评价糖化血红蛋白浓度与死亡率的相关性

hxq2007

A New Zealand linkage study examining the associations between glycosylated haemoglobin concentration and mortality

ABSTRACT

Objective: To examine associations between glycosylated haemoglobin (HbA1c) concentration and mortality in a New Zealand population.

Research Design and Methods: During a Hepatitis Foundation screening campaign for hepatitis B (1999 to 2001), participants were offered HbA1c testing. The participants were anonymously linked to the national mortality collection to 31st December 2004. Hazard ratios (HRs) and 95% confidence intervals (95%CI) adjusted for age, ethnicity, smoking and gender were estimated using Cox regression.

Results: There were 47,904 participants (71% Mori, 12% Pacific, 5% Asian, 12% Other). HbA1c measurements were categorised as: <4.0% (n=142); 4.0–<5.0% (reference category; n=12,867); 5.0–<6.0% (n=30,222); 6.0–<7.0% (n=2,669); 7.0% (n=1,596); there were also 408 participants with a previous diabetes diagnosis. During the follow-up period, 815 individuals died. In those without a prior diabetes diagnosis, there were steadily increasing HRs from the HbA1c reference category to the highest category (7.0%; HR 2.36, 95%CI 1.72–3.25). As well as all cause mortality, HbA1c was associated with mortality from diseases of the circulatory system, endocrine, nutritional and metabolic and immunity disorders, and ‘other and unknown causes&#39;. Mortality was also elevated in those with a prior diabetes diagnosis (HR 5.19, 95%CI 3.67–7.35), but this was only partially explained by their elevated HbA1c levels.

Conclusions: This is the largest study to date of HbA1c levels and subsequent mortality risk. It confirms previous findings that HbA1c levels are strongly associated with subsequent mortality in both men and women without a prior diabetes diagnosis.

http://care.diabetesjournals.org/cgi/content/abstract/dc07-2374v1

作者单位
1Centre for Public Health Research, Massey University, New Zealand
2Public Health Intelligence, Health and Disability Systems Strategy, Ministry of Health, New Zealand
3Research Centre for Mori Health and Development, Massey University, New Zealand
4Hepatitis Foundation of New Zealand
一项新西兰研究：评价糖化血红蛋白浓度与死亡率的相关性
摘要
目的：在新西兰人群中评价糖化血红蛋白（glycosylated haemoglobin，HbA1c）浓度与死亡率的相关性。
研究设计和方法：在肝炎基金会筛查B型肝炎过程（1999-2001年）中，测定所有受试者的HbA1c。受试者被匿名归入截止至2004年12月31日的全国死亡率调查中。采用Cox回归模型评估校正了年龄、种族、吸烟和性别的风险比（hazard ratio，HR）和95%可信区间（confidence interval，CI）。
结果：共纳入47 904名受试者（Mori，71%；太平洋，12%；亚洲人，5%；其他，12%）。根据HbA1c测定值将受试者分为以下几组：<4.0%（n=142）、4.0～<5.0%（参考值；n=12 867）、5.0～<6.0%（n=30 222）、6.0～<7.0%（n=2 669）、7.0%（n=1 596）；另有408名受试者既往已确诊为糖尿病。随访过程中，815名个体死亡。既往无糖尿病个体的死亡HRs随HbA1c从参考值到最高值（7.0%; HR 2.36，95%CI 1.72～3.25）逐渐升高。HbA1c除了与全因死亡，还与循环系统疾病及内分泌、营养代谢与免疫系统疾病引起的以及其他未知原因的死亡相关。先前已确诊糖尿病的个体死亡率也有所上升（HR 5.19，95%CI 3.67～7.35），但只是部分源于其HbA1c水平升高。
结论：这是迄今最大的一项关于HbA1c和随后死亡风险的研究，结果证实了之前的结论，即无糖尿病的男性和女性个体的HbA1c水平均与其随后的死亡率强相关。