住院冠心病患者血糖控制水平调查
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摘要
目的：2型糖尿病是冠心病的等危症，住院冠心病患者合并糖尿病比例很高，中国心脏调查发现我国住院冠心病病人的糖代谢异常率高达80%，关注住院冠心病患者的糖代谢情况，了解冠心病合并糖尿病患者的血糖控制情况对于改善病人预后十分重要，但对于住院冠心病合并糖尿病患者的血糖控制情况目前还报道甚少，为此，我们对住院冠心病患者的血糖情况以及冠心病合并糖尿病的血糖控制情况进行了调查。
方法：
1研究对象2011年1月至10月于我院心血管内科住院且符合入选标准的冠心病患者连续入选。
2研究方法（1）对所有入选的患者进行空腹血糖（FPG）、午餐后2h血糖(PPG)及HbA_(1c)测定。应用美国BIO-RAD公司D-10糖化血红蛋白仪测定HbA_(1c)，其检测原理是高压液相色谱（HPLC）分析，使用试剂、标准品均为BIO-RAD配套产品；用葡萄糖氧化酶法检测FPG值；用便携式血液葡萄糖检测仪检测午餐后2h血糖值（PPG）。（2）根据2007年《中国2型糖尿病防治指南》将HbA_(1c)控制状态分成3类：<6.5%控制良好，>7.5%控制差，两者之间的控制水平为一般，评估入院已知糖尿病患者HbA_(1c)控制水平；根据《中国2型糖尿病HbA_(1c)控制目标的专家共识》推荐，HbA_(1c)≤7.5%为血糖控制达标，评估入院已知糖尿病患者的血糖达标情况；根据2010年ADA指南推荐，HbA_(1c)≥6.5%者可诊断为糖尿病，5.7～6.4%者可视为糖尿病前期，本次研究将入院未知糖尿病患者分为3组即新发糖尿病组、糖尿病前期组及正常组，计算该部分患者糖代谢异常率；将所有住院患者的结果纳入分析，比较HbA_(1c)、FPG、PPG在不同性别、年龄组【青年（22～44岁）、中年（45～59岁）、老年（60～88岁）】及职业（工人、农民、干部）间的差异；以≥5.7%规定为糖代谢异常，计算不同类型冠心病（慢性稳定性心绞痛、急性冠脉综合征、陈旧性心肌梗死）患者的糖代谢异常率。
3统计学方法用SPSS13.0软件进行数据分析，计数资料采用χ~2检验及Kruskal-Wallis H检验及两独立样本的秩和检验进行组间比较，HbA_(1c)与年龄、FPG及PPG的关系用秩相关分析，以P <0.05（0.01）为差异有统计学意义。
结果：
1本次研究共收集有效病例353例，男性232例，女性121例，年龄（61.6±10.7）岁（22～88岁）。其中，已知糖尿病组84例（23.8%），未知糖尿病组269例（76.2%）。
2已知糖尿病的冠心病患者的HbA_(1c)控制水平很不理想，58.3%的患者HbA_(1c)水平>7.5%，29.8%处于6.5%～7.5%，仅11.9%的患者HbA_(1c)水平<6.5%；该组人群的HbA_(1c)达标率为41.7%，即约有60%的患者仍未达标。
3未知糖尿病的冠心病患者中33.32%的HbA_(1c)≥6.5%，57.51%的HbA_(1c)处于5.7～6.4%，仅9.17%的患者HbA_(1c)<5.7%，糖代谢异常率高达90%。
4秩相关分析显示已知糖尿病的冠心病患者的HbA_(1c)与FPG呈正相关（r=0.446, P <0.01），亦与PPG呈正相关（r=0.637，P<0.01）。
5所有研究对象的HbA_(1c)、FPG、PPG3项检测指标中仅HbA_(1c)存在性别差异，男性HbA_(1c)第90百分位数为8.5%，女性HbA_(1c)第90百分位数为9.5%，女性较男性HbA_(1c)水平高。
6HbA_(1c)与年龄呈正相关（r=0.256, P<0.01）,老年组的HbA_(1c)及PPG分别与青年组及中年组间均有统计学差异（P<0.05），青、中年组间未发现统计学差异（P>0.05）；FPG未发现存在组间差异（P>0.05）。
7不同职业间3项检测指标未发现存在统计学差异。
8不同类型的冠心病患者（慢性稳定性心绞痛、急性冠脉综合征、陈旧性心肌梗死）的HbA_(1c)异常率均在50%左右。
结论：
1已知糖尿病的住院冠心病患者HbA_(1c)控制水平很不理想，达标率低。
2未知糖尿病的住院冠心病患者糖代谢异常率很高
3在已知糖尿病的冠心病患者中，午餐后血糖较空腹血糖与HbA_(1c)的关系更为密切。
4住院冠心病患者老年女性较男性血糖水平高。
Objective: Recently, a great deal of studies have shown that diabetesmellitus is a risk factor of equivalent of coronary artery disease (CAD).Diabetes mellitus is common in patients with CAD. China Heart SurveyGroup has confirmed that the rate of abnormal glucose metabolism is80%ininpatients with CAD. In order to improve patients’ prognosis, we should paymore attention to the glucose metabolism of inpatients with CAD, and thecontrolling of blood glucose of CAD patients complicated with diabetesmellitus.Even though important of this aspect,it is is rarely be reported. Theaim of our survey is to know glucose metabolism of inpatients with CAD, andthe controlling of blood glucose of inpatients with CAD complicated withdiabetes.
Methods:
1CAD patients fitted to the recruited standard and hospitalized to the secondhospital of Hebei Medical University were collected from January2011toOctober2011.
2Study methods (1) FPG, PPG and HbA_(1c)were obtained in all subjects. Thetype of D-10equipment with agents and standard preparation matched, whichwas applied to detect HbA_(1c), was produced by BIO-RAD company inAmerican, and its principle was high performance liquid chromatography(HPLC).The FPG was detected by glucose oxidase method. The PPG wasobtained by mobile blood glucose detector.(2) According to Chinese type2diabetes mellitus prevention and cure guide made in2007year, the controllevel of HbA_(1c)was assorted into3groups:<6.5%,>7.5%, and6.5%～7.5%,respectively defined as well, poor and general. According to complicated withor not diabetes, all the objects are divided into two groups to evaluate thecontrol level of HbA_(1c). According to the Chinese type2diabetes HbA_(1c)ofcontrol target experts consensus, the cut-point of7.5%applied to evaluate the target control of HbA_(1c)in diabetic patients. According to the ADA2010guideline, HbA_(1c)was used as one of the diagnostic criteria. Patients whoseHbA_(1c)≥6.5%, can be regarded as diabetes, and those between5.7~6.4%canbe regarded as pre-diabetes. Patients who did not know diabetes were dividedinto three groups: diabetes, pre-diabetes and normal, and the rate of diabeteswas calculated. HbA_(1c), FPG and PPG were compared among different genderand age groups [young(22-44year), middle age(45-59year) and old（60~88year）] and occupations (workers, peasants and leaders). The result ofHbA_(1c)was divided into2groups according to the cut-point of5.7%. The partof≥5.7%was considered as abnormal, the rate of which was calculatedamong different CAD (Chronic stability angina, Acute coronary syndrome andChronic myocardial infarction).
3All data were analyzed using SPSS13.0software. Chi-square test andKruskal-Wallis H test and two-independent-samples nonparametric tests wereused to assess difference among groups. Spearman rank correllation was usedto analyze the correlation among FPG, PPG and HbA_(1c). In all instances,P<0.05was considered significant.
Results:
1353cases were collected, the mean age of the patients is61.6±10.7years,232male and121female.23.8%of all the cases were diabetes, and76.2%ofcases were undiagnosed diabetes.
2The controlling of HbA_(1c)of patients with diabetes was not ideal,58.3%ofwhich was>7.5%, and19.8%of which was between6.5%and7.5%, and therest was <6.5%.The percentile of HbA_(1c)≤7.5%of diabetes was41.7%. Thatwas to say, respect to the level of HbA_(1c), about60%of diabetes with CADwere out of control.
3In undiagnosed diabetes group, the rate of diabetes was33.32%,pre-diabetes was57.51%and normal patients was9.17%.
4HbA_(1c)was positive correlated with FPG（coefficient of correlation r=0.446, P<0.01, with statistical significance）, and so did with PPG(coefficientof correlation r=0.637, P<0.01, with statistical significance).
5Among HbA_(1c), FPG and PPG of all the research objects, only HbA_(1c)existgender difference, with8.5%at90th percentile of male, while with9.5%offemale.
6HbA_(1c)was positively correlated with ag（er=0.256, P<0.01）. Both HbA_(1c)andPPG existed statistic difference(P<0.05）between old age and young group,and the difference also appeared between old age and middle agegroup(P<0.05). But the difference was not found between middle-age andyoung group（P>0.05）.While FPG did not show difference among groups（P>0.05）.
7HbA_(1c), FPG and PPG of all the objects did not show statistic differenceamong different career.
8The abnormal rate of HbA_(1c)in different CAD (Chronic stability angina,Acute coronary syndrome and Chronic myocardial infarction) was about50%.
Conclusions:
1The control level of HbA_(1c)is poor in CAD patients with diabetes, a largeproportion of which is far away from the aim of control level.
2The rate of abnormal glucose metabolism is high in patients with CAD whoare undiagnosed with diabetes.
3The relationship between HbA_(1c)and PPG is closer than that between FPGand HbA_(1c)in CAD patients with diabetes.
4The glucose level of old female patients with CAD is inferior to that of malepatients.
方法：
1研究对象2011年1月至10月于我院心血管内科住院且符合入选标准的冠心病患者连续入选。
2研究方法（1）对所有入选的患者进行空腹血糖（FPG）、午餐后2h血糖(PPG)及HbA_(1c)测定。应用美国BIO-RAD公司D-10糖化血红蛋白仪测定HbA_(1c)，其检测原理是高压液相色谱（HPLC）分析，使用试剂、标准品均为BIO-RAD配套产品；用葡萄糖氧化酶法检测FPG值；用便携式血液葡萄糖检测仪检测午餐后2h血糖值（PPG）。（2）根据2007年《中国2型糖尿病防治指南》将HbA_(1c)控制状态分成3类：<6.5%控制良好，>7.5%控制差，两者之间的控制水平为一般，评估入院已知糖尿病患者HbA_(1c)控制水平；根据《中国2型糖尿病HbA_(1c)控制目标的专家共识》推荐，HbA_(1c)≤7.5%为血糖控制达标，评估入院已知糖尿病患者的血糖达标情况；根据2010年ADA指南推荐，HbA_(1c)≥6.5%者可诊断为糖尿病，5.7～6.4%者可视为糖尿病前期，本次研究将入院未知糖尿病患者分为3组即新发糖尿病组、糖尿病前期组及正常组，计算该部分患者糖代谢异常率；将所有住院患者的结果纳入分析，比较HbA_(1c)、FPG、PPG在不同性别、年龄组【青年（22～44岁）、中年（45～59岁）、老年（60～88岁）】及职业（工人、农民、干部）间的差异；以≥5.7%规定为糖代谢异常，计算不同类型冠心病（慢性稳定性心绞痛、急性冠脉综合征、陈旧性心肌梗死）患者的糖代谢异常率。
3统计学方法用SPSS13.0软件进行数据分析，计数资料采用χ~2检验及Kruskal-Wallis H检验及两独立样本的秩和检验进行组间比较，HbA_(1c)与年龄、FPG及PPG的关系用秩相关分析，以P <0.05（0.01）为差异有统计学意义。
结果：
1本次研究共收集有效病例353例，男性232例，女性121例，年龄（61.6±10.7）岁（22～88岁）。其中，已知糖尿病组84例（23.8%），未知糖尿病组269例（76.2%）。
2已知糖尿病的冠心病患者的HbA_(1c)控制水平很不理想，58.3%的患者HbA_(1c)水平>7.5%，29.8%处于6.5%～7.5%，仅11.9%的患者HbA_(1c)水平<6.5%；该组人群的HbA_(1c)达标率为41.7%，即约有60%的患者仍未达标。
3未知糖尿病的冠心病患者中33.32%的HbA_(1c)≥6.5%，57.51%的HbA_(1c)处于5.7～6.4%，仅9.17%的患者HbA_(1c)<5.7%，糖代谢异常率高达90%。
4秩相关分析显示已知糖尿病的冠心病患者的HbA_(1c)与FPG呈正相关（r=0.446, P <0.01），亦与PPG呈正相关（r=0.637，P<0.01）。
5所有研究对象的HbA_(1c)、FPG、PPG3项检测指标中仅HbA_(1c)存在性别差异，男性HbA_(1c)第90百分位数为8.5%，女性HbA_(1c)第90百分位数为9.5%，女性较男性HbA_(1c)水平高。
6HbA_(1c)与年龄呈正相关（r=0.256, P<0.01）,老年组的HbA_(1c)及PPG分别与青年组及中年组间均有统计学差异（P<0.05），青、中年组间未发现统计学差异（P>0.05）；FPG未发现存在组间差异（P>0.05）。
7不同职业间3项检测指标未发现存在统计学差异。
8不同类型的冠心病患者（慢性稳定性心绞痛、急性冠脉综合征、陈旧性心肌梗死）的HbA_(1c)异常率均在50%左右。
结论：
1已知糖尿病的住院冠心病患者HbA_(1c)控制水平很不理想，达标率低。
2未知糖尿病的住院冠心病患者糖代谢异常率很高
3在已知糖尿病的冠心病患者中，午餐后血糖较空腹血糖与HbA_(1c)的关系更为密切。
4住院冠心病患者老年女性较男性血糖水平高。
Objective: Recently, a great deal of studies have shown that diabetesmellitus is a risk factor of equivalent of coronary artery disease (CAD).Diabetes mellitus is common in patients with CAD. China Heart SurveyGroup has confirmed that the rate of abnormal glucose metabolism is80%ininpatients with CAD. In order to improve patients’ prognosis, we should paymore attention to the glucose metabolism of inpatients with CAD, and thecontrolling of blood glucose of CAD patients complicated with diabetesmellitus.Even though important of this aspect,it is is rarely be reported. Theaim of our survey is to know glucose metabolism of inpatients with CAD, andthe controlling of blood glucose of inpatients with CAD complicated withdiabetes.
Methods:
1CAD patients fitted to the recruited standard and hospitalized to the secondhospital of Hebei Medical University were collected from January2011toOctober2011.
2Study methods (1) FPG, PPG and HbA_(1c)were obtained in all subjects. Thetype of D-10equipment with agents and standard preparation matched, whichwas applied to detect HbA_(1c), was produced by BIO-RAD company inAmerican, and its principle was high performance liquid chromatography(HPLC).The FPG was detected by glucose oxidase method. The PPG wasobtained by mobile blood glucose detector.(2) According to Chinese type2diabetes mellitus prevention and cure guide made in2007year, the controllevel of HbA_(1c)was assorted into3groups:<6.5%,>7.5%, and6.5%～7.5%,respectively defined as well, poor and general. According to complicated withor not diabetes, all the objects are divided into two groups to evaluate thecontrol level of HbA_(1c). According to the Chinese type2diabetes HbA_(1c)ofcontrol target experts consensus, the cut-point of7.5%applied to evaluate the target control of HbA_(1c)in diabetic patients. According to the ADA2010guideline, HbA_(1c)was used as one of the diagnostic criteria. Patients whoseHbA_(1c)≥6.5%, can be regarded as diabetes, and those between5.7~6.4%canbe regarded as pre-diabetes. Patients who did not know diabetes were dividedinto three groups: diabetes, pre-diabetes and normal, and the rate of diabeteswas calculated. HbA_(1c), FPG and PPG were compared among different genderand age groups [young(22-44year), middle age(45-59year) and old（60~88year）] and occupations (workers, peasants and leaders). The result ofHbA_(1c)was divided into2groups according to the cut-point of5.7%. The partof≥5.7%was considered as abnormal, the rate of which was calculatedamong different CAD (Chronic stability angina, Acute coronary syndrome andChronic myocardial infarction).
3All data were analyzed using SPSS13.0software. Chi-square test andKruskal-Wallis H test and two-independent-samples nonparametric tests wereused to assess difference among groups. Spearman rank correllation was usedto analyze the correlation among FPG, PPG and HbA_(1c). In all instances,P<0.05was considered significant.
Results:
1353cases were collected, the mean age of the patients is61.6±10.7years,232male and121female.23.8%of all the cases were diabetes, and76.2%ofcases were undiagnosed diabetes.
2The controlling of HbA_(1c)of patients with diabetes was not ideal,58.3%ofwhich was>7.5%, and19.8%of which was between6.5%and7.5%, and therest was <6.5%.The percentile of HbA_(1c)≤7.5%of diabetes was41.7%. Thatwas to say, respect to the level of HbA_(1c), about60%of diabetes with CADwere out of control.
3In undiagnosed diabetes group, the rate of diabetes was33.32%,pre-diabetes was57.51%and normal patients was9.17%.
4HbA_(1c)was positive correlated with FPG（coefficient of correlation r=0.446, P<0.01, with statistical significance）, and so did with PPG(coefficientof correlation r=0.637, P<0.01, with statistical significance).
5Among HbA_(1c), FPG and PPG of all the research objects, only HbA_(1c)existgender difference, with8.5%at90th percentile of male, while with9.5%offemale.
6HbA_(1c)was positively correlated with ag（er=0.256, P<0.01）. Both HbA_(1c)andPPG existed statistic difference(P<0.05）between old age and young group,and the difference also appeared between old age and middle agegroup(P<0.05). But the difference was not found between middle-age andyoung group（P>0.05）.While FPG did not show difference among groups（P>0.05）.
7HbA_(1c), FPG and PPG of all the objects did not show statistic differenceamong different career.
8The abnormal rate of HbA_(1c)in different CAD (Chronic stability angina,Acute coronary syndrome and Chronic myocardial infarction) was about50%.
Conclusions:
1The control level of HbA_(1c)is poor in CAD patients with diabetes, a largeproportion of which is far away from the aim of control level.
2The rate of abnormal glucose metabolism is high in patients with CAD whoare undiagnosed with diabetes.
3The relationship between HbA_(1c)and PPG is closer than that between FPGand HbA_(1c)in CAD patients with diabetes.
4The glucose level of old female patients with CAD is inferior to that of malepatients.
引文
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23Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascularcomplications in veterans with type2diabetes. N Engl J Med2009;360:129-39
24胡大一，郭艺芳，孙艺红.稳定性冠心病血糖管理的中国专家共识[J].心脑血管病防治，2010,10:4-9
25俞匀,卞茸文,莫永珍.2型糖尿病HbA1c筛查值和诊断值的探讨.中国糖尿病杂志，2011,19:910-13
26DECODE Study Group. Glucose tolerance and cardiovascular mortality:comparison of fasting and2-hour diagnostic criteria [J]. Arch Intern Med2001;161(3):397-405
27Nakagami T, Qiao Q, Tuomilehto J, Balkau B, Tajima N, Hu G et al.Screen-detected diabetes, hypertension and hypercholesterolemia aspredictors of cardiovascular mortality in five populations of Asianorigin: the DECODA study [J]. Eur J Cardiovasc Prev Rehabil,2006;13(4):555-61
28Levitan EB, Song Y, Ford ES, Liu S. Is nondiabetic hyperglycemia a riskfactor for cardiovascular disease? A meta-analysis of prospective studies[J]. Arch Intern Med2004;164(19):2147-55
29Avignon A,Radauceanu A,Monnier L,Nonfasting plasma glucose is abetter marker of diabetic control than fasting plasma glucose in type2diabetes[J].Diabetes Care,1997,20:1822-26
30黄敬泽，王健，2型糖尿病糖化血红蛋白与全天不同时间血糖水平的关系[J],中国综合临床，2006，22：1101-3
31Schrot RJ, Targeting plasma glucose: preprandial versus postprandial.[J].Clinical diabetes,2004,22:169-72
32Monnier L.Lapinski,Colette C.Contributions of fasting and postprandialplasma glucose increments to the overall diurual hyperglycemia of type2diabetes [J].Diabetes Care,2003,26:881-5
33校娟,李宏亮，等.国际糖尿病联盟餐后血糖管理指南[J].药品评价，2008,5:39-42
34Longo-Mbenza B,On’Kin JB,Okwe AN, et al. Metabolic syndrome, aging,physical inactivity, and incidence of type2diabetes in general Africanpopulation[J].Dia Vasc Dis Res,2010,7:28-39
35Bartnik M, Malmberg K, Hamsten A, et al. Abnormal glucose Tolerance acommon risk factor in patients with acute myocardial infarction incomparison with population based controls [J]. J Int Med,2004,256:288-97
36NorhammarA, Tenerz A, Nilsson G, et al. Glucose metabolism in Patientswith acute myocardial infarction and no previous diagnosis of diabetesmellitus: a prospective study [J].Lancet,2002,359:2140-4
37WahabNN, Cowden EA, Pearce NJ, et al. Is blood glucose an independentpredictor of mortality in acute myocardial infarction in the thrombolytic era?[J]. J Am CollCardiol,2002,40:1748-54
38ADA. Standards of medical care in diabetes[J]. Diabetes Care.2005,28Suppl1:S4-S36
39Vlassov F. Glycated Haemoglobin, diabetes,and mortality in men.Medicine is now using diagnostic criteria rather than reference ranges[J].BMJ,2001,322:997
40Hadjadj S,CoisneD,Mauco G, eta1. Prognostic value of admission plasmaglucose and HBA in acute myocardial infarction[J]. DiabetMed,2004,21:305-10
41TenerzA,Nilsson G, Forberg R, et a1. Basal glucometabolic status has animpacton longterm prognosis following an acutemyocardial infarction innondiabetic patients[J]. J InternMed,2003,254:494-503
42DPP research group. Impact of Intensive Lifestyle and Metformin Therapyon Cardiovascular Disease Risk Factors in the Diabetes PreventionProgram [J]. Diabetes Care,2005,28:888-94
43Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M.Acarbose reduces the risk for myocardial infarction in type2diabeticpatients: meta-analysis of seven long-term studies [J]. Eur Heart J2004;25:10-16
1Haffner SM,Lehto S,Ronnemaa T,et al.Mortality from coronary heartdisease in subjects with type2diabetes and in nondiabetic subjects withand without prior myocardial infarction[J].N Eng J Med,1998,339:229-34
2中国心脏调查组.中国住院冠心病患者糖代谢异常研究-中国心脏调查[J].中华内分泌代谢杂志，2006,22:7-10
3WHO. Laboratory Diagnosis and Monitoring of Diabetes Mellitus.WHODocuments Production Services,2002,Geneva,Switzerland Sacks DB.Bruns DE, et al.Guidelines and recommendentions for Laboratory analysisin the diagnosis in the diagnosis and management of diabetes mellitus[J].Clin Chem,2002,48:436-72
4中华医学会检验分会，卫生部临床检验中心，中华检验医学杂志辑委员会.糖尿病诊断治疗中实验室检测项目的应用建议[J].中华检验医学杂志，2010,33:8-15
5American Diabetes Association.Diagnosis and Classification of DiabetesMellitus[J].Diabetes Care,2009,55:850-2
6中华医学会糖尿病分会.空腹血糖受损下限诊断切割点的建议[J].中华医学杂志.2005,85:1947-50
7HoelzelW,Weykamp C,Jeppsson JO, et a1. IFCC reference system formeasurement of hemoglobin Alc in human blood and the nationalstandardization schemes in the United States, Japan, and Sweden: amethod comparison study[J]. Clin Chem,2004,50:168-74
8Bartnik M, Malmberg K, Norhammar A, et al. Newly detected abnormalglucose tolerance: an important predictor of long term outcomeaftermyocardial infarction[J]. Eur Heart J,2004,25:1990-7
9Khaw KT,Wareham N,Bingham S, et al. Association of hemoglobinAlcwith cardiovascular disease and mortality in adults: the Europeanprospective investigation into cancer in Norfolk[J]. Ann Intern Med,2004,5:413-20
10GoldsteinDE,Little RR,LorenzRA, et al. Testsof glycemia indiabetes[J].Diabetes Care,2004,27:1761-73
11CollinsMcNeilJ,Holston EC, EdwardsCL, et al. Depressive symptoms,cardiovascular risk, and diabetes self care strategies in African Americanwomen with type2diabetes[J]. Arch Psychiatr Nurs,2007,21:201-9
12Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia： anindependent marker of in-hospital mortality in patients with undiagnoseddiabetes. J Clin Endocrinol Metab,2002,87:978-82
13ADA. Standards of medical care in diabetes[J]. DiabetesCare.2005,28Suppl1:S4-S36
14中华医学会内分泌学分会.中国2型糖尿病HbA1c控制目标的专家共识[J].中华内分泌代谢杂志，2011,27:371-4
15胡大一，郭艺芳，孙艺红.稳定性冠心病血糖管理的中国专家共识[J].心脑血管病防治，2010,10:4-9
16UK Prospective Diabetes Study Group.Effect of intensive blood glucosecontrol with metformin on complications in overweight patients with type2diabetes(UKPDS34)[J]. Lancet,1998,352;854-65
17Knowler WC,Barrett connor E,Fowler SE;Diabetes Prevention ProgramResearch Group.Reduction in the incidence of type2Diabetes Withlifestyle intervention or metformin[J].N Engl J Med,2002,346:393-403
18The Action to Control Cardiovascular Risk in Diabetes Study Group.Effects of intensive glucose lowering in type2diabetes. N Engl J Med2008;358:2545-59
19Ismail-Begi F, Craven T, Banerji MA, et al. Effect of intensive treatmentof hyperglycaemia on microvascular outcomes in type2diabetes: ananalysis of the ACCORD randomized trial. Lancet2010;376:419-30
20ADVANCE Collaborative Group. Intensive blood glucose control andvascular outcomes in patients with type2diabetes. N Engl J Med2008;358:2560-72
21Beulens JWJ, Patel A, Vingerling JR, et al. Effects of blood pressurelowering and intensive glucose control on the incidence and progression ofretinopathy in patients with type2diabetes mellitus: a randomisedcontrolled trial. Diabetologia2009;52:2027-36
22Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascularcomplications in veterans with type2diabetes. N Engl J Med2009;360:129-39
23胡大一，杨进刚.关注冠心病患者的糖代谢异常[J].中华内科杂志.2006，45:793-5
24Haffer SM,Lehto S,Ronnemaa T,et al.Mortality from coronary heartdisease in subjects with type2diabetes and in nondiabetic subjects withand without prior myocardial infarction[J].N Engl J Med,1998,339:229-34
25Bartnik M, Malmberg K, Hamsten A, Efendic S, et al. Abnormal glucosetolerance--a common risk factor in patients with acute myocardialinfarction in comparison with population-based controls[J]. J Intern Med.2004:256:288-97
26Capes SE, HuntD,MalmbergK, et al. Stress hyperglycaem ia and increasedrisk of death aftermyocardial infarction in patients with and withoutdiabetes: a systematic overview[J]. Lancet,2000,355:773-8
27Malmberg K, NorhammarA, W edelH, et al. Glycometabolic state atadmission:important riskmarkerofmortality in conventionally treatedpatients with diabetes mellitus and acute myocardial infarction: long termresults from the Diabetes and Insulin Glucose Infusion in AcuteMyocardial Infarction (DIGAM I) study[J].Circulation,1999,99:2626-32
28Stranders I, D iamantM, van GelderR, et al. Adm ission blood glucoselevel as risk indicatorof death aftermyocardial infarction in patients withand without diabetes mellitus[J]. Arch Intern Med,2004,164:982-8
29SuleimanM, HammermanH, BoulosM, et al. Fasting glucose is animportant in dependent risk factor for30day mortality in patients withacute myocardial infarction[J]. Circulation,2005,111:754-60
30Moghissi ES, Korytkowski MT, DiNardo M, et al. American Associationof Clinical Endocrinologists and American Diabetes Associationconsensus statement on inpatient glycemic control. Endocr Pract,2009,15:353-69
31American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care,2010,33(Suppl1):11-61
32NorhammarA, TenerzA, NilssonG, et al. Glucosemetabolism in patientswith acute myocardial infarction and no previous diagnosis ofdiabetes-mellitus: a prospective study [J]. Lancet,2002,359:2140-4
33van denBergheG,W ilmerA, H ermansG, et al. Intensive insulin therapy inthe medical ICU[J]. N Engl JMed,2006,354:449-61
34Purnell JQ, Hokanson JE, Marcovina SM, et al. Effect of excessive weightgain with intensive therapy of type1diabetes on lipid levels and bloodpressure. JAMA,1998,280:140
35Purnell JQ, Dev RK, Steffes MW, et al. Relationship of family history oftype2diabetes, hypoglycemia, and conventional therapy in the DiabetesControl and Complications Trial. Diabetes,2003,52:2623
36Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acuteglucose fluctuations compared with sustained chronic hyperglycemia inpatients with type2diabetes.JAMA,2006,295:1681-7
37张雪莲，陆菊明，潘长玉，等.血糖变异性对急性冠脉综合征患者近期预后的影响.解放军医学杂志，2008,33:1022-4
2中国心脏调查组.中国住院冠心病患者糖代谢异常研究-中国心脏调查[J].中华内分泌代谢杂志，2006,22:7-10
3Hoelzel W,Weykamp C,Jeoosson JO,et al.IFCC reference system formeasurement of hemoglobin A1c in human blood and the standardizationschemes in the United States,Japan,and Sweden: a method-comparisonstudy [J].Clin Chem,2004,50:168-74
4Bartnik M,Malmberg K,Norhammar A,et al.Newly detected abnormalglucose tolerance:an important predictor of long-term outcome aftermyocardial infarction[J].Eur Heart J,2004,25:1990-97
5American Diabetes Association.Standards of medical care for patients withdiabetes mellitus [J].Diabetes Care,2003,26(suppl):S33-50
6中华医学会糖尿病学分会.2007年版中国2型糖尿病防治指南[J].中华内分泌代谢杂志，2008，24：增录2a-1-增录2a-23
7中华医学会内分泌学分会.中国2型糖尿病HbA1c控制目标的专家共识[J].中华内分泌代谢杂志，2011,27:371-4
8American Diabetes Association.Standards of medical care in diabetes2010[J].Diabetes Care，2010,33:S11-S61
9Coutinho M, Gerstein HC, Wang Y, et al. The relationship between glucoseand incident cardiovascular events: a meta regression analysis of publisheddata from20studiesof95783individuals followed for12.4years[J].Diabetes Care,1999,22:233-40
10The DECODE study group on behalf of the European DiabetesEpidemiology Group. Glucose tolerance and cardiovascular mortality[J].Arch IntMed,2001,161:397-404
11Bartnik M, Malmberg K, Norhammar A, et al. Newly detected abnormalglucose tolerance: an important predictor of long term outcome aftermyocardial infarction[J]. Eur Heart J,2004,25:1990-97
12Bartnik M, Ryden L, Ferrari R, et al. The prevalence of abnormal glucoseregulation in patients with coronary artery disease across Europe: the EuroHeart Surveyon diabetes and the heart[J]. Eur Heart J,2004,25:1880-90
13许樟荣.住院患者高血糖管理.中国糖尿病杂志.19:877-880
14Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia： anindependent marker of in-hospital mortality in patients with undiagnoseddiabetes. J Clin Endocrinol Metab,2002,87:978-82
15胡耀敏,刘伟,陈雅文,等.内科重症监护病房住院患者高血糖临床资料分析.中华内分泌代谢杂志，2010,26:448-51
16Coutinho M, Gerstein HC, Wang Y, et al. The relationship betweenglucose and incident cardiovascular events: a meta regression analysis ofpublished data from20studiesof95783individuals followed for12.4years[J]. Diabetes Care,1999,22:233-40
17王虹，高颖，梁红，等.应用两种方法检测糖化血红蛋白结果的比较[J],医药世界，2006,7:82-3
18Khaw KT, Wareham N, Luben R, et al. Glycated haemoglobin, diabetes,and mortality in men in Norfolk cohort of European ProspectiveInvestigation of cancer and Nutrition (EPIC Norfolk)[J].BMJ,2001,322:15
19The Action to Control Cardiovascular Risk in Diabetes Study Group.Effects of intensive glucose lowering in type2diabetes. N Engl J Med2008;358:2545-59
20Ismail-Begi F, Craven T, Banerji MA, et al. Effect of intensive treatment ofhyperglycaemia on microvascular outcomes in type2diabetes: an analysisof the ACCORD randomized trial. Lancet2010;376:419-30
21ADVANCE Collaborative Group. Intensive blood glucose control andvascular outcomes in patients with type2diabetes. N Engl J Med2008;358:2560-72
22Beulens JWJ, Patel A, Vingerling JR, et al. Effects of blood pressurelowering and intensive glucose control on the incidence and progression ofretinopathy in patients with type2diabetes mellitus: a randomisedcontrolled trial. Diabetologia2009;52:2027-36
23Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascularcomplications in veterans with type2diabetes. N Engl J Med2009;360:129-39
24胡大一，郭艺芳，孙艺红.稳定性冠心病血糖管理的中国专家共识[J].心脑血管病防治，2010,10:4-9
25俞匀,卞茸文,莫永珍.2型糖尿病HbA1c筛查值和诊断值的探讨.中国糖尿病杂志，2011,19:910-13
26DECODE Study Group. Glucose tolerance and cardiovascular mortality:comparison of fasting and2-hour diagnostic criteria [J]. Arch Intern Med2001;161(3):397-405
27Nakagami T, Qiao Q, Tuomilehto J, Balkau B, Tajima N, Hu G et al.Screen-detected diabetes, hypertension and hypercholesterolemia aspredictors of cardiovascular mortality in five populations of Asianorigin: the DECODA study [J]. Eur J Cardiovasc Prev Rehabil,2006;13(4):555-61
28Levitan EB, Song Y, Ford ES, Liu S. Is nondiabetic hyperglycemia a riskfactor for cardiovascular disease? A meta-analysis of prospective studies[J]. Arch Intern Med2004;164(19):2147-55
29Avignon A,Radauceanu A,Monnier L,Nonfasting plasma glucose is abetter marker of diabetic control than fasting plasma glucose in type2diabetes[J].Diabetes Care,1997,20:1822-26
30黄敬泽，王健，2型糖尿病糖化血红蛋白与全天不同时间血糖水平的关系[J],中国综合临床，2006，22：1101-3
31Schrot RJ, Targeting plasma glucose: preprandial versus postprandial.[J].Clinical diabetes,2004,22:169-72
32Monnier L.Lapinski,Colette C.Contributions of fasting and postprandialplasma glucose increments to the overall diurual hyperglycemia of type2diabetes [J].Diabetes Care,2003,26:881-5
33校娟,李宏亮，等.国际糖尿病联盟餐后血糖管理指南[J].药品评价，2008,5:39-42
34Longo-Mbenza B,On’Kin JB,Okwe AN, et al. Metabolic syndrome, aging,physical inactivity, and incidence of type2diabetes in general Africanpopulation[J].Dia Vasc Dis Res,2010,7:28-39
35Bartnik M, Malmberg K, Hamsten A, et al. Abnormal glucose Tolerance acommon risk factor in patients with acute myocardial infarction incomparison with population based controls [J]. J Int Med,2004,256:288-97
36NorhammarA, Tenerz A, Nilsson G, et al. Glucose metabolism in Patientswith acute myocardial infarction and no previous diagnosis of diabetesmellitus: a prospective study [J].Lancet,2002,359:2140-4
37WahabNN, Cowden EA, Pearce NJ, et al. Is blood glucose an independentpredictor of mortality in acute myocardial infarction in the thrombolytic era?[J]. J Am CollCardiol,2002,40:1748-54
38ADA. Standards of medical care in diabetes[J]. Diabetes Care.2005,28Suppl1:S4-S36
39Vlassov F. Glycated Haemoglobin, diabetes,and mortality in men.Medicine is now using diagnostic criteria rather than reference ranges[J].BMJ,2001,322:997
40Hadjadj S,CoisneD,Mauco G, eta1. Prognostic value of admission plasmaglucose and HBA in acute myocardial infarction[J]. DiabetMed,2004,21:305-10
41TenerzA,Nilsson G, Forberg R, et a1. Basal glucometabolic status has animpacton longterm prognosis following an acutemyocardial infarction innondiabetic patients[J]. J InternMed,2003,254:494-503
42DPP research group. Impact of Intensive Lifestyle and Metformin Therapyon Cardiovascular Disease Risk Factors in the Diabetes PreventionProgram [J]. Diabetes Care,2005,28:888-94
43Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M.Acarbose reduces the risk for myocardial infarction in type2diabeticpatients: meta-analysis of seven long-term studies [J]. Eur Heart J2004;25:10-16
1Haffner SM,Lehto S,Ronnemaa T,et al.Mortality from coronary heartdisease in subjects with type2diabetes and in nondiabetic subjects withand without prior myocardial infarction[J].N Eng J Med,1998,339:229-34
2中国心脏调查组.中国住院冠心病患者糖代谢异常研究-中国心脏调查[J].中华内分泌代谢杂志，2006,22:7-10
3WHO. Laboratory Diagnosis and Monitoring of Diabetes Mellitus.WHODocuments Production Services,2002,Geneva,Switzerland Sacks DB.Bruns DE, et al.Guidelines and recommendentions for Laboratory analysisin the diagnosis in the diagnosis and management of diabetes mellitus[J].Clin Chem,2002,48:436-72
4中华医学会检验分会，卫生部临床检验中心，中华检验医学杂志辑委员会.糖尿病诊断治疗中实验室检测项目的应用建议[J].中华检验医学杂志，2010,33:8-15
5American Diabetes Association.Diagnosis and Classification of DiabetesMellitus[J].Diabetes Care,2009,55:850-2
6中华医学会糖尿病分会.空腹血糖受损下限诊断切割点的建议[J].中华医学杂志.2005,85:1947-50
7HoelzelW,Weykamp C,Jeppsson JO, et a1. IFCC reference system formeasurement of hemoglobin Alc in human blood and the nationalstandardization schemes in the United States, Japan, and Sweden: amethod comparison study[J]. Clin Chem,2004,50:168-74
8Bartnik M, Malmberg K, Norhammar A, et al. Newly detected abnormalglucose tolerance: an important predictor of long term outcomeaftermyocardial infarction[J]. Eur Heart J,2004,25:1990-7
9Khaw KT,Wareham N,Bingham S, et al. Association of hemoglobinAlcwith cardiovascular disease and mortality in adults: the Europeanprospective investigation into cancer in Norfolk[J]. Ann Intern Med,2004,5:413-20
10GoldsteinDE,Little RR,LorenzRA, et al. Testsof glycemia indiabetes[J].Diabetes Care,2004,27:1761-73
11CollinsMcNeilJ,Holston EC, EdwardsCL, et al. Depressive symptoms,cardiovascular risk, and diabetes self care strategies in African Americanwomen with type2diabetes[J]. Arch Psychiatr Nurs,2007,21:201-9
12Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia： anindependent marker of in-hospital mortality in patients with undiagnoseddiabetes. J Clin Endocrinol Metab,2002,87:978-82
13ADA. Standards of medical care in diabetes[J]. DiabetesCare.2005,28Suppl1:S4-S36
14中华医学会内分泌学分会.中国2型糖尿病HbA1c控制目标的专家共识[J].中华内分泌代谢杂志，2011,27:371-4
15胡大一，郭艺芳，孙艺红.稳定性冠心病血糖管理的中国专家共识[J].心脑血管病防治，2010,10:4-9
16UK Prospective Diabetes Study Group.Effect of intensive blood glucosecontrol with metformin on complications in overweight patients with type2diabetes(UKPDS34)[J]. Lancet,1998,352;854-65
17Knowler WC,Barrett connor E,Fowler SE;Diabetes Prevention ProgramResearch Group.Reduction in the incidence of type2Diabetes Withlifestyle intervention or metformin[J].N Engl J Med,2002,346:393-403
18The Action to Control Cardiovascular Risk in Diabetes Study Group.Effects of intensive glucose lowering in type2diabetes. N Engl J Med2008;358:2545-59
19Ismail-Begi F, Craven T, Banerji MA, et al. Effect of intensive treatmentof hyperglycaemia on microvascular outcomes in type2diabetes: ananalysis of the ACCORD randomized trial. Lancet2010;376:419-30
20ADVANCE Collaborative Group. Intensive blood glucose control andvascular outcomes in patients with type2diabetes. N Engl J Med2008;358:2560-72
21Beulens JWJ, Patel A, Vingerling JR, et al. Effects of blood pressurelowering and intensive glucose control on the incidence and progression ofretinopathy in patients with type2diabetes mellitus: a randomisedcontrolled trial. Diabetologia2009;52:2027-36
22Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascularcomplications in veterans with type2diabetes. N Engl J Med2009;360:129-39
23胡大一，杨进刚.关注冠心病患者的糖代谢异常[J].中华内科杂志.2006，45:793-5
24Haffer SM,Lehto S,Ronnemaa T,et al.Mortality from coronary heartdisease in subjects with type2diabetes and in nondiabetic subjects withand without prior myocardial infarction[J].N Engl J Med,1998,339:229-34
25Bartnik M, Malmberg K, Hamsten A, Efendic S, et al. Abnormal glucosetolerance--a common risk factor in patients with acute myocardialinfarction in comparison with population-based controls[J]. J Intern Med.2004:256:288-97
26Capes SE, HuntD,MalmbergK, et al. Stress hyperglycaem ia and increasedrisk of death aftermyocardial infarction in patients with and withoutdiabetes: a systematic overview[J]. Lancet,2000,355:773-8
27Malmberg K, NorhammarA, W edelH, et al. Glycometabolic state atadmission:important riskmarkerofmortality in conventionally treatedpatients with diabetes mellitus and acute myocardial infarction: long termresults from the Diabetes and Insulin Glucose Infusion in AcuteMyocardial Infarction (DIGAM I) study[J].Circulation,1999,99:2626-32
28Stranders I, D iamantM, van GelderR, et al. Adm ission blood glucoselevel as risk indicatorof death aftermyocardial infarction in patients withand without diabetes mellitus[J]. Arch Intern Med,2004,164:982-8
29SuleimanM, HammermanH, BoulosM, et al. Fasting glucose is animportant in dependent risk factor for30day mortality in patients withacute myocardial infarction[J]. Circulation,2005,111:754-60
30Moghissi ES, Korytkowski MT, DiNardo M, et al. American Associationof Clinical Endocrinologists and American Diabetes Associationconsensus statement on inpatient glycemic control. Endocr Pract,2009,15:353-69
31American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care,2010,33(Suppl1):11-61
32NorhammarA, TenerzA, NilssonG, et al. Glucosemetabolism in patientswith acute myocardial infarction and no previous diagnosis ofdiabetes-mellitus: a prospective study [J]. Lancet,2002,359:2140-4
33van denBergheG,W ilmerA, H ermansG, et al. Intensive insulin therapy inthe medical ICU[J]. N Engl JMed,2006,354:449-61
34Purnell JQ, Hokanson JE, Marcovina SM, et al. Effect of excessive weightgain with intensive therapy of type1diabetes on lipid levels and bloodpressure. JAMA,1998,280:140
35Purnell JQ, Dev RK, Steffes MW, et al. Relationship of family history oftype2diabetes, hypoglycemia, and conventional therapy in the DiabetesControl and Complications Trial. Diabetes,2003,52:2623
36Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acuteglucose fluctuations compared with sustained chronic hyperglycemia inpatients with type2diabetes.JAMA,2006,295:1681-7
37张雪莲，陆菊明，潘长玉，等.血糖变异性对急性冠脉综合征患者近期预后的影响.解放军医学杂志，2008,33:1022-4