维持性血液透析的糖尿病患者空腹血糖水平与心血管预后的关系

Relationship of fasting plasma glucose with cardiovascular events in diabetic patients treated with maintenance hemodialysis

目的探讨维持性血液透析的糖尿病患者空腹血糖控制情况与心血管事件发生风险的关系。方法根据空腹血糖，将2009年7月在本科进行规律血液透析的154例患者分为3组：非糖尿病空腹血糖正常组（A组，n=84）、糖尿病空腹血糖控制良好组（B组，n=41）、糖尿病空腹血糖控制欠佳组（C组，n=29），收集患者人体测量学指标、实验室数据，并随访36个月，记录患者心血管事件及低血糖发生情况。结果B组和C组患者超敏C反应蛋白（CRP）及甘油三酯较A组患者高，腰围较A组大；C组患者高密度脂蛋白胆固醇及全段甲状旁腺激素水平最低，而体重指数最高（P〈0．05）。随访期间共发生47例心血管事件．用Kaplan—Meier法分析心血管事件累计发生率，C组明显高于A组和B组（均P〈0．01），而后2组间差异无统计学意义。经多因素Cox风险回归分析表明空腹血糖≥7．2mmol/L、超敏CRP是心血管事件累计发生的独立危险因素（P〈0．05或P〈0．01）。结论空腹血糖控制在5．6—7．2mmol／L可显著改善合并糖尿病的维持性血液透析患者心血管预后。

Objective To investigate the potential contributing effects of fasting plasma glucose on cardiovascular events in diabetic patients treated with maintenance hemodialysis. Methods According to fasting plasma glucose, 154 patients undergoing maintenance hemodialysis in our department were assigned into group A （ n = 84） nondiabetic with normal fasting blood glucose, group B （n = 41 ） diabetic with good control of fasting blood glucose, and group C （ n = 29 ） diabetic with poor control of fasting glucose. Anthropometric and laboratory data were collected, and the participants were followed up for36 months. Cardiovascular events and hypoglycemia were recorded and analyzed. Results Highly-sensitive C reactive protein （hs-CRP） , triglyceride, and waist circumference were significantly higher in group B and group C compared with group A. Body mass index in group C was the highest while high density lipoprotein-cbolesterol and intact parathyroid hormone levels were the lowest among 3 groups （ P 〈 0.05 ）. During the 36 months follow-up, 47 cases of cardiovascular events occurred. Kaplan-Meier curves showed that cumulative incidence of cardiovascular events was significantly higher in group C than group A and B （ both P〈0.01 ） , and no significant difference was found between group A and B. Cox regressive analysis revealed that fasting plasma glucose and hs-CRP were independant risk factors for cumulative incidence of cardiovascular events （ P〈0.05 or P〈 0. 01 ）. Conclusions If fasting plasma glucose is controlled within the range of 5.6 to 7.2 mmol/L, cardiovascular outcomes may be significantly ameliorated in diabetic patients treated with maintenance hemodialysis.