冠状动脉旁路移植术患者中术前血浆HbA1c水平预测术后房颤发生率的研究  

Preoperative Hemoglobin A1c Predicts Atrial Fibrillation after Coronary Artery Bypass Grafting Procedure

作　　者：荆朝辉[1] 李明秋[1] 荣晓松[1] 

机构地区：[1]南京医科大学附属无锡市人民医院心脏外科,江苏省无锡市214023

出　　处：《医学理论与实践》2016年第2期141-143,共3页The Journal of Medical Theory and Practice

摘　　要：目的：分析冠状动脉旁路移植术（CABG）患者术前H b A1c水平与术后房颤（AF）发生率之间的关系。方法：选取本中心连续的397例CABG患者进入本研究样本。根据血浆糖化血红蛋白（Hb A1c）水平将这些病例分组为：低值组,H b A1c在3.8%~5.6%（142例）,中值组5.7%~6.7%（141例）;高值组6.8%~11.4%（114例）,统计其不同分组间的房颤发生率并与术前Hb A1c分组进行相关性分析。结果：术后共有78例发生房颤（19.6%）。在低值组,术后房颤的发生率为28.2%（40/142）,中值组为17.0%（24/141）,高值组为12.3%（14/114）（P=0.01）。二者之间联系95%可信区间为0.7（0.61~0.83）。高值组与低值组比率为0.42。术前血浆H b A1c水平作为预测术后房颤发生率95%可信区间为0.7（0.65~0.75）（P=0.01）。结论 ：术前Hb A1c的水平能够独立预测CABG患者术后房颤的发生率,并制定一定的策略来降低由Hb A1c预测的术后高发人群的AF发生率。Objective： To investigate the association between preoperative hemoglobin Alc and atrial fibrillation （AF） after coronary artery bypass grafting. Methods： 397 consecutive patients undergoing isolated coronary bypass surgery were selected. We categorized hemoglobin Alc levels into three tertiles. The cutoff points for the tertiles were as follows：lower,3. 8%-5.6%（n=142）;middle, 5.7-6. 7%（n=141）;upper,6.8-11.4%（n=114）. Results： AF occurred in 78 patients （19.6%） after surgery. The incidence of postoperative AF was 28. 2%（40/142） in the lower tertile, 17. 0% （14/141 ） in the middle tertile, and 12. 3 % （14/114） in the upper tertile （P for trend = 0. 01）. The unadjusted odds ratio （95% confidence interval） for the association between hemoglobin Alc and postoperative AF was 0. 70 （0. 61-0. 83）and 0. 42（0. 29-0. 70） for the upper versus the lower tertile. The area under the receiver operator characteristic curve （95% confidence interval） for preoperative hemoglobin Alc as a predictor of postoperative AF was 0. 70 （0. 65-0. 75）（P=0. 01）. Conclusion： Preoperative hemoglobin Alc independently predicts the occurrence of AF after isolated on-pump coronary bypass grafting.

关 键 词：房颤 糖化血红蛋白 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]