糖化血红蛋白变异指数与糖尿病慢性并发症发生风险的相关性研究

Associations between HbA1c Glycation Index and Risk of Chronic Complications of Diabetes Mellitus

背景糖化血红蛋白变异指数(HGI)作为一种简单易行的衡量血红蛋白糖化程度的指标,与糖尿病微血管和大血管并发症之间的独立相关性在国外研究中已有报道,但在亚洲人群中研究尚不全面。目的分析中国南京市某社区人群HGI与多种糖尿病慢性并发症(糖尿病肾病、糖尿病视网膜病变、糖尿病足、糖尿病神经病变)之间的关联性,探讨HGI在糖尿病慢性并发症发病风险预测中的作用。方法收集2015年4月2018年1月于南京市某社区医院糖尿病专案管理的644例糖尿病患者的临床资料,计算HGI。将患者按照HGI三分位数法分为低HGI组(HGI≤-0.313%)、中HGI组(-0.313%<HGI≤0.160%)和高HGI组(HGI>0.160%),进而评估不同HGI水平与糖尿病慢性并发症发生风险的关系。结果本研究糖尿病足患者仅8例,因此本研究将其他几种并发症的患病情况作为因变量纳入多因素Logistic回归分析。调整年龄、性别、饮酒史、糖尿病分型、BMI、高血压、高脂血症、冠心病、糖化血红蛋白(HbA1c)后的多因素Logistic回归分析显示,与低HGI组相比,高HGI组的糖尿病患者发生糖尿病慢性并发症[调整OR=2.576,95%CI(1.077,6.164),P=0.033],尤其是糖尿病肾病[调整OR=3.402,95%CI(1.070,10.817),P=0.038]的风险增高,未发现HGI与糖尿病视网膜病变、糖尿病神经病变之间存在关联性(P>0.05)。结论高HGI水平的糖尿病患者可能更易发生糖尿病慢性并发症尤其是糖尿病肾病,HGI检测有望用于临床上糖尿病患者并发糖尿病肾病等并发症的个性化风险评估和预测。

Background HbA1c glycation index(HGI) is a simply and conveniently measured indicator that reflects the level of glycosylated hemoglobin.Its associations with microvascular and macrovascular complications of diabetes have been reported in foreign studies,but have not been well studied in Asian.Objective To investigate the value of HGI in predicting chronic complications of diabetes by examining its associations with multiple chronic complications of diabetes(diabetic nephropathy,diabetic retinopathy,diabetic foot,diabetic neuropathy) in populations from a community of Nanjing,China.Methods Clinical data of 644 diabetic patients who received services from a diabetes management project of a community hospital,Nanjing from April 2015 to January 2018 were collected.Based on the calculated HGI level,they were divided into low HGI group(tertile 1:HGI≤-0.313%),medium HGI group(tertile 2:-0.313%0.160%).Association of HGI and the risk of chronic complications of diabetes was estimated.Results As the sample size of diabetic foot (only 8 cases) was too small,so only the prevalence rates of other three complications were incorporated in the multivariate Logistic regression model as dependent variables.After adjusting for age,sex,history of alcohol consumption,type of diabetes,BMI,hypertension,hyperlipidemia,coronary heart disease,and HbA1c,Logistic regression analysis showed that high HGI group had a significantly increased risk of chronic diabetic complications〔adjusted OR=2.576,95%CI(1.077,6.164),P=0.033〕,and showed an even higher risk of diabetic nephropathy〔adjusted OR=3.402,95%CI(1.070,10.817),P=0.038〕 compared with low HGI group.But no significant associations of HGI with the risk of diabetic retinopathy and diabetic neuropathy were found(P>0.05).Conclusion The patients with high HGI may be more likely to develop chronic diabetic complications,especially diabetic nephropathy.HGI measurement is expected to be used for personalized assessment and prediction of diabetic nephropathy in diabetic patients in clinic practice.