糖化血红蛋白水平在急性心肌梗死患者中的预后意义

The Prognostic Value of Glycated Haemoglobin in Patients With Acute Myocardial Infarction

目的:探索糖化血红蛋白(HbA1c)水平在急性心肌梗死患者中与预后的关系。方法:回顾性分析1 952例急性心肌梗死患者,根据既往病史及HbA1c水平分为四组:已诊断糖尿病组(既往有糖尿病病史或应用降糖药物)492例、新诊断糖尿病组(住院期间诊断糖尿病,HbA1c≥6.5%)128例、糖尿病前期组(HbA1c 5.7%~6.4%)783例和非糖尿病组(HbA1c<5.7%)549例,随访25.6个月,以单因素和多因素分析法评估四组间住院及随访期间预后的差异。结果:住院期间上述四组患者的死亡率分别是4.88%、3.91%、3.96%和2.91%,差异无统计学意义(P=0.435)。随着HbA1c水平的升高,全因死亡、非致死性心肌梗死及再住院率均升高,但组间差异无统计学意义。四组复合终点主要不良心脏事件(MACE)发生率分别是39.84%、35.94%、33.97%和27.87%,差异有统计学意义(P=0.001)。以非糖尿病组为对照,其他三组的比值比(OR)及95%可信区间(CI)分别是1.33(1.05~1.69)、1.45(0.97~2.18)和1.71(1.32~2.22),趋势P值为<0.001。经基线各项其他指标校正后,差异仍有统计学意义(趋势P值为0.008)。结论:急性心肌梗死患者随访期间MACE发生率随着HbA1c水平的升高而升高,但未发现其与住院死亡率的关系。对于急性心肌梗死患者应常规筛查HbA1c,必要时可适当进行生活方式或药物的干预。

Objective： To evaluate the prognostic value of glycated haemoglobin （HbAlc） in patients with acute myocardial infarction （AMI）. Methods： A total of 1952 AMI patients were retrospectively studied. Based on medical history and HbAlc level, the patients were divided into 4 groups： Diabetes mellitus （DM） group, the patients with known DM or taking hypoglycemic drugs, n=492, Newly diagnosed DM group, MD was diagnosed during hospital stay and HbA1c≥6.5%, n 128, Pre-DM group, HbAlc 5.7%-6.4%, n=783 and Non-DM group, HbAlc〈5.7%, n=549. The patients were followed-up for 25.6 months, prognostic differences during hospital stay and follow-up period were assessed by single- and multi-factor analysis. Results： The in-hospital mortality in DM group, Newly diagnosed DM group, Pre-DM group and Non-DM group were 4.88%, 3.91%, 3.96% and 2.91% respectively,P=0.435. As HbAlc level increasing, the incidences of all-cause mortality, nonfatal M1 and re-hospitalization were elevating, while the differences among groups were similar. The incidences of major adverse cardiovascular events （MACE） in above 4 groups were 39.84%, 35.94%, 33.97% and 27.87% respectively, P=0.001. Compared with Non-DM group, MACE incidences in the other 3 groups were as OR=1.33, 95% CI 1.05-1.69, OR=1.45, 95% CI 0.97-2.18 and OR= 1.71, 95% CI 1.32-2.22 respectively, Ptrend〈0.001; with adjusted baseline parameters, Ptrend=0.008. Conclusion： In our research, MACE incidence was increasing upon HbAlc level elevating in AMI patients and it was not related to in-hospital death. HbAlc level should be screened in AMI patients, lifestyle and drug intervention could be used as necessity.