10年来HbA1c的终端轨迹支持HbA1c悖论:使用健康和退休研究数据的纵向研究
Zeyi Zhang1, Longshan Yang2, Heng Cao1
1Department of Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
高和低的血红蛋白A1c (HbA1c) 水平显示出与老年人死亡风险的复杂关联. 这项研究表明反向因果关系,下降的HbA1c可能表明即将死亡,不一定导致死亡.
科学领域:
- 老年学是一门学科.
- 内分泌学 在内分泌学.
- 流行病学 流行病学
背景情况:
- 用血红蛋白A1c (HbA1c) 测量的血糖控制对于管理糖尿病和预测健康结果至关重要.
- 了解HbA1c与老年人群死亡率之间的关系对于临床实践和公共卫生战略至关重要.
研究的目的:
- 研究50岁及以上个体的HbA1c水平与全因死亡率之间的动态关联.
- 分析HbA1c在死亡前几年的终端轨迹,以阐明潜在的潜在机制.
主要方法:
- 一项使用健康和退休研究 (HRS) 数据的纵向研究,涉及10,408名年龄≥50岁的参与者.
- 使用受限制立方线的考克斯回归评估了HbA1c与随时间推移的死亡率的关联,而线性混合效应模型则使用逆向时间尺度分析了终端HbA1c轨迹.
主要成果:
- 与最高HbA1c四分位数相关的死亡风险随着更短的随访期而减少.
- 相反,最低HbA1c四分位数在较短的随访期间显示死亡风险增加.
- 患有糖尿病和没有糖尿病的死者在死亡前5-6年表现出HbA1c的加速下降.
结论:
- HbA1c与死亡率之间的关联是随时间变化的,并且与HbA1c的终端下降有关.
- 高和低的HbA1c水平都可能对死亡风险产生明显的临床影响.
- 反向因果关系,即HbA1c的前终性下降反映了早期死亡的表现,可能解释了观察到的"HbA1c悖论".
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