Diabetes Care：HbA1c低水平或可预测普通人群死亡风险

8月1日，《糖尿病护理》(Diabetes Care)杂志发表了美国学者的一项研究成果，在非糖尿病患者的普通人群中，糖化血红蛋白(HbA1c)水平低可能是死亡风险的泛化标志物。

此项前瞻性队列研究共纳入13288例受试者。利用Logistic回归分析确认低HbA1c(<5%)的横断面相关性，并利用Cox比例风险模型评估低HbA1c与死因别死亡率的相关性。

结果显示，与HbA1c处于正常范围的受试者相比，低HbA1c者较为年轻，吸烟可能性较低，体质指数(BMI)、白细胞计数和纤维蛋白原水平较低，并且高胆固醇血症患病率以及冠心病既往患病率较低。然而，低HbA1c者贫血可能性较高，并且平均红细胞压积较高。在以HbA1c为5.0～5.7为参照组的校正Cox模型中，HbA1c<5.0%与全因死亡(危险比[HR] 1.32)和癌症死亡(HR 1.47)风险显著升高具有相关性;心血管性和呼吸系统性死亡风险具有非显著升高趋势。HbA1c与肝脏疾病住院之间呈J形相关。

doi:10.2337/dc11-2531
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Low Hemoglobin A1c in Nondiabetic Adults

An elevated risk state?

Vikas Aggarwal, MD1, Andrea L.C. Schneider, PHD2,3 and Elizabeth Selvin, PHD, MPH

OBJECTIVE To identify predictors of low hemoglobin A1c (HbA1c) (<5.0%) and to investigate the association of low HbA1c with cause-specific mortality and risk of liver disease hospitalization.

RESEARCH DESIGN AND METHODS Prospective cohort study of 13,288 participants in the Atherosclerosis Risk in Communities Study. Logistic regression was used to identify cross-sectional correlates of low HbA1c and Cox proportional hazards models were used to estimate the association of low HbA1c with cause-specific mortality.

RESULTS Compared with participants with HbA1c in the normal range (5.0 to <5.7%), participants with low HbA1c were younger, less likely to smoke, had lower BMI, lower white cell count and fibrinogen levels, and lower prevalence of hypercholesterolemia and history of coronary heart disease. However, this group was more likely to have anemia and had a higher mean corpuscular volume. In adjusted Cox models with HbA1c of 5.0 to <5.7% as the reference group, HbA1c <5.0% was associated with a significantly increased risk of all-cause mortality (hazard ratio [HR]: 1.32, 95% CI: 1.13–1.55) and of cancer death (1.47, 95% CI: 1.16–1.84). We also noted nonsignificant trends toward increased risk of death from cardiovascular causes (1.27; 95% CI, 0.93–1.75) and respiratory causes (1.42, 95% CI: 0.78–2.56). There was a J-shaped association between HbA1c and risk of liver disease hospitalization.

CONCLUSIONS No single cause of death appeared to drive the association between low HbA1c and total mortality. These results add to evidence that low HbA1c values may be a generalized marker of mortality risk in the general population.