糖尿病血液透析患者的血糖控制和心血管事件
Christiane Drechsler1, Vera Krane, Eberhard Ritz
1Department of Medicine, Division of Nephrology, University Hospital, Oberdürrbacherstrasse 6, D-97080 Würzburg, Germany. c.drechsler@gmx.net
Circulation
|December 2, 2009
概括
低血糖控制显著增加糖尿病血液透析患者突然心脏死亡的风险. 这种风险增加有助于整体心血管事件和死亡率,强调需要更好地管理血糖.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
背景情况:
- 维持透析的患者面临高死亡率,主要是心脏突然死亡.
- 血糖控制不佳是一般人群心血管疾病的已知危险因素.
- 本研究研究了糖尿病血液透析患者的血糖控制和心脏/血管结果之间的联系.
研究的目的:
- 研究血糖控制对心脏和血管结果的影响.
- 评估糖尿病血液透析患者的HbA1c水平与特定不良事件之间的关联.
- 为了确定血糖控制不良是否预测心脏突然死亡,心肌梗塞,中风或全因死亡率.
主要方法:
- 德国糖尿病和透析研究 (4D研究) 包括1255名糖尿病血液透析患者.
- 葡萄糖血红蛋白A1c (HbA1c) 在基线测量.
- 考克斯回归分析被用来确定预定义终点的危险比率,平均随访时间为4年.
主要成果:
- 与HbA1c ≤6%的患者相比,HbA1c>8%的患者患心脏突然死亡的风险超过两倍.
- 每增加1%的HbA1c与突然死亡风险上升18%,心血管事件和死亡率上升8%有关.
- 心肌梗塞风险没有显著影响,但趋势表明中风和心力衰竭死亡风险更高.
结论:
- 血糖控制不良与糖尿病血液透析患者的突然心脏死亡有很强的联系.
- 由于血糖控制不佳导致的突然心脏病死亡,导致心血管事件和死亡率增加.
- 需要进一步的研究,以确定密集的血糖控制是否能减少这一群体的突然心脏病死亡.
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