老年男性2型糖尿病患者糖化血红蛋白与全因死亡风险的相关性分析  

Association between glycated hemoglobin A1c and all-cause mortality risk in older men with type 2 diabetes mellitus

作　　者：苗新宇[1] 姚尧 杨帆[3] 胡帆[1] 闫双通[1] 李春霖[1] 田慧[1] Miao Xinyu;Yao Yao;Yang Fan;Hu Fan;Yan Shuangtong;Li Chunlin;Tian Hui(Department of Endocrinology,the Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Center for Healthy Aging and Development Studies,National School of Development,Peking University,Beijing 100871,China;Department of Pharmacy,Medical Security Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心内分泌科,北京100853 [2]北京大学国家发展研究院健康老龄与发展研究中心,100871 [3]解放军总医院第一医学中心药剂室,北京100853

出　　处：《中华糖尿病杂志》2020年第10期802-807,共6页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：军队保健专项科研课题(19BJZ29);国家重点研发计划(2018YFC2000400);国家自然科学基金(81774119,81903392,81941021);中国博士后科学基金(2019M650359)。

摘　　要：目的分析保健条件良好的老年男性2型糖尿病患者糖化血红蛋白(HbA1c)与10年全因死亡风险的关系。方法长期在解放军总医院第二医学中心年度体格检查人群中,选取2008年年龄≥60岁,2型糖尿病病程平均10.4年的老年男性患者256例,其中完成10年随访者233例,按HbA1c水平进行三分位数分组(包括:最低组为HbA1c<6.2%;中间组为HbA1c 6.2%~6.8%;最高组为HbA1c>6.8%),采用Kaplan-Meier生存曲线比较基线不同HbA1c水平随访10年的生存率,采用Cox比例风险回归分析并根据限制性样条回归模拟基线HbA1c与患者全因死亡风险的相关性。结果 (1)调查对象平均年龄(78.1±8.6)岁,基线HbA1c最低组、中间组和最高组的老年糖尿病患者10年生存率分别为66.3%、63.9%和51.3%,组间差异具有统计学意义(P<0.01);(2)Cox比例风险回归分析发现基线HbA1c水平与全因死亡风险呈正相关,基线HbA1c每升高1个单位(1%),全因死亡风险升高至1.33倍(95%可信区间为1.08~1.65);校正年龄、体质指数、吸烟、饮酒、血压、合并症、用药治疗、空腹血糖、血红蛋白、血尿酸、血脂、肝功、肾小球滤过率等混杂因素后,基线HbA1c每升高1个单位(1%),患者10年全因死亡风险升高至1.55倍(95%可信区间为1.20~2.02);(3)限制性样条Cox回归拟合曲线显示,基线HbA1c≤6.5%组患者死亡风险最低,当基线HbA1c>6.5%时,随着HbA1c水平的升高,患者10年全因死亡风险逐步升高,趋势具有统计学意义。结论在一组保健条件良好的老年男性2型糖尿病患者中,基线HbA1c水平与10年全因死亡风险呈正相关。当HbA1c ≤6.5%时10年死亡风险最低,提示老年2型糖尿病患者亦能从良好血糖控制中获益。Objective To evaluate the longitudinal association of glycated hemoglobin A1c(HbA1c)and 10-year all-cause mortality in a group of older men with type 2 diabetes mellitus(T2DM)and favorable health care.Methods A total of 256 older male patients(≥60 years old)with course of T2DM for an average of 10.4 years were selected from an annual physical examination population from a Beijing upper first-class hospital in 2008,and 233 of them finished the follow-up.All patients were grouped according to the tertile of HbA1c levels(the lowest HbA1c group:HbA1c<6.2%;the intermediate HbA1c group:HbA1c 6.2%-6.8%;the highest HbA1c group:HbA1c>6.8%).Kaplan-Meier survival curve was used to compare 10-year survival rates of patients with different baseline HbA1c levels.Cox hazards regression analysis with restricted spline were implemented to investigate the association of baseline HbA1c level and 10 years all-cause mortality risk.Results The mean age of the participants was(78.1±8.6)years old.The 10-year survival rates of those who were in the lowest,intermediate,and highest HbA1c groups were 66.3%,63.9%,and 51.3%,respectively(P<0.01).Cox proportional hazards regression analysis showed that the baseline HbA1c level was positively associated with 10 years all-cause mortality risk,and the univariate hazard ratio was 1.33(95%confidence interval:1.08-1.65)for each unit(1%)increase of baseline HbA1c level.After adjustment for confounders including age,body mass index,smoking,alcohol consumption,blood pressure,complications,medications,fasting blood glucose,hemoglobin,serum uric acid,blood lipids,liver function and estimated glomerular filtration rate,the hazard ratio of the 10-year all-cause mortality risk was 1.55(95%confidence interval:1.20-2.02)for every unit(1%)increase of baseline HbA1c level.Restricted spline Cox regression curve showed that patients with baseline HbA1c≤6.5%had the lowest 10 years mortality risk.When baseline HbA1c>6.5%,the 10-year all-cause mortality risk increased gradually with the increase of HbA1c level.C

关 键 词：糖尿病 2型 糖化血红蛋白 全因死亡 老年男性 

分 类 号：R587.1[医药卫生—内分泌]