Moorthy Vikaesh, Sim Ming Ann, Liu Weiling, Ti Lian Kah, Chew Sophia Tsong Huey
National University of Singapore, Yong Loo Lin School of Medicine, Singapore.
National University Hospital, Department of Anaesthesia, Singapore.
J Cardiothorac Vasc Anesth. 2019 Feb;33(2):388-393. doi: 10.1053/j.jvca.2018.03.010. Epub 2018 Mar 7.
Postoperative hyperglycemia is a known risk factor for adverse outcomes following cardiac surgery. Therefore, the authors investigated the association between ethnicity and postoperative hyperglycemia in a Southeast Asian multiethnic population undergoing cardiac surgery.
Perioperative data were analyzed prospectively.
Perioperative data were obtained from 2008 to 2010 at the 2 main heart centers in Singapore.
Data from 911 adult patients were collected.
All patients underwent elective cardiac surgery.
Perioperative variables, genetic associations, and outcomes of hyperglycemic versus normoglycemic patients were compared. Of the 911 patients analyzed, 47.7% (n = 435) were diabetic and 77.7% (n = 708) had postoperative hyperglycemia. Patients with postoperative hyperglycemia after cardiac surgery were more likely to have diabetes; be female, older, and more obese; and have hypertension and renal impairment. Patients of Indian ethnicity had a significantly higher incidence of postoperative hyperglycemia (86.7%, p = 0.043), as compared to Malays (79.1%) and Chinese (75.9%). Ethnicity was identified as an independent risk factor for postoperative hyperglycemia, with Indians having a significantly higher risk than Chinese (OR 2.115, p = 0.015). Although Indian ethnicity was associated with the presence of angiotensin-converting enzyme D allele (65.7%, p = 0.044), no genetic associations with postoperative hyperglycemia were identified. Postoperative hyperglycemia also was associated significantly with poorer outcomes of longer high-dependency unit stay and new-onset cardiac arrhythmias.
The authors' findings demonstrated Indian ethnicity as an independent risk factor of postoperative hyperglycemia, likely due to insulin resistance and exaggerated hyperglycemic stress response, emphasizing the need for ethnic-based data unique to each population group.
术后高血糖是心脏手术后不良结局的已知危险因素。因此，作者调查了东南亚多民族心脏手术人群中种族与术后高血糖之间的关联。
对围手术期数据进行前瞻性分析。
围手术期数据于2008年至2010年在新加坡的2个主要心脏中心获取。
收集了911例成年患者的数据。
所有患者均接受择期心脏手术。
比较了围手术期变量、基因关联以及高血糖与血糖正常患者的结局。在分析的911例患者中，47.7%（n = 435）患有糖尿病，77.7%（n = 708）出现术后高血糖。心脏手术后出现术后高血糖的患者更可能患有糖尿病；为女性、年龄较大且更肥胖；并患有高血压和肾功能损害。与马来人（79.1%）和华人（75.9%）相比，印度裔患者术后高血糖的发生率显著更高（86.7%，p = 0.043）。种族被确定为术后高血糖的独立危险因素，印度裔患者的风险显著高于华人（比值比2.115，p = 0.015）。尽管印度裔与血管紧张素转换酶D等位基因的存在相关（65.7%，p = 0.044），但未发现与术后高血糖的基因关联。术后高血糖还与高依赖病房停留时间延长和新发心律失常等较差结局显著相关。
作者的研究结果表明，印度裔是术后高血糖的独立危险因素，可能是由于胰岛素抵抗和过度的高血糖应激反应，强调了针对每个群体的基于种族的数据的必要性。
