糖尿病前期及糖尿病患者与射血分数减低心力衰竭的危险关系  

Correlation between the heart failure with reduced ejection fraction and prediabetic patients as well as diabetic patients

作　　者：李真真[1] 赵正焱 LI Zhenzhen;ZHAO Zhengyan(Department of Endocrine and Geriatrics,The Seventh People’s Hospital of Zhengzhou City,Henan,Zhengzhou 450006,China)

机构地区：[1]河南省郑州市第七人民医院内分泌老年病科,450006

出　　处：《河北医药》2018年第21期3232-3236,共5页Hebei Medical Journal

摘　　要：目的观察糖尿病前期和糖尿病患者与射血分数减低心力衰竭之间的关系。方法观察827例心力衰竭和射血分数减低患者的临床结局,根据糖尿病病史和血糖状态[基线糖化血红蛋白(Hb A1c)<6. 0%、6. 0%～6. 4%或≥6. 5%]进行分组,应用Cox回归模型调整不良结局的已知预测因子。结果具有糖尿病病史患者(n=291,35. 2%)与无糖尿病病史患者比较,前者心力衰竭住院主要组成结局或心血管死亡率显著增高(调整风险比1. 38; 95%CI,1. 25～1. 52; P <0. 01)。Hb A1c检测结果显示111例(13. 2%)未诊断为糖尿病,210例(25. 4%)为糖尿病。未确诊糖尿病患者(Hb A1c> 6. 5%)和已知糖尿病患者与Hb A1c <6. 0%者相比风险比分别为[1. 39(1. 17～1. 64); P <0. 01]和[1. 64(1. 43～1. 87); P <0. 01]。糖尿病前期患者与Hb A1c <6. 0%者相比亦具有较高的风险[风险比1. 27(1. 10～1. 47); P <0. 01]。结论心力衰竭和射血分数减低患者,血糖异常十分多见,糖尿病前期与不良心血管结局较高危险相关。Objective To investigate the correlation between the heart failure(HF)with reduced ejection fraction and prediabetic patients as well as diabetic patients.Methods The clinical outcomes of 827 HF patients with decreased ejection fraction were observed,these patients divided into groups according to the medical history of diabetes mellitus and conditions of blood glucose[baseline glycosylated hemoglobin,(HbA1c)<6.0%,6.0%<HbA1c<6.4%,6.5%<HbA1c].The known predictive factors of adworse outcome was adjusted by means of Cox regression model.Results The major outcomes and cardiovascular mortality of HF patients with diabetes history(n=291,35.2%)were significantly higher than those of patients without diabetes history,with the adjusted risk ratio being 1.38,95%CI,1.25~1.52(P<0.01).The results of HbA1c detection showed that 111 cases(13.2%)were not diagnosed as diabetes mellitus,and 210 cases(25.4%)were diagnosed as diabetes mellitus.The relative risk ratio of diagnosis undetermined diabetes patients(HbA1c>6.5%)and diagnosis determined diabetes patients(HbA1c<6.0%)was[1.39(1.17~1.64),P<0.01]and[1.64(1.43~1.87),P<0.01],respectively.Moreover the risk ratio of prediabetic patients was significantly higher than that of patients with HbA1c<6.0%[risk ratio 1.27(1.10~1.47),P<0.01].Conclusion The abnormal blood glucose is common in patients with heart failure and reduced ejection fraction,and prediabetes is associated with higher risk of adverse cardiovascular outcome.

关 键 词：糖尿病 心力衰竭 预后 血糖 糖基化血红蛋白 

分 类 号：R587.1[医药卫生—内分泌]