Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Clin Endocrinol Metab. 2022 May 17;107(6):e2563-e2571. doi: 10.1210/clinem/dgac062.
Previous cross-sectional studies show diabetes and higher levels of plasma hemoglobin A1c (HbA1c) are associated with a higher prevalence of gastrointestinal (GI) complications. However, whether the glycemic status is associated with incident acid-related upper GI disorders remains unclear.
We aimed to determine the effect of hyperglycemia per se, in terms of HbA1c, on the incidence of acid-related disorders.
We analyzed consecutive subjects who had undergone repeated upper endoscopies as part of the health examinations at the National Taiwan University Hospital from 2005 to 2011. Acid-related endoscopic abnormalities were defined as erosive esophagitis (EE), Barrett's esophagus (BE), and peptic ulcer disease (PUD), which included gastric ulcers (GUs) and duodenal ulcers (DUs). All subjects were categorized by 3 tertiles of HbA1c levels. We analyzed the occurrence of respective acid-related disorders during the follow-up period.
A total of 11 391 participants (mean HbA1c level 5.6 ± 0.7%) were enrolled in this longitudinal study. During the 38 426.3 person-years of follow-up (mean duration 3.37 ± 1.59 years), the incidence of EE, BE, GU, DU, PUD, and any acid-related disorders were 22.1%, 0.5%, 4.5%, 8.6%, 12.3%, and 30.3%, respectively. The higher HbA1c level was associated with higher risk of disease incidents, except BE, during the follow-up (all log-rank P < .001). In the Cox regression analyses with confounding factors fully adjusted, the hazard ratios for EE, GU, DU, PUD, and acid-related disorders were 1.174, 1.339, 1.24, 1.24, and 1.186, respectively, for the third tertile of HbA1c (all P < .05).
Higher HbA1c level was associated with a higher risk of acid-related upper GI endoscopic abnormalities. Efforts toward better glycemic control may help to prevent the development of late GI complications.
先前的横断面研究表明，糖尿病和较高水平的血浆血红蛋白 A1c（HbA1c）与胃肠道（GI）并发症的患病率较高有关。然而，血糖状态与酸相关的上 GI 疾病的发生率之间是否存在关联尚不清楚。
我们旨在确定 HbA1c 本身的高血糖对酸相关疾病发生率的影响。
我们分析了 2005 年至 2011 年期间在台湾大学医院进行健康检查时接受重复上内窥镜检查的连续受试者。酸相关的内镜异常定义为糜烂性食管炎（EE）、巴雷特食管（BE）和消化性溃疡病（PUD），包括胃溃疡（GU）和十二指肠溃疡（DU）。所有受试者均按 HbA1c 水平的 3 个三分位数进行分类。我们分析了随访期间各自酸相关疾病的发生情况。
共有 11391 名参与者（平均 HbA1c 水平为 5.6±0.7%）被纳入这项纵向研究。在 38426.3 人年的随访期间（平均持续时间为 3.37±1.59 年），EE、BE、GU、DU、PUD 和任何酸相关疾病的发生率分别为 22.1%、0.5%、4.5%、8.6%、12.3%和 30.3%。在随访期间，较高的 HbA1c 水平与疾病事件的发生风险增加有关，但 BE 除外（所有对数秩 P<0.001）。在调整混杂因素的 Cox 回归分析中，HbA1c 第三三分位数的 EE、GU、DU、PUD 和酸相关疾病的风险比分别为 1.174、1.339、1.24、1.24 和 1.186（均 P<0.05）。
较高的 HbA1c 水平与酸相关的上 GI 内镜异常风险增加有关。努力实现更好的血糖控制可能有助于预防晚期 GI 并发症的发生。
