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JACC:糖化血红蛋白水平与肌钙蛋白呈线性正相关

约翰霍普金斯大学彭博学院公共卫生及流行病学系Jonathan Rubin博士在Journal of the American College of Cardiology2012年第5期上发表研究称,糖化血红蛋白的基线水平与肌钙蛋白呈线性正相关。

HbA1c作为慢性高血糖的指标,与冠心病的发生和全因死亡率增加相关。但是,慢性高血糖与亚临床冠心病的关系还不明确。

研究者从ARIC(社区中的动脉粥样硬化风险)研究的观测性数据中发现长期高血糖与无冠心病或心衰临床迹象参与者的T型肌钙蛋白水平相关。以连续变量建模的糖化血红蛋白基线水平被划分为3组:<5.7%,5.7%-6.4%,和≥6.5%。用能测出低于临床阈值水平的高敏检测方法记录6年后的肌钙蛋白水平。研究者得出初始模型后,加入体重指数、受教育程度、收缩压和舒张压、吸烟史、低密度脂蛋白和高密度脂蛋白、酒精依赖程度、高血压药物服用情况、左心室肥大程度、糖尿病病史、预计肾小球滤过率和快速血糖等变量作校正。同时他们深入分析后剔除了未进行测量潜在混杂因素,比如房颤,低预计肾小球滤过率,肌钙蛋白监测前的中风和监测6月后冠脉事件等。

研究者发现糖化血红蛋白的基线水平与肌钙蛋白呈线性正相关。从肌钙蛋白水平看,糖化血红蛋白≥ 6.5%和在5.7%-6.4%区间者比糖化血红蛋白< 5.7%的人要高近70%和25%。在校正后的模型里,糖化血红蛋白水平每升高一个百分点,肌钙蛋白就相应升高0.7ng/L(95%可信区间, 0.5-1.0; P 值< 0.001)。与糖化血红蛋白< 5.7%者相比,高糖化血红蛋白会使肌钙蛋白明显升高(≥14.0ng/L)。校正除快速血糖外所有的危险因子后,糖化血红蛋白在5.7%-6.4%水平的人出现肌钙蛋白升高可能性要大26%(优势比1.26; 95%可信区间, 1.01-1.56),而糖化血红蛋白≥6.5%的人出现肌钙蛋白升高可能性要大2倍(优势比, 1.97; 95%可信区间, 1.44-2.70)。

文献出处:

Chronic hyperglycemia and subclinical myocardial injury.

J Am Coll Cardiol 2012;595:484-9

Rubin J Matsushita K Ballantyne CM Hoogeveen R Coresh J Selvin E

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.

Abstract

The purpose of this study was to examine the association between hyperglycemia and subclinical myocardial injury in persons without clinically evident coronary heart disease (CHD). Hyperglycemia is associated with an increased risk of cardiac events, but limited information is available on its relationship to subclinical myocardial damage. Elevated cardiac troponin T even below traditional detection levels can be detected by a novel high-sensitivity assay. We examined the association between baseline glycated hemoglobin (HbA1c) and high-sensitivity cardiac troponin T (hs-cTnT) in 9,661 participants free of CHD and heart failure in the ARIC (Atherosclerosis Risk in Communities) study. Multivariable logistic regression models characterized the association between clinical categories of HbA1c (&lt;5.7%, 5.7% to 6.4%, and ≥6.5%) and our primary outcome of elevated hs-cTnT (≥14 ng/l). Higher baseline values of HbA1c were associated in a graded fashion with elevated hs-cTnT (p for trend &lt; 0.001). After adjusting for traditional risk factors, compared to persons with HbA1c &lt;5.7%, the odds ratios of elevated hs-cTnT for persons with HbA1c 5.7% to 6.4% and ≥6.5% were 1.26 (95% confidence interval: 1.01 to 1.56) and 1.97 (95% confidence interval: 1.44 to 2.70), respectively. Higher HbA1c is associated with elevated hs-cTnT among persons without clinically evident CHD, suggesting that hyperglycemia contributes to myocardial injury beyond its effects on development of clinical atherosclerotic coronary disease.

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