糖化血红蛋白的变异性对老年终末期糖尿病肾脏病腹膜透析患者预后的影响

Effect of glycosylated hemoglobin variability on the prognosis of elderly patients with end-stage diabetes nephropathy undergoing peritoneal dialysis

目的 探讨糖化血红蛋白(HbA1c)的变异性对老年糖尿病肾脏病腹膜透析患者临床结局的影响。方法 回顾性纳入2013年6月—2022年6月南通市海门区中医院85例老年终末期糖尿病肾脏病腹膜透析患者,根据HbA1c变异性将患者分为4组,HbA1c的变异性被定义为每个患者的变异系数(CV),即HbA1c的标准差与HbA1c的平均值的比例,并采用COX回归进行分析。结果 85例患者中有44例死亡(55.3%)。多变量分析结果显示,HbA1c变异系数>2.83是影响患者生存率的主要危险因素(HR为2.88, 95%CI 1.21~5.55,P<0.001)。Kaplan-Meier分析结果显示,患者生存率随着HbA1c变异系数的增加而降低。结论 HbA1c变异性增加明显升高老年糖尿病肾脏病腹膜透析患者全因死亡率,减少HbA1c变异性可能是改善患者结局的关键策略之一。

Objective To investigate the effect of glycosylated hemoglobin(HbA1c)variability on the clinical outcomes of elderly patients with end-stage diabetes nephropathy undergoing peritoneal dialysis.Methods A total of 85 elderly patients with end-stage diabetes nephropathy undergoing peritoneal dialysis in Traditional Chinese Medicine Hospital of Haimen District from June 2013 to June 2022 were retrospectively included.They were divided into 4 groups according to HbA1c variability.The HbA1c variability was defined as the coefficient of variation(CV)for each patient,which was the ratio of the standard deviation of HbA1c to the mean of HbA1c.COX regression was used for analysis.Results Out of 85 patients,44 died(55.3%).The results of multivariate analysis showed that HbA1c CV>2.83 was a significant risk factor affecting patient survival(HR=2.88,95%CI 1.21-5.55,P<0.001).The Kaplan Meier analysis results showed that the survival rate of patients decreased with the increase of HbA1c CV.Conclusion Elevated HbA1c variability significantly increases the all-cause mortality in elderly patients with diabetes nephropathy undergoing peritoneal dialysis.Reducing HbA1c variability may be a key strategy to improve patient outcomes.