文章摘要
陈琰姝,连立飞,许奕华,李绪辉,张莹,黄佳瑜,李檬妤,杨洁,王芙蓉.入院时糖化血红蛋白A1与脑出血患者预后的关系[J].中华流行病学杂志,2019,40(11):1445-1449
入院时糖化血红蛋白A1与脑出血患者预后的关系
Association of glycosylated hemoglobin level at admission with outcomes of intracerebral hemorrhage patients
收稿日期:2019-04-05  出版日期:2019-11-26
DOI:10.3760/cma.j.issn.0254-6450.2019.11.019
中文关键词: 脑出血;糖化血红蛋白;预后
英文关键词: Intracerebral hemorrhage;HbA1c;Outcome
基金项目:国家重点研发计划(2017YFC1310000)
作者单位E-mail
陈琰姝 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
连立飞 华中科技大学同济医学院附属同济医院神经内科, 武汉 430030  
许奕华 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030 xuyihua_6@hotmail.com 
李绪辉 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
张莹 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
黄佳瑜 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
李檬妤 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
杨洁 华中科技大学同济医学院公共卫生学院流行病与卫生统计学系, 环境与健康教育部重点实验室, 武汉 430030  
王芙蓉 华中科技大学同济医学院附属同济医院神经内科, 武汉 430030 wangfurong.china@163.com 
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中文摘要:
      目的 探究自发性脑出血(ICH)患者入院时糖化血红蛋白A1(HbA1c)水平与脑出血后90 d预后之间的关系。方法 前瞻性连续纳入2017年1-12月同济医院神经内科住院ICH患者,收集患者入院时相关临床资料,在患者出血后90 d使用改良的RANKIN量表评估其功能结局。构建单变量及多变量条件logistic回归模型,根据HbA1c测量值的四分位数将患者分为4组,以每组患者HbA1c的M为替代值纳入模型,计算趋势检验P值。应用限制性立方样条法拟合logistic回归模型,评估入院时HbA1c水平与ICH预后的关系。结果 共纳入ICH患者345例,其中预后良好214例,预后不良131例(严重残疾99例,死亡32例)。多因素logistic回归分析结果显示,随着入院时HbA1c升高,ICH后90 d发生预后不良的风险升高,趋势检验P<0.001(与HbA1c低水平组相比,中、高及极高水平组90 d预后不良的风险分别为OR=2.33,95%CI:1.07~5.07;OR=2.52,95%CI:1.12~5.64;OR=6.80,95%CI:3.01~15.34)。限制性样条结果显示,入院时HbA1c水平与ICH患者出血后90 d预后不良之间具有相关性(χ2=14.81,P<0.001),且为线性关系(非线性检验:P=0.118)。入院时HbA1c<6.5%的患者与HbA1c=6.5%的患者相比,随着HbA1c含量的降低,预后不良的风险呈线性降低趋势;HbA1c>6.5%的患者与HbA1c=6.5%的患者相比,预后不良的风险更大,但差异无统计学意义。结论 入院时HbA1c水平升高与出血后90 d时预后不良风险有联系,HbA1c升高是脑出血预后不良的独立预测因子。
英文摘要:
      Objective To explore the association of the glycosylated hemoglobin (HbA1c) level at admission with 90 days functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods Patients admitted to the Department of Neurology, Tongji Hospital from January to December 2017 were prospectively and continuously enrolled in this study. Clinical data were collected at admission and functional outcomes 90 days after ICH were assessed by using the modified RANKIN scale. Univariate and multivariate conditional logistic regression models were constructed. Patients were divided into four groups according to the quartile of HbA1c values. The median value of HbA1c in each group was taken as the substitute value and P for trend was calculated. The logistic regression model was fitted by restricted cubic splines to investigate the association between HbA1c level and outcome of ICH. Results A total of 345 patients with ICH were enrolled, including 214 with favorable outcomes and 131 with poor outcomes (99 severe disability cases and 32 deaths). The risk of poor 90 days outcomes was significantly associated with HbA1c level at admission indicated by multivariate logistic regression analysis, and the P for trend test was <0.001 (middle-level group vs. low-level group:OR=2.33, 95%CI:1.07-5.07; high-level group vs. low-level group:OR=2.52, 95%CI:1.12-5.64; extremely high-level group vs. low-level group:OR=6.80, 95%CI:3.01-15.34). Results from the restricted cubic spline showed that there was a linear correlation between HbA1c level at admission and poor 90 days outcomes of ICH (χ2=14.81, P<0.001; non-linear test:P=0.118). Compared with patients with HbA1c level of 6.5%, the risk of poor outcomes in patients with HbA1c level of <6.5% decreased linearly with the decrease in HbA1c level at admission, and the risk in patients with HbA1c level>6.5% was higher but not significantly. Conclusion There was correlation between high HbA1c level at admission and 90 days poor outcome of ICH. High HbA1c level is an independent prediction indicator for ICH.
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