2型糖尿病合并慢性心力衰竭患者糖化血红蛋白与N末端B型钠尿肽原的相关性分析  

Analyzing the correlation between glycosylated hemoglobin and N-terminal pro-brain B-type natriuretic peptides in type 2 diabetes mellitus patients with chronic heart failure

作　　者：余颖[1] 饶祖华[1] 江淼[1] 张波庆 

机构地区：[1]浙江省衢州市常山县人民医院综合科,浙江省衢州324200

出　　处：《中国慢性病预防与控制》2015年第10期733-735,738,共4页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：浙江省医药卫生一般研究计划(2014KYB304)

摘　　要：目的探讨2型糖尿病（T2DM）合并慢性心力衰竭患者糖化血红蛋白（Hb A1C）与N末端B型钠尿肽原（NT-pro BNP）相关性。方法选取2013年6月至2014年12月我院收治的126例T2DM合并慢性心力衰竭患者为研究对象,测定所有患者入院时的Hb A1C、空腹血糖（FPG）及NT-pro BNP,记录入院24 h内的心脏超声指标。按照Hb A1C的控制水平将所有患者分为4组：A组为Hb A1C〈7.0%（54例）,B组为7.0%~8.0%（29例）,C组为8.1%~9.0%（23例）,D组为〉9.0%（20例）;同时将所有患者NT-pro BNP水平按照中位数（本研究中NT-pro BNP水平的中位数为2 225.1 pg/ml）分为2组：Ⅰ组（NT-pro BNP〈2 225.1 pg/ml）、Ⅱ组（NT-pro BNP≥2 225.1 pg/ml）,每组63例,比较两组相关指标的差异。结果从A组到D组糖尿病病程依次延长,分别为（14.1±3.2）、（15.9±3.6）、（18.3±4.0）和（21.1±4.4）年,FPG及NT-pro BNP、左室舒张末期内径（LVEDD）逐渐增高,而左室射血分数（LVEF）逐渐降低,4组相关指标比较,差异均有统计学意义（P〈0.05,P〈0.01）。Ⅱ组患者的Hb A1C、FPG[分别为7.9%±1.7%、（9.4±2.4）mmol/L]高于Ⅰ组[分别为6.6%±1.3%、（6.5±1.5）mmol/L],糖尿病病程[（18.1±3.7）年]长于Ⅰ组[（15.5±3.0）年],Hb A1C水平控制情况亦差于Ⅰ组,两组间比较,差异均有统计学意义（P〈0.05,P〈0.01）。Pearson相关分析显示,糖尿病病程、Hb A1C水平、FPG和LVEDD与NT-pro BNP呈正相关（r值分别为0.316、0.412、0.389和0.274,P〈0.05）;多元回归分析显示,Hb A1C水平、糖尿病病程、LVEF和FPG是影响NT-pro BNP水平的独立危险因素。结论 Hb A1C水平控制情况与T2DM合并慢性心力衰竭患者心功能密切相关,临床应当积极控制Hb A1C水平进而提高心衰患者血糖达标率,对延缓心功能恶化,提高患者预后具有重要意义。Objective To explore the correlation between glycosylated hemoglobin（Hb A1C） and N-terminal pro-brain B-type natriuretic peptides（NT-pro BNP） in type 2 diabetes mellitus（T2DM） patients with chronic heart failure. Methods From June of2013 to December of 2014, 126 T2 DM patients with chronic heart failure in changshan hospital were selected as the subjects,Hb A1 C, FPG and NT-pro BNP on admission were detected, echocardiogram indexes were also recorded within 24 h after admission.All subjects were divided into A group（54 cases, Hb A1C： 7.0%）, B group（29 cases, Hb A1C： 7.0%-8.0%）, C group（23 cases,Hb A1C： 8.1%-9.0%） and D group（20 cases, Hb A1C： 9.0%） according to Hb A1 Clevels. According to the median（2 225.1 pg/ml）of NT-pro BNP levels, all subjects were divided into Ⅰ group（63 cases, NT-pro BNP levels 2 225.1 pg/ml） and Ⅱ group（63cases, NT-pro BNP levels ≥ 2 225.1 pg/ml）. The differences of related indicators between two groups were compared. Results The courses of disease in A-D groups were 14.1±3.2, 15.9±3.6, 18.3±4.0 and 21.1±4.4 years, respectively; also FPG, NT-pro BNP and left ventricular end-diastolic diameter（LVEDD） increased significantly with disease courses; the left ventricular ejection fractions（LVEF） in A-D groups decreased significantly with disease courses. There were significant differences of 4 related indicators in 4 groups（P〈0.05）. Hb A1 Cand FPG（7.9%±1.7% and 9.4±2.4 mmol/L） inⅡgroup were significantly higher than those（6.6%±1.3% and 6.5±1.5 mmol/L） inⅠgroup; the diabetes duration（18.1±3.7 years） in Ⅱgroup was significantly higher than that（15.5±3.0 years） inⅠgroup（P〈0.05）. Pearson correlation analysis showed that there were positive correlations among Hb A1 C, FPG, LVEDD and NT-pro BNP（r values were 0.316, 0. 412, 0.389 and 0.274, respectively, P〈0.05）. Multiple regression analysis indicated that Hb A1 Clevel, diabetes duration, LVEF and FPG were independent influencing factors fo

关 键 词：糖尿病 2型 心力衰竭 N末端B型钠尿肽原 糖化血红蛋白 

分 类 号：R587.1[医药卫生—内分泌]