不同HbA1c水平2型糖尿病STEMI行急诊PCI患者的血糖变异风险分析

Risk analysis of blood glucose variation in type 2 diabetic STEMI patients with different HbA1c levels undergoing emergency PCI

目的探讨不同糖化血红蛋白(HbA1c)水平下空腹血糖(FPG)的短期变异对ST段抬高型心肌梗死(STEMI)患者近期主要心血管不良事件(MACE)的影响。方法回顾性分析中国医学科学院阜外医院深圳医院2016年1月至2020年3月因STEMI行急诊经皮冠状动脉介入术(PCI)的2型糖尿病患者,将患者分为HbA1c达标组(<6.5%)和未达标组(≥6.5%),定义的血糖变异性指标包括:空腹血糖变异指数(FPG-VS)、独立于均数的血糖变异系数(VIM)和空腹血糖均数(FPG-M),采用logistic回归模型评估不同HbA1c水平、血糖变异风险指标与MACE之间的关系。结果612例患者最终纳入分析。HbA1c未达标组(302例)血糖变异性指标(FPG-VS、VIM)均高于达标组(310例):FPG-VS[(0.7±0.3)vs(0.4±0.4),P<0.001],VIM[(0.4±0.2)vs(0.3±0.2),P<0.001],而两组FPG-M差异无统计学意义[(7.9±3.2)vs(8.0±3.9),P=0.221]。在HbA1c未达标组,FPG-VS、VIM和FPG-M与30 d内MACE风险相关性分别为0.89(95%CI:0.69~1.15)、1.21(95%CI:0.65~2.25)和1.06(95%CI:0.97~1.16)(均P>0.05)。在HbA1c达标组,FPG-VS与30 d内MACE风险增加相关(P=0.04):其中FPG变异值≥1 mmol/L次数每增加1次,多因素校正后,30 d内MACE风险增加8%(OR=1.08,95%CI:0.71~1.65);与FPG-VS<20%相比,FPG-VS≥80%的30 d内MACE风险增加33%(OR=1.33,95%CI:0.21~8.25,P<0.01),而VIM和FPG-M与30 d内MACE风险相关性分别为1.65(95%CI:0.96~2.83)和1.15(95%CI:0.98~1.35)(均P>0.05)。结论高FPG-VS与HbA1c未达标的STEMI患者近期MACE风险相关,在HbA1c达标后,FPG-VS仍然是独立于HbA1c的MACE危险因素。

Objective To investigate the impact of short-term variability in fasting blood glucose(FPG)on the recent major cardiovascular adverse events(MACE)in patients with ST segment elevation myocardial infarction(STEMI)with different levels of glycated hemoglobin(HbA1c).Methods Retrospective analysis was made on the patients with type 2 diabetes mellitus who underwent emergency percutaneous coronary intervention(PCI)due to STEMI from January 2016 to March 2020 in Shenzhen Hospital,Fuwai Hospital,Chinese Academy of Medical Sciences.The patients were divided into HbA1c compliant group(<6.5%)and non-compliant group(≥6.5%).The blood glucose variability indexes defined included FPG variability score(FPG-VS),variability index independent of FPG mean(VIM)and mean fast plasma glucose(FPG-M).The logistic regression model was used to evaluate the relationship between different HbA1c levels,blood glucose variability risk indicators,and MACE.Results A total of 612 patients were ultimately included in the analysis.The blood glucose variability indicators(FPG-VS,VIM)of the HbA1c non-compliant group(302 cases)were higher than those of the compliant group(310 cases):[FPG-VS:(0.7±0.3)vs(0.4±0.4),P<0.001,VIM:(0.4±0.2)vs(0.3±0.2),P<0.001],while there was no statistically significant difference in FPG-M between the two groups[(7.9±3.2)vs(8.0±3.9),P=0.221].In the HbA1c non-compliant group,the correlation between FPG-VS,VIM,and FPG-M and the risk of MACE within 30 days was 0.89(95%CI:0.69-1.15),1.21(95%CI:0.65-2.25),and 1.06(95%CI:0.97-1.16),respectively(all P>0.05).In the HbA1c compliant group,FPG-VS was associated with an increase in MACE risk within 30 days(P=0.04):for each increase in FPG variation≥1 mmol/L,after multiple factor adjustment,the risk of MACE increased by 8%within 30 days(OR=1.08,95%CI:0.71-1.65);Compared with FPG-VS<20%,FPG-VS≥80%increased the risk of MACE within 30 days by 33%(OR=1.33,95%CI:0.21-8.25,P<0.01),while the correlation between VIM and FPG-M and the risk of MACE within 30 days was 1.65(95%CI:0.96-2.83)and 1.15(95%CI:0.98-1.35),respectively(all P>0.05).Conclusions High FPG-VS is associated with the recent MACE risk in STEMI patients who do not meet HbA1c standards.After reaching HbA1c standards,FPG-VS remains an independent MACE risk factor.