异性47.1%）检测新发AF发生的阈值。

结论

在T2DM患者中，较高的HbA1c变异性与未来AF的发生显著相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/97498e0f1adb/AJC-18-410-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/d3d1c65015e9/AJC-18-410-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/d53c5477564c/AJC-18-410-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/97498e0f1adb/AJC-18-410-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/d3d1c65015e9/AJC-18-410-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/d53c5477564c/AJC-18-410-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5f4/6282889/97498e0f1adb/AJC-18-410-g003.jpg

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