2型糖尿病患者糖化血红蛋白指数与糖尿病心脏自主神经病变的相关性研究

目的:探讨2型糖尿病患者糖化血红蛋白指数（HGI）与糖尿病心脏自主神经病变（DCAN）的相关性及HGI在DCAN发病风险预测中的作用。方法:本研究为回顾性研究。选取2017年10月至2020 年5月在重庆医科大学附属第一医院内分泌科住院的993例2型糖尿病患者作为研究对象。收集所有患者的性别、年龄、糖尿病家族史、糖尿病...

Correlation between hemoglobin glycation index and diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus

Objective To explore the correlation between hemoglobin glycosylation index(HGI)and diabetic cardiovascular autonomic neuropathy(DCAN)in patients with type 2 diabetes and the role of HGI in predicting the risk of DCAN.Methods This study was a retrospective study.The clinical data of 993 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from October 2017 to May 2020 were selected.The patients′gender,age,family history of diabetes,diabetes duration,systolic blood pressure and diastolic blood pressure,body mass index(BMI),and other data were collected,and fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),blood lipids,serum creatinine,hypersensitive C-reactive protein(hs-CRP),and other indicators were detected,and the estimated glomerular filtration rate(eGFR)was calculated.The 24-hour morning urine was collected for determination of urinary albumin creatinine ratio(UACR).Based on FPG and HbA1c,a linear regression equation was established and HGI was calculated.According to the HGI value,the patients were divided into three groups:low-HGI(L-HGI)group,medium-HGI(M-HGI)group,and high-HGI(H-HGI)group using the three-quantile method.One-way analysis of variance(ANOVA)and chi-square test were employed to analyze the differences of baseline data among three groups,multivariate logistic regression was used to analyze the risk factors of DCAN.Results Among the 993 patients with type 2 diabetes,there were 293 patients in the DCAN group and 700 patients in the non-DCAN(N-DCAN)group,and the incidence of DCAN was 29.5%(293/993).The incidence of DCAN in L-HGI group(331 cases),M-HGI group(331 cases),and H-HGI group(331 cases)was 15.1%(50/331),28.7%(95/331)and 44.7%(148/331),respectively.The incidence of DCAN increased with the increase of HGI level,and the difference between the three groups was statistically significant(χ2=69.50,P<0.01).The risk of DCAN in H-HGI group was 4.545 times higher than that in L-HGI group[95%confidence interval(CI)3.137 to 6.585,P<0.05],and the risk of DCAN in M-HGI group was 2.262 times higher than that in L-HGI(95%CI 1.541 to 3.320,P<0.05).Logistic regression analysis showed that the incidence of DCAN increased with the increase of HGI[odds ratio was 1.445(95%CI 1.281 to 1.629),P<0.01].After adjusting for age,family history of diabetes,FPG,HbA1c,hs-CRP,UACR>30 mg/g,eGFR,BMI,hypertension,and dyslipidemia confounding factors,HGI was an independent risk factor for DCAN(odds ratio was 1.578(95%CI 1.378 to 1.808),P<0.01].Conclusions HGI is closely related to the onset of the type 2 diabetes with DCAN.HGI testing is expected to be used for clinically personalized risk assessment and prediction of complications such as cardiovascular autonomic neuropathy in diabetic patients.