Correlation between glycated hemoglobin level and prognostic cardiac function in diabetic patients with myocardial infarction
-
摘要: 目的 探讨糖尿病并发心肌梗死患者糖化血红蛋白(HbA1c)水平和预后心功能的相关性。方法 选取2020年1月—2022年6月住院就诊治疗的心电图ST段抬高型心肌梗死患者(100例)，根据患者HbA1c水平分为对照组32例(HbA1c < 6.5%)和观察组68例(HbA1c≥6.5%)。出院前对2组患者进行血清指标检测，包括高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(Hs-CRP)、低密度脂蛋白胆固醇(LDL-C)及甘油三酯(TG)。统计患者住院期间的不良发生率。比较分析2组患者住院期间、出院时及出院后3个月的左室射血分数(LVEF)。2组患者均随访2年，计算心肌梗死复发率和病死率。结果 观察组较对照组心功能分级较差(P < 0.05)。观察组与对照组HDL-C、Hs-CRP、LDL-C比较差异无统计学意义，且观察组TG水平高于对照组(P < 0.05)。观察组不良发生率较对照组升高(P < 0.05)。2组患者入院、出院时LVEF无明显差异。观察组患者出院3个月后LVEF明显低于对照组(P < 0.05)。观察组较对照组的心肌梗死复发率和病死率在2年内升高(P < 0.05)。结论 HbAlc水平升高影响糖尿病并发心肌梗死患者心脏不良事件发生率，降低患者的预后生存率，患者必须积极地控制血糖，有助于预防糖尿病和心血管病。Abstract: Objective To explore the relationship between glycosylated hemoglobin level and prognosis of cardiac function in the patients with diabetes complicated with myocardial infarction.Methods ST segment elevation myocardial infarction (STEMI) patients who were hospitalized between January 2020 and June 2022 were selected, and divided into a control group of 32 cases(HbA1c < 6.5%) and an observation group of 68 cases(HbA1c≥6.5%) based on their HbA1c levels. Before discharge, serum indexes of the two groups of patients were tested, including high-density lipoprotein cholesterol(HDL-C), high-sensitivity C-reactive protein(Hs-CRP), low-density lipoprotein cholesterol(LDL-C) and triglyceride(TG). The incidence of adverse events during patient hospitalization was calculated. The LVEF of two groups of patients during hospitalization, at discharge, and 3 months after discharge was compared and analyzed. Both groups of patients were followed up for 2 years to calculate the recurrence rate and mortality of myocardial infarction.Results The classification of cardiac function in the observation group was worse than that in the control group(P < 0.05). There was no difference in HDL-C, hs-CRP and LDL-C between the observation group and the control group, and the TG level in the observation group was higher than that in the control group(P < 0.05). The incidence of adverse events in the observation group was higher than that in the control group(P < 0.05). There was no difference in LVEF between the two groups at the time of admission and discharge, but the LVEF of the observation group was lower than that of the control group at the third month after discharge(P < 0.05). The recurrence rate and mortality of myocardial infarction in the observation group were higher than those in the control group within two years(P < 0.05).Conclusion The increased level of HbAlc may affect the incidence of adverse cardiac events in the patients with diabetes complicated with myocardial infarction, and reduce the prognostic survival rate of patients. Patients must actively control blood sugar, which can be helpful for the prevention of diabetic cardiovascular disease.
-
Key words:
- diabetes /
- myocardial infarction /
- glycated hemoglobin /
- cardiac function classification
-
-
表 1 2组患者一般资料比较
项目 对照组(n=32) 观察组(n=68) t/χ2 P 性别(男：女) 18：14 38：30 0.026 0.872 年龄/岁 60.34±15.28 59.47±14.19 0.279 0.781 BMI 24.42±1.26 24.39±1.41 0.103 0.918 血糖水平/(mmol/L) 11.78±2.84 12.04±3.12 0.400 0.690 心血管病史/例(%) 8(25.00) 17(25.00) ＜0.001 1.000 吸烟、饮酒/例(%) 9(28.13) 12(17.65) 1.079 0.299 血糖控制/例(%) 胰岛素 11(34.38) 25(36.76) 0.054 0.816 口服药 8(25.00) 15(22.06) 0.008 0.928 饮食控制 13(40.63) 16(23.53) 3.089 0.079 
下载: 导出CSV
表 2 2组患者血清指标检测比较
mmol/L，X±S 组别 HDL-C Hs-CRP LDL-C TG 对照组(n=32) 1.15±0.23 0.16±0.07 2.76±0.55 2.96±0.85 观察组(n=68) 1.12±5.02 0.17±0.09 2.93±0.72 3.57±0.96 t 0.514 0.663 0.756 -12.306 P 0.258 0.219 0.151 < 0.001
下载: 导出CSV
表 3 2组患者不同时期LVEF比较
% 组别 住院治疗前 出院时 出院后3个月 对照组(n=32) 42.36±3.41 50.16±4.58 49.52±4.11 观察组(n=68) 43.58±4.06 49.67±4.25 46.24±3.86 t -1.472 0.525 3.883 P 0.144 0.601 < 0.001
下载: 导出CSV
-
[1] 王品, 郑振, 孙磊, 等. 2型糖尿病患者25(OH)VD3对血细胞指标和胰岛细胞自身抗体影响的研究[J]. 临床血液学杂志, 2021, 34(10): 713-717. doi: 10.13201/j.issn.1004-2806.2021.10.008
[2] 俞婷婷, 吴韩, 王昆. 非糖尿病STEMI患者直接PCI术后空腹血糖与微血管阻塞的相关性分析[J]. 临床心血管病杂志, 2022, 38(3): 197-201. doi: 10.13201/j.issn.1001-1439.2022.03.007
[3] 陈振飞, 方曹阳, 张静, 等. 血清YKL-40联合CHA2DS2-VASc-HSF评分在急性ST段抬高型心肌梗死诊断中的价值[J]. 临床心血管病杂志, 2022, 38(8): 643-648. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202208015.htm
[4] Alkharaiji M, Anyanwagu U, Donnelly R, et al. Effect of bariatric surgery on cardiovascular events and metabolic outcomes in obese patients with insulin-treated type 2 diabetes: a retrospective cohort study[J]. Obes Surg, 2019, 29(10): 3154-3164. doi: 10.1007/s11695-019-03809-4
[5] Park JJ, Kim SH, Kim MA, et al. Effect of hyperglycemia on myocardial perfusion in diabetic Porcine models and humans[J]. J Korean Med Sci, 2019, 34(29): e202. doi: 10.3346/jkms.2019.34.e202
[6] Nyström T, Sartipy U, Contardi A, et al. Glycated hemoglobin A1c levels in type 1 diabetes mellitus and outcomes after myocardial infarction[J]. Circulation, 2019, 139(20): 2380-2382. doi: 10.1161/CIRCULATIONAHA.118.039223
[7] Biancari F, Giordano S. Glycated hemoglobin and the risk of sternal wound infection after adult cardiac surgery: a systematic review and meta-analysis[J]. Semin Thorac Cardiovasc Surg, 2019, 31(3): 465-467. doi: 10.1053/j.semtcvs.2019.02.029
[8] Tripolt NJ, Kolesnik E, Pferschy PN, et al. Impact of EMpagliflozin on cardiac function and biomarkers of heart failure in patients with acute MYocardial infarction-The EMMY trial[J]. Am Heart J, 2020, 221: 39-47. doi: 10.1016/j.ahj.2019.12.004
[9] Robich MP, Iribarne A, Leavitt BJ, et al. Intensity of glycemic control affects long-term survival after coronary artery bypass graft surgery[J]. Ann Thorac Surg, 2019, 107(2): 477-484. doi: 10.1016/j.athoracsur.2018.07.078
[10] Reaven PD, Emanuele NV, Wiitala WL, et al. Intensive glucose control in patients with type 2 diabetes-15-year follow-up[J]. N Engl J Med, 2019, 380(23): 2215-2224. doi: 10.1056/NEJMoa1806802
[11] Nauck MA, Meier JJ. MANAGEMENT OF ENDOCRINE DISEASE: are all GLP-1 agonists equal in the treatment of type 2 diabetes?[J]. Eur J Endocrinol, 2019, 181(6): R211-R234. doi: 10.1530/EJE-19-0566
[12] Husain M, Birkenfeld AL, Donsmark M, et al. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes[J]. N Engl J Med, 2019, 381(9): 841-851. doi: 10.1056/NEJMoa1901118
[13] Spence JD, Viscoli CM, Inzucchi SE, et al. Pioglitazone therapy in patients with stroke and prediabetes: a post hoc analysis of the IRIS randomized clinical trial[J]. JAMA Neurol, 2019, 76(5): 526-535.
[14] Sheng ZX, Zhou P, Liu C, et al. Relationships of coronary culprit-plaque characteristics with duration of diabetes mellitus in acute myocardial infarction: an intravascular optical coherence tomography study[J]. Cardiovasc Diabetol, 2019, 18(1): 136.
[15] Rawshani A, Rawshani A, Sattar N, et al. Relative prognostic importance and optimal levels of risk factors for mortality and cardiovascular outcomes in type 1 diabetes mellitus[J]. Circulation, 2019, 139(16): 1900-1912.
[16] Qin JY, Tian JL, Liu GH, et al. Association between 1p13 polymorphisms and peripheral arterial disease in a Chinese population with diabetes[J]. J Diabetes Investig, 2018, 9(5): 1189-1195.
[17] Rospleszcz S, Schafnitzel A, Koenig W, et al. Association of glycemic status and segmental left ventricular wall thickness in subjects without prior cardiovascular disease: a cross-sectional study[J]. BMC Cardiovasc Disord, 2018, 18(1): 162.
[18] Huang CJ, Wang WT, Sung SH, et al. Blood glucose reduction by diabetic drugs with minimal hypoglycaemia risk for cardiovascular outcomes: evidence from meta-regression analysis of randomized controlled trials[J]. Diabetes Obes Metab, 2018, 20(9): 2131-2139.
[19] Goncalves E, Bell DSH. Combination treatment of SGLT2 inhibitors and GLP-1 receptor agonists: symbiotic effects on metabolism and cardiorenal risk[J]. Diabetes Ther, 2018, 9(3): 919-926.
[20] Raghavan S, Liu WG, Ho PM, et al. Coronary artery disease severity modifies associations between glycemic control and both mortality and myocardial infarction[J]. J Diabetes Complications, 2018, 32(5): 480-487.
-