冠心病患者糖化血红蛋白水平和远期全因死亡的关系

Relationship between hemoglobin A1c level and long-term all-cause mortality in patients with coronary heart disease

目的探究冠心病患者血浆糖化血红蛋白(HbA1c)水平与远期全因死亡的关系。方法纳入2020年1月至2021年12月在广西壮族自治区人民医院心血管内科诊治且经冠状动脉造影诊断为冠心病的住院患者。应用Kaplan-Meier生存曲线、多因素Cox回归模型分析和限制性立方样条图探究血浆HbA1c水平与冠心病患者远期全因死亡风险之间的关系。结果共纳入1755例冠心病患者。在1年的随访期内,共99例患者(5.6%)死亡。Kaplan-Meier生存曲线分析显示,冠心病患者血浆HbA1c水平过低或过高,其远期全因死亡风险均升高(P<0.05)。多因素Cox回归分析结果显示,血浆HbA1c水平、年龄、慢性肾脏病、β受体阻滞剂使用情况均是冠心病患者远期全因死亡的影响因素;与血浆HbA1c水平5.6 mmol/L~<5.9 mmol/L的冠心病患者相比,血浆HbA1c水平<5.6 mmol/L和血浆HbA1c水平≥6.3 mmol/L的冠心病患者的远期全因死亡风险均显著增加(均P<0.05)。限制性立方样条图提示,校正年龄、慢性肾脏病、β受体阻滞剂使用情况后,血浆HbA1c水平与冠心病患者远期全因死亡呈非线性关系。结论血浆HbA1c水平与冠心病患者的远期全因死亡呈非线性关系,血浆HbA1c水平过高或过低均会增加冠心病患者远期全因死亡风险。

Objective To investigate the relationship between plasma hemoglobin A1c(HbA1c)level and long-term all-cause mortality in patients with coronary heart disease.Methods Inpatients diagnosed with coronary heart disease by coronary angiography and treated in the Department of Cardiovascular Medicine of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2020 to December 2021 were included.Kaplan-Meier survival curve,multivariate Cox regression model analysis,and restricted cubic spline were used to explore the relationship between plasma HbA1c level and long-term all-cause mortality risk in patients with coronary heart disease.Results A total of 1,755 patients with coronary heart disease were included.During the 1-year follow-up period,a total of 99 patients(5.6%)died.The Kaplan-Meier survival curve analysis showed that patients with coronary heart disease would have had an increased long-term all-cause mortality risk if the plasma HbA1c level had been too low or too high(P<0.05).The results of multivariate Cox regression analysis showed that the plasma HbA1c level,age,chronic kidney disease,and use ofβ-receptor blocker were influencing factors of long-term all-cause mortality in patients with coronary heart disease;compared with patients with coronary heart disease and the plasma HbA1c level of 5.6 mmol/L~<5.9 mmol/L,the long-term all-cause mortality risk was significantly increased in patients with coronary heart disease and the plasma HbA1c level<5.6 mmol/L or the plasma HbA1c level≥6.3 mmol/L(all P<0.05).The restricted cubic spline showed that after adjusting age,chronic kidney disease,and use ofβ-receptor blocker,the plasma HbA1c level had a nonlinear relationship with long-term all-cause mortality in patients with coronary heart disease.Conclusion The plasma HbA1c level has a nonlinear relationship with long-term all-cause mortality in patients with coronary heart disease,and a too-high or too-low plasma HbA1c level increases the long-term all-cause mortality risk in patients with coronary heart disease.