新疆医科大学学报

目的 探讨糖化血红蛋白变异指数(Glycosylated hemoglobin variation index, HGI)与老年急性心力衰竭(Acute heart failure, AHF)患者治疗后1年内疾病复发的关系。方法 选取2021年1月-2024年1月于我院接受治疗的200例老年AHF患者为研究对象，入院时按照HGI三分位法将患者分为3组：低HGI组：HGI≤-0.46(65例),中HGI组：-0.450.23(66例)。收集患者基线资料，使用全自动生化/血液分析仪检测脑钠肽(Brain natriuretic peptide, BNP)、同型半胱氨酸(Homocysteine, Hcy)、胆碱酯酶(Cholinesterase, CHE)、甲状旁腺激素(Parathyroid hormone, PTH)、空腹血糖(Fasting blood glucose, FBG)、总胆固醇(Total cholesterol, TC)、甘油三酯(Triglycerides, TG)、低密度脂蛋白胆固醇(Low-Density lipoprotein cholesterol, LDL-C)、红细胞分布宽度(Red blood cell distribution width, RDW)、糖化血红蛋白(Hemoglobin A1c, HbA1c)等血清指标，并估算的肾小球滤过率(Estimated glomerular filtration rate, eGFR);彩色超声仪测定左心室舒张末期内径(Left ventricular end diastolic dimension, LVED)、室间隔厚度(Interventricular septum thickness, IVS)、下腔静脉内径(Inferior vena cava diameter, IVC)。采用单因素及多因素Logistic回归分析疾病复发的危险因素；采用Kaplan-Meier曲线分析不同HGI水平的老年AHF患者治疗后1年内复发率；采用限制性立方样条(Restricted cubic spline, RCS)分析HGI与AHF疾病1年后复发的相关性，并进行亚组分析。结果 200例老年AHF患者中治疗后1年内有36例患者复发(18.00%),平均HGI为(-0.12±0.43),低、中、高HGI组的复发率分别为6.15%、8.70%及39.39%。与低、中HGI组相比，高HGI组的男性占比、年龄、体质量指数(Body mass index, BMI)、房颤、BNP、CHE、LVED、IVC、IVS、HbAlc、FBG、Hcy、RDW、PTH、TC、TG、LDL-C以及疾病复发率均升高；血管紧张素转换酶抑制剂(Angiotensin-converting enzyme inhibitors, ACEI)/血管紧张素Ⅱ受体拮抗剂(Angiotensin receptor blockers, ARB)、β受体阻滞剂使用率及LVEF水平均降低，差异有统计学意义(P<0.05)。多因素Logistic回归分析表明，年龄、BMI、房颤、BNP、CHE、IVS、HbAlc、Hcy、HGI、PTH均是疾病复发的危险因素，eGFR是保护因素(P<0.05)。Kaplan-Meier曲线表明，低HGI组AHF患者的复发率(6.15%)明显低于中HGI组(8.70%)和高HGI组(39.39%)(Log rank P<0.05)。RCS分析显示，HGI水平与老年AHF患者治疗后1年内复发风险之间存在线性正相关关系(P_总体=0.014,P_非线性=0.619)。亚组分析显示，HGI对BNP≥779.46 pg/mL、PTH≥96.78 pg/mL、Hcy≥16.78μmol/L亚组患者的治疗后1年内疾病复发风险具有显著增加作用，且HGI与BNP、PTH、Hcy存在交互作用，P_交互值分别为0.005、0.035、0.011。结论 HGI与老年AHF患者疾病复发率呈正相关关系，BNP、Hcy、PTH的升高可加重HGI诱导的AHF复发风险。

Objective To explore the relationship between the glycosylated hemoglobin variation index(HGI) and disease recurrence within 1 year after treatment in elderly patients with acute heart failure(AHF). Methods 200 elderly patients with AHF who were treated in the hospital from January 2021 to January 2024 were selected as the research subjects. At admission, the patients were divided into 3 groups according to the terquartile method of HGI: low HGI group: HGI≤-0.46(65 cases), medium HGI group:-0.450.23(66 cases). Baseline data of the patients were collected. Serum indicators such as brain natriuretic peptide(BNP), homocysteine(Hcy), cholinesterase(CHE), parathyroid hormone(PTH), fasting blood glucose(FBG), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), red blood cell distribution width(RDW), and hemoglobin A1c(HbA1c) were measured using fully automated biochemical/hematology analyzers. The estimated glomerular filtration rate(eGFR) was also calculated. Color ultrasound was used to measure the left ventricular end-diastolic dimension(LVED), interventricular septum thickness(IVS), and inferior vena cava diameter(IVC). Univariate and multivariate Logistic regression analyses were performed to identify risk factors for disease recurrence. The Kaplan-Meier curve was used to analyze the recurrence rate within 1 year after treatment in elderly AHF patients with different HGI levels. The correlation between HGI and the recurrence of AHF disease after 1 year was analyzed by restricted cubic spline(RCS), and subgroup analysis was conducted. Results Among 200 elderly patients with AHF, 36 patients relapsed within 1 year after treatment(18.00%), with a mean HGI of(-0.12±0.43). The recurrence rates in the low, medium, and high HGI groups were 6.15%, 8.70%, and 39.39%, respectively. Compared with the low and medium HGI groups, the high HGI group showed higher proportions of males, age, body mass index(BMI), atrial fibrillation, BNP, CHE, LVED, IVC, IVS, HbAlc, FBG, Hcy, RDW, PTH, TC, TG, LDL-C, and disease recurrence rate; the usage rates of angiotensin-converting enzyme inhibitors(ACEI)/angiotensin receptor blockers(ARB), beta-blockers, and LVEF levels were lower, with statistically significant differences(P<0.05). Multivariate Logistic regression analysis indicated that age, BMI, atrial fibrillation, BNP, CHE, IVS, HbA1c, Hcy, HGI, and PTH, were significant risk factors for disease recurrence, while eGFR was a protective factor(P<0.05). Kaplan-Meier curves showed that the recurrence rate in the low HGI group(6.15%) was significantly lower than that in the medium HGI group(8.70%) and the high HGI group(39.39%)(Log rank P<0.05). RCS analysis showed a linear positive correlation between HGI levels and the risk of recurrence within 1 year after treatment in elderly AHF patients(P_overall=0.014, P_non-linear=0.619). Subgroup analysis showed that HGI significantly increased the risk of disease recurrence within 1 year after treatment in patients with BNP≥779.46 pg/mL, PTH≥96.78 pg/mL, and Hcy≥16.78 μmol/L, and there were interactions between HGI and BNP, PTH, and Hcy, and the P_interaction values were 0.005, 0.035 and 0.011 respectively. Conclusion HGI was positively correlated with the recurrence rate of elderly AHF patients, and the increase of BNP, Hcy, and PTH could aggravate the risk of HGI-induced AHF recurrence.