糖代谢异常与慢性心力衰竭预后的相关性分析

Prognostic importance of abnormal glucose metabolism in chronic heart failure

目的 探讨糖代谢异常对慢性心力衰竭（CHF）患者预后的影响.方法 连续收集北京大学第三医院2005年1月至2007年12月因CHF失代偿于心内科住院患者444例,根据是否合并糖尿病分为糖尿病组（153例）和非糖尿病组（291例）;非糖尿病组又根据空腹血糖（FPG）水平分为血糖正常组（FPG〈5.6 mmol/L,178例）和空腹血糖受损（IFG）组（FPG 5.6～6.9 mmol/L,113例）.随访所有入选者,记录临床情况、生化指标及终点事件（1年内全因死亡）,分析糖代谢异常与终点事件的相关性.结果 444例入选者中,随访期间共死亡83例（18.7%）,失访31例（7.0%）;糖尿病组病死率28.8%（44例）明显高于非糖尿病组13.4%（39例）（P〈0.01）,合并糖尿病是CHF患者1年内全因死亡的独立危险因素（OR=2.383,95%CI：1.317～4.312,P=0.004）;非糖尿病组中,IFG组病死率明显高于血糖正常组（21.2%比8.4%,P〈0.01）,合并IFG是非糖尿病CHF患者1年内全因死亡的独立危险因素（OR=3.564,95%CI：1.494～8.497,P=0.004）.结论 合并糖尿病是CHF患者1年内全因死亡的独立危险因素;对于非糖尿病CHF患者,合并IFG是其死亡的独立危险因素.

Objective To investigate the importance of abnormal glucose metabolism in a chronic heart failure （CHF） population. Methods A total of 444 patients were enrolled sequentially for decompensated CHF from January 1st, 2005 to December 31st, 2007 at our department They were divided into diabetic （n=153, 34.5%） and non-diabetic groups （n=291, 65. 5%）. Among the non-diabetics, there were 113 （25.4%） with impaired fasting glucose （IFG） （FPG 5.6 -6.9mmol/L） and 178 （40.1 %） with normal glucose levels. All subjects received a follow-up to record their clinical status, biochemical parameters and end-point events （all-cause death in one year） . And the correlations of abnormal glucose metabolism and end-point events were analyzed. Results Among these patients, 83 （17. 1%） died in 1 year, 31 （7. 0%） were lost to follow-up; among 83 dead patients, 15 （8. 4%） were within normal glucose levels, 34 （21. 2%） with IFG and 44 （28. 8%） with diabetes mellitus. Compared with normal glucose level patients, the mortality rates of diabetes mellitus and IFG patients were higher （P〈0.01）. There was no significant difference in mortality rate between diabetes mellitus and IFG patients. After adjustment for other prognostic attributes （age, sex and etc.）, diabetes mellitus was a predictor of 1-year allcause mortality （OR=2.383, 95%CI： 1.317 to 4.312; P=0.004）. In diabetics, the mortality of the higher glucose level group （FPG〉7.0 mmol/L） was 30.4% and that of the lower glucose level group （FPG≤7.0 mmol/L） 27.4%. And there was no significant difference （P〉0.05）. The FPG level could not predict the 1-year all-cause mortality. In non-diabetics, the mortality of IFG group （FPG 5.6 -6.9 mmol/L） was significantly higher than that of normal glucose levels group （21.2% vs 8.4%, P〈0.01）. IFG status predicted 1-year all-cause mortality （OR=3.564, 95%CI： 1.494-8.497, P=0.004）. The FPG level was also associated with the 1-year all-cause mortality （OR=1.791, 95% CI： 1.090-2.943, P=0.021） . Conclusion Diabetes mellitus is an independent predictor of 1-year all-cause mortality for CHF. And IFG and a higher FPG level are associated with 1-year all-cause mortality for CHF without diabetes mellitus.