Heart Institute, University of São Paulo, São Paulo, Brazil.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2018 Oct 9;72(15):1778-1786. doi: 10.1016/j.jacc.2018.07.067.
Diabetic medications can cause hypoglycemia, which may lead to myocardial damage.
This study sought to determine whether hypoglycemia is associated with higher levels of high-sensitivity cardiac troponin T (hsTnT).
The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial randomized patients with type 2 diabetes mellitus and stable coronary artery disease, and closely followed them for hypoglycemia over the first year. Hypoglycemia was classified by maximum severity and frequency. hsTnT was measured at baseline and 1 year, and analyzed using multivariable regression.
Of 1,984 patients, follow-up hypoglycemia was absent in 1,026 (52%) patients, mild in 875 (44%), and severe in 83 (4%), and occurred less than weekly in 561 (28%) and greater than or equal to weekly in 397 (20%). hsTnT levels were associated with hypoglycemia: a median of 11.4 ng/l (interquartile range [IQR]: 8.1 to 17.3 ng/l) for none, 12.5 ng/l (IQR: 8.3 to 19.3 ng/l) for mild, and 13.7 ng/l (IQR: 9.9 to 24.9 ng/l) for severe hypoglycemia (p = 0.0001); and 12.5 ng/l (IQR: 8.3 to 18.1 ng/l) for less than weekly and 13.0 ng/l (IQR: 8.8 to 21.1 ng/l) for greater than or equal to weekly hypoglycemia (p = 0.0013). Severe hypoglycemia was associated with 34% higher 1-year hsTnT levels (p < 0.0001) in unadjusted analysis, 17% higher (p = 0.006) after adjustment for baseline factors unrelated to diabetes, and 6% higher (p = 0.23) after further adjustment for the duration and severity of diabetes. Hypoglycemia greater than or equal to weekly was associated with 14% higher hsTnT (p = 0.0003) in unadjusted analysis, 12% higher (p = 0.0002) after adjustment for baseline factors unrelated to diabetes, and 4% higher (p = 0.16) after adjustment for diabetes related factors.
Hypoglycemia was associated with elevated hsTnT levels, but this may be due to more severe diabetes in patients who developed hypoglycemia, rather than the direct result of hypoglycemia. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI2D]; NCT00006305).
糖尿病药物可导致低血糖，进而可能导致心肌损伤。
本研究旨在确定低血糖是否与高敏心肌肌钙蛋白 T（hsTnT）水平升高有关。
BARI 2D（旁路血管成形术血运重建治疗 2 型糖尿病研究）试验将 2 型糖尿病和稳定型冠状动脉疾病患者随机分组，并在第一年密切监测他们的低血糖情况。低血糖按严重程度和频率进行分类。基线和 1 年后测定 hsTnT，采用多变量回归进行分析。
在 1984 例患者中，1026 例（52%）患者无低血糖，875 例（44%）患者出现轻度低血糖，83 例（4%）患者出现严重低血糖，561 例（28%）患者低血糖每周发作次数少于 1 次，397 例（20%）患者低血糖每周发作次数等于或多于 1 次。hsTnT 水平与低血糖相关：无低血糖者中位 hsTnT 水平为 11.4ng/L（四分位间距 [IQR]：8.117.3ng/L），轻度低血糖者为 12.5ng/L（IQR：8.319.3ng/L），严重低血糖者为 13.7ng/L（IQR：9.924.9ng/L）（p=0.0001）；每周发作次数少于 1 次者为 12.5ng/L（IQR：8.318.1ng/L），每周发作次数等于或多于 1 次者为 13.0ng/L（IQR：8.8~21.1ng/L）（p=0.0013）。未校正分析显示，严重低血糖患者 1 年时 hsTnT 水平升高 34%（p<0.0001），校正与糖尿病无关的基线因素后升高 17%（p=0.006），进一步校正糖尿病持续时间和严重程度后升高 6%（p=0.23）。每周发作次数等于或多于 1 次的低血糖患者 hsTnT 水平升高 14%（p=0.0003），未校正分析中升高 12%（p=0.0002），校正与糖尿病无关的基线因素后升高 4%（p=0.16）。
低血糖与 hsTnT 水平升高相关，但这可能是由于发生低血糖的患者糖尿病更为严重，而不是低血糖直接导致的。（2 型糖尿病旁路血管成形术血运重建治疗研究 [BARI2D]；NCT00006305）
