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糖尿病状况和心血管并发症非心脏手术中的风险:基于人口的队列研究
Yunxi Ji1, Zhihan Lyu2, Bin Cui1
1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
患有糖尿病前期或未诊断糖尿病的患者接受非心脏手术,面临更高的重大心血管不良事件 (MACE) 风险. 这凸显了血糖状况评估在手术风险分层中的重要性.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 在外科手术期间的医学.
背景情况:
- 糖尿病是手术患者心血管并发症的已知危险因素.
- 有限的数据存在于心脏外科手术中与糖尿病前期和未诊断的糖尿病相关的心血管风险.
- 血糖控制对于管理手术结果至关重要.
研究的目的:
- 研究不同糖化血红蛋白水平 (糖尿病前期,未诊断的糖尿病,已诊断的糖尿病) 与术后心血管风险之间的关联.
- 根据血糖状况,评估在接受非心脏手术的患者中主要心血管不良事件 (MACE) 的发生率.
- 为了确定MACE风险较高的特定患者亚组.
主要方法:
- 基于人口的队列研究,包括13,207名接受非心脏手术的患者.
- 患者被分为四组:非糖尿病,糖尿病前期,未诊断的糖尿病和已诊断的糖尿病.
- 主要终点:手术后30天的MACE. 二级终点:90天的术后MACE. 使用考克斯比例危险模型和卡普兰-梅尔曲线进行分析.
主要成果:
- 很大一部分患者患有糖尿病前期 (29.08%) 或未被诊断的糖尿病 (11.52%).
- 糖尿病前期 (HR 1.70),未诊断的糖尿病 (HR 2.36) 和已诊断的糖尿病 (HR 2.33) 与非糖尿病患者相比,与30天的MACE风险增加有关.
- 在90天后观察到类似的风险增加,性别和血糖状况之间有显著的相互作用.
结论:
- 许多接受非心脏手术的患者有糖尿病前期或未诊断的糖尿病.
- 这些血糖状态独立地与术后主要心血管不良事件的显著增加风险有关.
- 血糖状况是对非心脏手术的术后心血管风险评估的一个关键因素.
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