摘要
目的探讨空腹血糖水平与非瓣膜性心房颤动(NVAF)患者血栓栓塞事件发生的关系。方法本研究为前瞻性队列研究,研究数据来自多中心、前瞻性中国房颤注册队列研究,根据纳入及排除标准,连续纳入2011年8月至2018年12月北京市31家医院的NVAF患者18703例,根据患者入院时是否合并糖尿病及其空腹血糖水平,将患者分为5组,分别为血糖正常组、糖尿病前期组、血糖控制严格的糖尿病组、血糖控制一般的糖尿病组和血糖控制不佳的糖尿病组。患者入组后每6个月进行门诊或电话随访,主要随访终点为血栓栓塞事件,包括缺血性卒中和系统性栓塞;次要终点为心血管死亡和血栓栓塞事件的复合终点。采用Kaplan-Meier生存分析和多因素Cox回归分析空腹血糖水平与终点事件之间的相关性。结果纳入的18703例NVAF患者年龄(63.8±12.0)岁,男性11503例(61.5%)。其中血糖正常组11877例(63.5%)、糖尿病前期组2023例(10.8%)、血糖控制严格的糖尿病组1131例(6.0%)、血糖控制一般的糖尿病组811例(4.3%),血糖控制不佳的糖尿病组2861例(15.3%)。已经明确诊断为糖尿病的4803例患者中,严格控制血糖达标的患者共1131例(23.5%),其中血糖过低(入院时空腹血糖水平<4.4 mmol/L)的患者有328例(29.0%)。随访(51±23)个月,最长82个月,随访结束时984例(5.3%)患者发生血栓栓塞事件。Kaplan-Meier生存曲线分析显示,血糖正常组、糖尿病前期组、血糖控制严格的糖尿病组、血糖控制一般的糖尿病组和血糖控制不佳的糖尿病组的NVAF患者血栓栓塞事件发生率分别为1.10/100、1.41/100、2.09/100、1.46/100和1.71/100人年(χ^(2)=53.0,log-rankP<0.001);复合终点事件发生率分别为:1.86/100、2.17/100、4.08/100、2.58/100、3.16/100人年(χ^(2)=72.3,log-rankP<0.001);血栓栓塞事件和复合终点事件发生率其余4组均较血糖正常组高(P均<0.001)。多因素Cox回归分析显示,与血糖正常�
Objective To explore the relationship between fasting blood glucose level and thromboembolism events in patients with non-valvular atrial fibrillation(NVAF).Methods This was an observational study based on data from a multicenter,prospective Chinese atrial fibrillation registry cohort,which included 18703 consecutive patients with atrial fibrillation(AF)in 31 hospitals in Beijing from August 2011 to December 2018.Patients were divided into 5 groups according to status of comorbid diabetes and fasting glucose levels at admission:normal blood glucose(normal glucose group),pre-diabetes group,strict glycemic control group,average glycemic control group and poor glycemic control group.Patients were followed up by telephone or outpatient service every 6 months.The primary follow-up endpoint was thromboembolic events,including ischemic stroke and systemic embolism.The secondary endpoint was the composite endpoint of cardiovascular death and thromboembolic events.Kaplan-Meier survival analysis and multifactorial Cox regression were used to analyze the correlation between fasting glucose levels and endpoint events.Results The age of 18703 patients with NVAF was(63.8±12.0)years,and there were 11503(61.5%)male patients.There were 11877 patients(63.5%)in normal blood glucose group,2023 patients(10.8%)in pre-diabetes group,1131 patients(6.0%)in strict glycemic control group,811 patients in average glycemic control group and 2861 patients(4.3%)in poor glycemic control group.Of the 4803 diabetic patients,1131 patients(23.5%)achieved strict glycemic control,of whom 328(29.0%)were hypoglycemic(fasting blood glucose level<4.4 mmol/L at admission).During a mean follow-up of(51±23)months(up to 82 months),thromboembolic events were reported in 984 patients(5.3%).The survival curve analysis of Kaplan Meier showed that the incidence rates of thromboembolic events in normal glucose group,pre-diabetes group,strict glycemic control group,average glycemic control group and poor glycemic control group were 1.10/100,1.41/100,2.09/100,1.46/
作者
薄小雯
左嵩
蒋超
何柳
赵欣
李松南
汤日波
龙德勇
杜昕
董建增
马长生
Bo Xiaowen;Zuo Song;Jiang Chao;He Liu;Zhao Xin;Li Songnan;Tang Ribo;Long Deyong;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing 100029,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2022年第3期243-248,共6页
Chinese Journal of Cardiology
基金
国家重点研发计划(2020YFC2004803)
国家自然科学基金(82000322)。
关键词
心房颤动
空腹血糖升高
血栓栓塞
Atrial fibrillation
Fasting blood glucose elevation
Thromboembolism
