糖尿病腹膜透析患者血清糖化血红蛋白水平与颈动脉钙化及心血管事件的关系

Associations among HbA_(1C),carotid plaques and cardiovascular events in peritoneal dialysis patients with diabetes mellitus

目的：探讨糖尿病腹膜透析患者糖化血红蛋白（ HbA1C ）水平与颈动脉钙化及心血管事件的关系。方法将60例基础病为糖尿病肾病的腹膜透析患者按照HbA1C的水平分成两组，检测血清HbA1C水平及相关因素，所有的患者均接受颈动脉斑块超声检测，随访1年，观察两组患者血清HbA1C水平、颈动脉钙化的动态变化及心血管事件发生情况。结果低HbA1C组患者颈动脉钙化及心血管事件发生均低于高HbA1C组（ P＜0.05）；随访1年，低HbA1C组的颈动脉钙化进展及新发心血管事件明显少于高HbA1C组（P＜0.05），logistic 回归分析显示血清HbA1C升高是颈动脉钙化发生的重要影响因素（OR＝1.72，95％CI 0.92～3.87， P＝0.024），而HbA1C升高（OR＝1.43，95％CI 0.73～3.46， P＝0.012）及颈动脉钙化（OR＝3.17，95％CI 1.38～5.99， P＝0.018）是糖尿病腹膜透析患者心血管事件发生的重要影响因素。结论血清HbA1C水平与糖尿病腹膜透析患者颈动脉钙化发生关系密切，HbA1C升高及颈动脉钙化是此类患者心血管事件发生的重要影响因素。

Objective To investigate the correlations among HbA 1C , carotid plaques and cardiovascular events in peritoneal dialysis patients with diabetes mellitus .Methods Sixty peritoneal dialysis patients , whose original diseases were diabetes mellitus, were divided into two groups according to the serum HbA 1C level.HbA1C and other serum related parameters were assessed , and carotid intima-media thickness （ cIMT） was checked by B-mode ultrasonography .After one year follow-up, the associations among the serum HbA 1C level, deterioration of cIMT and newly -occurring cardio-vascular events were analyzed .Results Significantly higher cIMT and cardiovascular event rate were observed in high HbA1C group than low HbA1C group （P〈0.05）.After one year follow-up, progression of cIMT and newly occurring car-diovascular events were significantly higher in high HbA 1C group than low HbA1C group.Logistic regression analysis indica-ted that serum HbA1C level was risk factor of cIMT （OR=1.72, 95%CI：0.92-3.87, P=0.024）;while serum HbA1C （OR=1.43, 95%CI：0.73-3.46, P=0.012） level and cIMT （OR=3.17, 95%CI：1.38-5.99, P=0.018） were risk factors of cardiovascular events in peritoneal dialysis patients with diabetes mellitus .Conclusion Serum HbA1C is a risk factor of carotid plaques , and serum HbA1C and cIMT were risk factors of cardiovascular events in peritoneal dialysis with diabetes mellitus .