2021 年第 1 期 第 16 卷

糖化血红蛋白变异指数与糖尿病合并血管病变发生风险的相关性研究

Study on the correlation between glycated hemoglobin variation index and the risk of diabetes complicated with vascular diseases

作者：郝鑫琳万沁柳怡莹蒋玥芾

英文作者：Hao Xinlin Wan Qin Liu Yiying Jiang Yuefei

单位：西南医科大学附属医院内分泌科，四川省泸州市646000

英文单位：Department of Endocrinology Affiliated Hospital of Southwest Medical University Sichuan Province Luzhou 646000 China

关键词：糖尿病；糖尿病血管病变；糖化血红蛋白变异指数

英文关键词：Diabetesmellitus;Diabeticvasculopathy;Glycosylatedhemoglobinvariationindex

• 摘要：

• 目的 探讨糖化血红蛋白变异指数(HGI)与糖尿病合并血管病变发生风险的相关性。方法 选取2017年9月至2019年5月于西南医科大学附属医院内分泌科就诊的916例糖尿病患者为研究对象，根据患者是否合并血管病变分为单纯糖尿病组(448例)和糖尿病合并血管病变组(468例)。比较2组体重指数、空腹血糖、糖化血红蛋白（HbA1c）、血压、内脏脂肪面积(VFA)、血脂、HGI、肱踝脉搏波传导速度(baPWV)等相关指标；同时将患者按照HGI三分位数法分为低HGI组(HGI≤-1.392%，306例)、中HGI组(-1.392%<HGI≤0.589%，305例)和高HGI组(HGI>0.589%，305例)，进而采用Logistic回归分析方法评估不同HGI水平与糖尿病合并血管病变发生风险的关系。结果糖尿病合并血管病变组HbA1c、收缩压、舒张压、VFA、HGI、baPWV明显高于/大于单纯糖尿病组，差异均有统计学意义(均P＜0.05)。Logistic回归分析结果显示，HGI、VFA、baPWV是糖尿病合并血管病变的独立相关因素，糖尿病合并血管病变的发生风险随HGI、VFA、baPWV的增加而增加。受试者工作特征曲线评价HGI值对糖尿病合并血管病变发生的价值判断结果显示，曲线下面积为0.569(95%置信区间：0.532～0.606，P＜0.001)，当HGI取-1.627%时，约登指数达最大(0.100)，此时预测敏感度为75.4%，特异度为34.6%。与低HGI组相比，中HGI组以及高HGI组更容易发生糖尿病血管病变和糖尿病足病；与低HGI组相比，高HGI组更容易发生糖尿病视网膜病变(均P<0.05)。结论 HGI为糖尿病合并血管病变发生的独立预测因素，高HGI水平的糖尿病患者可能更易发生血管病变尤其是糖尿病足病、糖尿病视网膜病变，HGI有望用于糖尿病患者发生血管病变的个性化风险评估和预测。

• Objective To explore the correlation between the glycated hemoglobin variation index(HGI) and the risk of diabetes complicated with vascular disease, and the role of HGI in predicting the risk of diabetes. Methods Totally 916 diabetic patients who were treated at the Department of Endocrinology, Affiliated Hospital of Southwest Medical University from September 2017 to May 2019 were collected as research objects. They were divided into simple diabetes group(448 cases) and diabetic combined with vascular disease group(468 cases). Body mass index, fasting blood glucose, glycaemic hemoglobin (HbA1c), blood pressure, visceral fat area (VFA), blood fat, HGI, and brachial ankle pulse wave conduction velocity (baPWV) were compared between the two groups. Meantime, the patients were divided into low HGI group(HGI≤-1.392%, 306 cases), middle HGI group(-1.392<HGI≤0.589%, 305 cases) and high HGI group(HGI>0.589%, 305 cases). Logistic regression analysis was used to evaluate the relationship between different HGI levels and the risk of diabetic vascular lesions.Results The HbA1c, systolic blood pressure, diastolic blood pressure, VFA, HGI and baPWV in the diabetic combined vascular disease group were significantly higher than those in the simple diabetes group(all P＜0.05). Logistic regression analysis showed that HGI, VFA and baPWV were independent correlated factors of diabetes complicated with vascular disease, and the risk of diabetic complicated with vascular disease increased with the increasing of HGI, VFA and baPWV. Receiver operating characteristic curve was used to evaluate the value of HGI value in the occurrence of diabetes complicated with vascular disease, and the result showed that the area under curve was 0.569(95% confidence interval: 0.532-0.606, P<0.001), When HGI was -1.627%, the Youden′s index reached the maximum(0.100). At this time, the predicted sensitivity was 75.4% and the specificity was 34.6%. Compared with low HGI group, middle and high HGI groups were more prone to present with diabetic vascular disease and diabetic foot disease, and high HGI group was more prone to have diabetic retinopathy (all P<0.05). Conclusions  HGI is an independent predictor for the development of diabetes with vascular disease. Diabetic patients with high HGI levels may be more prone to develop vascular disease, especially diabetic foot disease and diabetic retinopathy. HGI is expected to be used for individualized risk assessment and prediction of angiopathy in diabetic patients.