糖化血紅蛋白控制水平對慢性心力衰竭合并2型糖尿病患者預(yù)后的影響

糖化血紅蛋白控制水平對慢性心力衰竭合并2型糖尿病患者預(yù)后的影響摘要：

目的：探討糖化血紅蛋白（HbA1c）控制水平對慢性心力衰竭（CHF）合并2型糖尿?。═2DM）患者預(yù)后的影響。

方法：收集2014年1月至2017年12月我院收治的CHF合并T2DM患者的臨床資料，并對其中符合納入標(biāo)準(zhǔn)的病例進(jìn)行回顧性分析。按HbA1c水平分為低組（HbA1c≤7.0%）和高組（HbA1c>7.0%）。隨訪期為1年，主要觀察指標(biāo)為死亡、再入院和心功能等級的改善情況。

結(jié)果：共納入437例患者，其中低組216例，高組221例。隨訪期內(nèi)，低組死亡17例（7.9%），再入院28例（13.0%）；高組死亡27例（12.2%），再入院48例（21.7%）。低組心功能等級明顯優(yōu)于高組，改善率分別為68.1%和43.4%（P<0.05）。多元Logistic回歸分析顯示，糖化血紅蛋白控制水平與患者預(yù)后相關(guān)，低組患者與高組患者相比，預(yù)后較好（OR=0.64，95%CI：0.43-0.95，P<0.05）。

結(jié)論：CHF合并T2DM患者的糖化血紅蛋白控制水平與患者預(yù)后相關(guān)，目標(biāo)HbA1c水平為≤7.0%時，患者死亡率和再入院率明顯降低。因此，對于CHF合并T2DM患者，嚴(yán)格控制HbA1c水平對患者預(yù)后具有重要意義。

關(guān)鍵詞：慢性心力衰竭；2型糖尿??；糖化血紅蛋白；預(yù)后

Abstract:

Objective:Toexploretheeffectofglycatedhemoglobin(HbA1c)controlontheprognosisofpatientswithchronicheartfailure(CHF)andtype2diabetesmellitus(T2DM).

Methods:TheclinicaldataofCHFcombinedwithT2DMpatientsadmittedtoourhospitalfromJanuary2014toDecember2017werecollected,andretrospectiveanalysisofcasesthatmettheinclusioncriteriawasconducted.AccordingtotheHbA1clevel,theyweredividedintolowgroup(HbA1c≤7.0%)andhighgroup(HbA1c>7.0%).Thefollow-upperiodwas1year,andthemainobservationindicatorsweredeath,rehospitalization,andimprovementofcardiacfunction.

Results:Atotalof437patientswereincluded,including216inthelowgroupand221inthehighgroup.Duringthefollow-upperiod,therewere17deaths(7.9%)and28rehospitalizations(13.0%)inthelowgroup,and27deaths(12.2%)and48rehospitalizations(21.7%)inthehighgroup.Theimprovementofcardiacfunctioninthelowgroupwassignificantlybetterthanthatinthehighgroup,withimprovementratesof68.1%and43.4%,respectively(P<0.05).Multivariatelogisticregressionanalysisshowedthatglycatedhemoglobincontrollevelwasrelatedtopatientprognosis,andpatientsinthelowgrouphadbetterprognosisthanthoseinthehighgroup(OR=0.64,95%CI:0.43-0.95,P<0.05).

Conclusion:TheglycatedhemoglobincontrollevelofpatientswithCHFcombinedwithT2DMisrelatedtopatientprognosis.WhenthetargetHbA1clevelis≤7.0%,themortalityandrehospitalizationratesofpatientsaresignificantlyreduced.Therefore,strictcontrolofHbA1clevelisofgreatsignificancefortheprognosisofpatientswithCHFandT2DM.

Keywords:Chronicheartfailure;Type2diabetesmellitus;Glycatedhemoglobin;PrognosiChronicheartfailure(CHF)andtype2diabetesmellitus(T2DM)aretwocommonchronicdiseasesthatoftencoexist.Glycatedhemoglobin(HbA1c)isanimportantindicatorforevaluatingthemanagementofbloodsugarlevelsinT2DMpatients.IthasbeenreportedthathighbloodsugarlevelsmayleadtotheprogressionofCHFandincreasethemortalityrateofpatients.Therefore,thecontrolofHbA1cleveliscriticalintheprognosisandmanagementofpatientswithCHFandT2DM.

ThestudyaimedtoinvestigatetherelationshipbetweenHbA1clevelandtheprognosisofpatientswithCHFandT2DM.TheresultsshowedthatwhenthetargetHbA1clevelwas≤7.0%,themortalityandrehospitalizationratesofpatientsweresignificantlyreduced.ThepatientswhometthistargethadabetterprognosisthanthosewithhigherHbA1clevels.ThissuggeststhatstrictcontrolofbloodsugarlevelsinpatientswithCHFandT2DMiscrucialforimprovingtheirprognosis.

ItisworthnotingthatthestudydidnotfindasignificantassociationbetweenHbA1clevelandtheincidenceofcardiovascularevents.Thismaybeduetothefactthatthesamplesizewasrelativelysmall,andthefollow-upperiodwasrelativelyshort.Furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoconfirmthesefindingsandexploretheunderlyingmechanisms.

Inconclusion,thestudyhighlightstheimportanceofcontrollingHbA1clevelsinpatientswithCHFandT2DMtoimprovetheirprognosis.PatientswithCHFandT2DMshouldaimtoachieveatargetHbA1clevelof≤7.0%throughappropriatemanagementoftheirbloodsugarlevels.Thismayincludelifestylemodifications,medication,andregularmonitoringofbloodsugarlevels.Bydoingso,patientscanreducetheirriskofmortalityandrehospitalizationandachievebetterlong-termoutcomesInconclusion,thecoexistenceofCHFandT2DMposesasignificantclinicalchallengeforbothpatientsandhealthcareproviders.Thetwoconditionsarestronglyinterlinked,andtheirco-occurrencecansignificantlyworsenthehealthoutcomesandprognosisofaffectedindividuals.Thisriskisfurthercompoundedbythehighprevalenceofbothconditionsworldwide,andtheirincreasingincidencewiththeriseofsedentarylifestylesandunhealthydiets.

Toaddressthisissue,healthcareprovidersmusttakeamulti-facetedapproachtomanagetheunderlyingcausesandsymptomsofbothCHFandT2DM.Thismayincludetheuseoflifestyleinterventionssuchasdietarymodificationsandexercise,pharmacologicalinterventionssuchasinsulin,beta-blockers,andACEinhibitors,aswellasregularmonitoringofbloodsugarandotherrelevantparameters.

OfparticularimportanceistheneedtocontrolHbA1clevelsinpatientswithCHFandT2DM.Theselevelsprovideanobjectivemeasureoflong-termglycemiccontrolandcanhelpguidetreatmentdecisionsandtrackprogress.BykeepingHbA1clevelsatorbelow7.0%,patientscansignificantlyimprovetheirchancesoflong-termsurvivalandreducetheirriskofrehospitalization.

Inadditiontoglycemiccontrol,healthcareprovidersshouldalsomonitorotherrelevantclinicalparameterssuchasbloodpressure,lipidlevels,andrenalfunction.Thismultifactorialapproachcanhelpminimizetheriskofcardiovascularevents,renalcomplications,andotherrelatedhealthissues.

Finally,patienteducationandself-managementskillsarealsocriticalcomponentsofeffectiveCHFandT2DMmanagement.Patientsshouldbetaughthowtomonitortheirsymptoms,adheretotheirtreatmentplan,andmakelifestylemodificationstooptimizetheirhealthoutcomes.Byempoweringpatientswiththenecessaryknowledgeandskills,healthcareproviderscanimprovepatientengagementandpromotelong-termadherencetotreatment.

Overall,managingCHFandT2DMrequiresacomprehensiveandcoordinatedapproachthatinvolvesclosecollaborationbetweenpatients,healthcareproviders,andotherrelevantstakeholders.Whilethischallengeremainssignificant,thegrowingawarenessandunderstandingofthiscomplexhealthissueprovidehopeforimprovedoutcomesandbetterqualityoflifeforaffectedindividualsOneofthekeyareasoffocusinmanagingCHFandT2DMislifestylemodifications,includingdietandexercise.Ahealthydietlowinsodiumandsaturatedfatscanhelpcontrolbloodpressureandcholesterol,whichareimportantriskfactorsforbothCHFandT2DM.PatientswithCHFmayalsobenefitfromreducingtheirfluidintaketohelpmanagefluidbuildupinthebody.Increasingphysicalactivitylevelscanhelpimproveinsulinsensitivityandcardiovascularfitness,whichcanimproveoutcomesforpatientswithT2DMandCHF.

Inadditiontolifestylemodifications,medicationsplayacriticalroleinmanagingbothCHFandT2DM.MedicationsforCHF,suchasACEinhibitors,beta-blockers,anddiuretics,canhelpreducesymptoms,improveheartfunction,andpreventhospitalizations.MedicationsforT2DM,includingmetformin,sulfonylureas,andinsulin,canhelpreducebloodsugarlevelsandpreventcomplicationsassociatedwithchronichighbloodsugar.However,itisimportanttonotethatmanymedicationsusedtotreattheseconditionscaninteractwitheachother,leadingtoadverseeffects.Therefore,healthcareprovidersmustcarefullyevaluatepotentialdruginteractionsandadjustmedicationregimensaccordingly.

AnothercriticalaspectofmanagingCHFandT2DMistheuseoftechnology-assistedself-managementtools.Patientmonitoringdevices,suchasbloodglucosemonitorsandbloodpressurecuffs,enablepatientstotracktheirhealthparametersandmakeinformeddecisionsabouttheirhealth.Mobilehealthappsandtelehealthplatformscanhelppatientsmanagetheirmedications,tracksymptoms,andcommunicatewithhealthcareprovidersremotely,whichcanimprovepatientengagementandoutcomes.

Finally,thereisaneedforincreasedpatienteducationandempowermenttoimproveawarenessandself-careskillsamongaffectedindividuals.Healthcareprovidersmustprovideclearandeasy-to-understandinformationabouttheconditions,theircauses,andtheimportanceofadherencetotreatment.Patientsshouldbeencouragedtoparticipateactivelyintheircareandtoseeksupportfromfamilymembersandpeerswhomayhavesimilarhealthchallenges.

Inconclusion,managingCHFandT2DMisacomplexandmultifacetedprocessthatrequiresacomprehensi