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糖化血红蛋白水平是1型糖尿病视网膜病变和肾病的危险因素
作者:小柯机器人 发布时间:2019/8/29 17:12:41

2019年8月28日,瑞典哥德堡大学Marcus Lind课题组在《英国医学杂志》在线发表论文,宣布他们发现糖化血红蛋白水平可作为儿童和成人1型糖尿病视网膜病变和肾病的危险因素。

10398名患有1型糖尿病的儿童和成人参与了该项研究,他们的平均年龄为14.7岁,女性占43.4%,平均病程为1.3年,平均HbA1c水平为8.0%。对年龄、性别、病程、血压、血脂水平、体重指数和吸烟等因素进行校正后,对任何视网膜病变而言平均HbA1c<6.5%与6.5-6.9%的优势比为0.77,增殖前糖尿病视网膜病变或更糟者为3.29,增殖性糖尿病视网膜病变为2.48,微量白蛋白尿或更糟者为0.98,大蛋白尿为2.47。

与HbA1c水平6.5-6.9%相比,HbA1c水平7.0-7.4%增加了任何视网膜病变(1.31)和微量白蛋白尿(1.55)的风险。HbA1c水平>8.6%时,增殖性视网膜病变(5.98)和大蛋白尿(3.43)的风险显著增加。平均HbA1c<6.5%时,与6.5-6.9%相比,严重低血糖的风险增加,相对风险为1.34。

HbA1c水平<6.5%时,与6.5-6.9%相比,视网膜病变和肾病的风险相差不大,但严重低血糖的风险显著增高。HbA1c水平>8.6%时容易发生严重并发症,HbA1c水平>7.0%时易发生较轻的并发症。

据介绍,1型糖尿病是儿童糖尿病的主要形式,其特征是胰岛素缺乏导致血糖水平升高。

附:英文原文

Title: HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study

Author: Marcus Lind, professor, Aldina Pivodic, statistician, Ann-Marie Svensson, associate register director, Arndis F Ólafsdóttir, diabetes nurse, Hans Wedel, professor, Johnny Ludvigsson, professor

Issue&Volume: 28 August 2019

Abstract: 

Objective To evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes.

Design Population based cohort study.

Setting Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017.

Participants 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017.

Main outcome measures Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c.

Results Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005).

Conclusions Risk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.

DOI: https://doi.org/10.1136/bmj.l4894

Source: https://www.bmj.com/content/366/bmj.l4894

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj