糖化血红蛋白指数作为 2 型糖尿病患者心血管疾病风险因素的获益有限。
Limited benefit of haemoglobin glycation index as risk factor for cardiovascular disease in type 2 diabetes patients.
机构信息
Department of Vascular Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 22, 2200 Copenhagen N, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 22, 2200 Copenhagen N, Denmark.
出版信息
Diabetes Metab. 2019 Jun;45(3):254-260. doi: 10.1016/j.diabet.2018.04.006. Epub 2018 May 8.
BACKGROUND
The haemoglobin glycation index (HGI) has been proposed as a marker of interindividual differences in haemoglobin glycosylation. Previous studies have shown a relationship between high HGI and risk of cardiovascular disease (CVD) in patients with diabetes. However, no studies have investigated the role of previous CVD in this association.
METHODS
The study cohort comprised patients with type 2 diabetes mellitus (T2DM; n=1910) included in the Second Manifestations of Arterial Disease (SMART) study. The relationship between either HGI or HbA and a composite of cardiovascular events as the primary outcome, and mortality, cardiovascular mortality, myocardial infarction and stroke as secondary outcomes, was investigated using Cox proportional-hazards models. Similar analyses were performed after stratification according to previous CVD.
RESULTS
A 1-unit higher HGI was associated with a 29% greater risk of a composite of cardiovascular events (HR: 1.29, 95% CI: 1.06-1.57) in patients without previous CVD, whereas no such relationship was seen in patients with previous CVD (HR: 0.96, 95% CI: 0.86-1.08). The direction and magnitude of the hazard ratios (HRs) of HGI and HbA in relation to outcomes were similar. Additional adjustment for HbA in the association between HGI and outcomes lowered the HRs.
CONCLUSION
Similar to HbA, higher HGI is related to higher risk of cardiovascular events in patients with T2DM without CVD. As HbA has proved to be a comparable risk factor, and obtaining and interpreting the HGI is complicated, any additional benefit of applying the HGI in clinical settings is likely to be limited.
背景
血红蛋白糖基化指数（HGI）已被提出作为血红蛋白糖基化个体间差异的标志物。先前的研究表明，高 HGI 与糖尿病患者心血管疾病（CVD）风险增加有关。然而，尚无研究探讨既往 CVD 在这种关联中的作用。
方法
本研究队列包括纳入第二表现动脉疾病（SMART）研究的 2 型糖尿病（T2DM）患者（n=1910）。使用 Cox 比例风险模型研究 HGI 或 HbA 与心血管事件复合主要结局，以及死亡率、心血管死亡率、心肌梗死和中风作为次要结局之间的关系。根据既往 CVD 进行分层后，进行了类似的分析。
结果
在无既往 CVD 的患者中，HGI 每增加 1 单位，心血管事件复合的风险增加 29%（HR：1.29，95%CI：1.06-1.57），而在既往 CVD 的患者中未见这种关系（HR：0.96，95%CI：0.86-1.08）。HGI 和 HbA 与结局相关的危险比（HRs）的方向和大小相似。在 HGI 与结局之间的关联中，对 HbA 进行额外调整降低了 HRs。
结论
与 HbA 相似，在无 CVD 的 T2DM 患者中，较高的 HGI 与心血管事件风险增加相关。由于 HbA 已被证明是一个可比的风险因素，并且获得和解释 HGI 很复杂，因此在临床环境中应用 HGI 的任何额外益处可能很有限。
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