一小時血糖值可能可以作為心血管風險的標記

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　December 10, 2009 — 根據線上發表於11月16日糖尿病照護(Diabetes Care)期刊的研究結果，對於無明顯糖尿病(DM)者，一小時血糖(1-hour plasma glucose[1hPG])上升可以作為心血管風險的標記。
　　
　　義大利佛羅倫斯大學的Gianluca Bardini博士等人寫道，糖尿病前期定義為空腹血糖不佳的人，和/或有葡萄糖耐受不佳(impaired glucose tolerance[IGT])之第2型糖尿病(type 2 diabetes [DM2])高風險者；再者，它也與胰島素阻抗性，次臨床發炎與心血管疾病(cardiovascular diseases [CVD]) 有關，最近，葡萄糖耐受測試(glucose tolerance test [OGTT])時的一小時血糖值155 mg/dl，被視為後續發生DM2以及早期頸動脈粥狀硬化風險增加的切點。
　　
　　研究目標是評估1062名正常葡萄糖耐受(normal glucose tolerance[NGT])和糖尿病前期者的發炎標記與代謝特徵。在口服葡萄糖耐受測試之後，比較1hPG值高於和未高於155 mg/dL者的纖維素原和白血球數量(WBC)，以檢測次臨床發炎、脂質比率、使用Matsuda指數測量之胰島素敏感性。
　　
　　相較於1hPG值小於等於155 mg/dL者，1hPG值大於155 mg/dL者的發炎標記和脂質比率顯著增加(各種比較之P值均<.05)。校正年紀、性別與身體質量指數後之分析顯示，1hPG與WBC數量及纖維素原顯著增加有關(P < .05)。相較於1hPG值小於等於155 mg/dL者，1hPG值大於155 mg/dL者的胰島素敏感性顯著較低(P < .01)。
　　
　　研究作者寫道，正常葡萄糖耐受和糖尿病前期者的1hPG值增加，與次臨床發炎、較高的脂質比率和胰島素阻抗性等有關，因此，1hPG大於155 mg/dl可以視為新的心血管風險標記。
　　
　　研究作者皆宣告沒有相關財務關係。
　　
　　Diabetes Care. 線上發表於2009年11月16日。


One-Hour Plasma Glucose Levels May Be a Marker for Cardiovascular Risk

By Laurie Barclay, MD
Medscape Medical News

December 10, 2009 — Elevated 1-hour plasma glucose (1hPG) levels in persons without overt diabetes (DM) may be a marker for cardiovascular risk, according to the results of a study reported online in the November 16 issue of Diabetes Care.

"[Pre-DM] identifies subjects with impaired fasting glucose...and/or impaired glucose tolerance (IGT) at high risk for type 2 diabetes (DM2); moreover, it is associated to insulin resistance..., subclinical inflammation and cardiovascular diseases (CVD)," write Gianluca Bardini, MD, PhD, from the University of Florence in Italy, and colleagues. "Recently, 1-hour hyperglycaemia (1hPG) during glucose tolerance test (OGTT) with a cut point of 155 mg/dl has been indicated as a further risk factor for DM2 and showed early carotid atherosclerosis."

The study goal was to evaluate metabolic characteristics and markers of inflammation in 1062 participants with normal glucose tolerance (NGT) and pre-DM. Fibrinogen and leukocytes count (WBC) for subclinical inflammation, lipid ratios, and insulin sensitivity measured with the Matsuda Index were compared in participants with or without 1hPG levels higher than 155 mg/dL after oral glucose loading.

Compared with participants with 1hPG levels of 155 mg/dL or lower, those with 1hPG levels higher than 155 mg/dL had significantly increased inflammatory markers and lipid ratios (P < .05 for all comparisons). An analysis adjusted for age, sex, and body mass index showed that 1hPG was associated with significantly increased WBC count and fibrinogen (P < .05). Compared with patients with 1hPG levels of 155 mg/dL or lower, those with 1hPG levels higher than 155 mg/dL had significantly lower insulin sensitivity (P < .01).

"Elevated 1hPG in NGT and pre-DM subjects is associated to subclinical inflammation, high lipid ratios and insulin resistance," the study authors write. "Therefore, 1hPG >155 mg/dl could be considered a new 'marker' for cardiovascular risk."

The study authors have disclosed no relevant financial relationships.

Diabetes Care. Published online November 16, 2009.