Liu Liwei, Ye Jianfeng, Ying Ming, Li Qiang, Chen Shiqun, Wang Bo, Lin Yihang, Chen Guanzhong, Lun Zhubin, Huang Haozhang, Li Huangqiang, Xu Danyuan, Tan Ning, Chen Jiyan, Liu Jin, Liu Yong
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Front Cardiovasc Med. 2021 Feb 26;8:632704. doi: 10.3389/fcvm.2021.632704. eCollection 2021.
Although glycated hemoglobin (HbA1c) was considered as a prognostic factor in some subgroup of coronary artery disease (CAD), the specific relationship between HbA1c and the long-term all-cause death remains controversial in patients with CAD. The study enrolled 37,596 CAD patients and measured HbAlc at admission in Guangdong Provincial People's Hospital. The patients were divided into 4 groups according to HbAlc level (Quartile 1: HbA1c ≤ 5.7%; Quartile 2: 5.7% < HbA1c ≤ 6.1%; Quartile 3: 6.1% < HbA1c ≤ 6.7%; Quartile 4: HbA1c > 6.7%). The study endpoint was all-cause death. The restricted cubic splines and cox proportional hazards models were used to investigate the association between baseline HbAlc levels and long-term all-cause mortality. The median follow-up was 4 years. The cox proportional hazards models revealed that HbAlc is an independent risk factor in the long-term all-cause mortality. We also found an approximate U-shape association between HbA1c and the risk of mortality, including increased risk of mortality when HbA1c ≤ 5.7% and HbA1c > 6.7% [Compared with Quartile 2, Quartile 1 (HbA1c ≤ 5.7), aHR = 1.13, 95% CI:1.01-1.26, < 0.05; Quartile 3 (6.1% < HbA1c ≤ 6.7%), aHR = 1.04, 95% CI:0.93-1.17, =0.49; Quartile 4 (HbA1c > 6.7%), aHR = 1.32, 95% CI:1.19-1.47, < 0.05]. Our study indicated a U-shape relationship between HbA1c and long-term all-cause mortality in CAD patients.
尽管糖化血红蛋白（HbA1c）在某些冠状动脉疾病（CAD）亚组中被视为预后因素，但在CAD患者中，HbA1c与长期全因死亡之间的具体关系仍存在争议。该研究纳入了37596例CAD患者，并在广东省人民医院入院时测量了HbAlc。根据HbAlc水平将患者分为4组（四分位数1：HbA1c≤5.7%；四分位数2：5.7%＜HbA1c≤6.1%；四分位数3：6.1%＜HbA1c≤6.7%；四分位数4：HbA1c＞6.7%）。研究终点为全因死亡。采用受限立方样条和Cox比例风险模型来研究基线HbAlc水平与长期全因死亡率之间的关联。中位随访时间为4年。Cox比例风险模型显示，HbAlc是长期全因死亡率的独立危险因素。我们还发现HbA1c与死亡风险之间存在近似U形关联，包括当HbA1c≤5.7%和HbA1c＞6.7%时死亡风险增加[与四分位数2相比，四分位数1（HbA1c≤5.7），校正风险比（aHR）=1.13，95%置信区间（CI）：1.01-1.26，P＜0.05；四分位数3（6.1%＜HbA1c≤6.7%），aHR =1.04，95%CI：0.93-1.17，P =0.49；四分位数4（HbA1c＞6.7%），aHR =1.32，95%CI：1.19-1.47，P＜0.05]。我们的研究表明，CAD患者中HbA1c与长期全因死亡率之间存在U形关系。
