糖化血红蛋白对糖尿病患者术后结局影响的系统回顾

英国诺丁汉大学医院、诺福克和诺里奇大学医院

　　本研究分析了1980年至2014年发表的文献原文，其中共20项研究报告了术前糖化血红蛋白（HbA1c）水平对术后结局的影响，包括19514例糖尿病患者。术前血糖控制并未对30天死亡率产生影响。血糖控制的住重症治疗病房（ITU）天数、再次入院、静脉血栓栓塞性疾病、卒中发生率无显著差异。大多数研究提示术前HbA1c水平与急性肾损伤或需要术后透析、心律紊乱、非手术部位相关感染和总住院天数之间无关。文献关于心肌事件、手术部位感染和再手术率的差异很大。

　　因此，术前HbA1c升高与糖尿病患者术后发病率或死亡率增加的关系并不肯定。纳入该系统回顾的研究存在相对异质性，主要为回顾性，而且通常所含患者数量少，这表明高质量证据是必要的。

Clin Nutr. 2016 Apr;35(2):308-16.

Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus.

Rollins KE, Varadhan KK, Dhatariya K, Lobo DN.

• Nottingham University Hospitals, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.

• Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.

BACKGROUND & AIMS: Diabetes is a significant risk factor for surgical complications and also increases the prevalence of comorbidities, thereby increasing surgical risk. The aim of this systematic review was to establish the relationship between long-term preoperative glycemic control as measured by HbA1c and postoperative complications.

METHODS: A systematic search was conducted to source articles published between 1980 and 2014 pertinent to the review. Full-text articles were included if they met the pre-determined criteria as determined by two reviewers. Studies reporting the impact of preoperative HbA1c levels on postoperative outcomes in all disciplines of surgery were included.

RESULTS: Twenty studies, including a total of 19,514 patients with diabetes mellitus from a range of surgical specialties, were suitable for inclusion. Preoperative glycemic control did not have a bearing on 30-day mortality. There were no significant differences in the incidence of stroke, venous thromboembolic disease, hospital readmission and ITU length of stay based on glycemic control. The majority of studies suggested no link between preoperative HbA1c levels and acute kidney injury or need for postoperative dialysis, dysrhythmia, infection not related to the surgical site and total hospital length of stay. The literature was highly variable with regards to myocardial events, surgical site infection and reoperation rates.

CONCLUSIONS: Elevated preoperative HbA1c was not definitively associated with increased postoperative morbidity or mortality in patients with diabetes mellitus. The studies included in this review were relatively heterogeneous, predominantly retrospective, and often contained small patient numbers, suggesting that good quality evidence is necessary.

PMID: 25840840

DOI: 10.1016/j.clnu.2015.03.007