2型糖尿病患者糖化血红蛋白水平与内皮功能评估指数的相关性

目的探讨糖化血红蛋白(HbA1c)与反应性充血指数(RHI)的相关性。方法入选2017年1月至2019年2月南京医科大学第一附属医院内分泌科收治的2型糖尿病患者608例,住院期间所有患者均使用Endo-PAT无创血管内皮功能检测技术计算出评估指数RHI。根据RHI结果分组,RHI≥1.67为对照组,RHI<1.67为观察组;根据HbA1c水平分为HbA1c<7%组、HbA1c 7%~9%组和HbA1c>9%组。比较各组的一般资料、生化指标、血糖及胰岛素抵抗指标等。采用Spearman相关性分析评估HbA1c与RHI相关性;采用多元线性回归分析影响内皮功能的因素,评估HbA1c与RHI的关系。结果与对照组相比,观察组HbA1c明显增高(P=0.001),而年龄、体质量指数、血脂、血糖、稳态模型胰岛素抵抗指数、稳态模型胰岛β细胞功能指数等无统计学意义(P>0.05)。不同HbA1c亚组间随HbA1c水平升高RHI降低(P=0.004)。Spearman相关分析提示2型糖尿病患者HbA1c与RHI呈明显负相关,多因素回归和logistic回归分析显示HbA1c是血管内皮功能评估指数的独立显著预测因子(OR=0.864,95%CI 0.786~0.950,P=0.002)。结论对于2型糖尿病患者,通过检测HbA1c可以评估近期内皮功能情况;通过积极控制血糖水平,可改善其血管内皮功能障碍,从而降低周围血管等靶器官损害和预防心血管事件。

Relationship between glycosylated hemoglobin A1c and vascular endothelial function assessment hyperemia index in patients with type 2 diabetes mellitus

Objective To investigate the correlation between glycosylated hemoglobin A1c(HbA1c)and reactive hyperemia index(RHI)in the patients with type 2 diabetes mellitus(T2DM).Methods A total of 608 T2DM patients admitted to the Endocrinology Department of First Affiliated Hospital of Nanjing Medical University from January 2017 to February 2019 were enrolled in this study.During the hospitalization,all patients were evaluated by using Endo-PAT non-invasive vascular endothelial function detection technology to calculate RHI.The patients with RHI≥1.67 were assigned into the control group,and those with RHI<1.67 were into the study group.According to the HbA1c level,they were divided into HbA1c<7%group,HbA1c 7%-9%group and HbA1c>9%group.Their general data,biochemical indices,blood glucose level and insulin resistance index were compared among the groups.Spearman correlation analysis was used to evaluate the correlation between HbA1c and RHI.The relationship was evaluated by multiple linear regression analysis on the factors affecting endothelial function.Results HbA1c level was significantly higher in the study group than in the control group(P=0.001),but no statistical significances were seen in age,body mass index,blood lipid,blood glucose,and homeostatic model assessment of insulin resistance(HOMA-IR)and ofβ-cell function(HOMA-β)between two groups.With the increase of HbA1c,RHI was decreased in the groups of different HbA1c level(P=0.004).Spearman correlation analysis showed that HbA1c level was negatively correlated with RHI in T2DM patients,and multivariate regression and logistic regression analysis indicated that HbA1c was an independent and significant predictor for vascular endothelial function assessment index(OR=0.864,95%CI 0.786-0.950,P=0.002).Conclusion For T2DM patients,HbA1c can be used to evaluate the recent endothelial function.Actively controlling the blood glucose can improve vascular endothelial dysfunction,and thus the damage to peripheral vessels and other target organs will be thereby reduced and cardiovascular events be prevented.