Page 91 - 中国全科医学2022-17

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201203，China
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Corresponding author：WU Jing，Associate professor；E-mail：jingwuclose@126.com
【Abstract】 Background The association between preoperative glycosylated hemoglobin（HbA 1c ） and prognosis
of adult patients undergoing cardiac surgery has attracted attentions of scholars. However，due to various reference values of
preoperative HbA 1c ，the prognostic threshold of preoperative HbA 1c used for these patients is different. Objective To perform a
Meta-analysis to examine the association between preoperative HbA 1c and prognosis in adult patients undergoing cardiac surgery.
Methods Databases of CNKI，Wanfang Data，Medline，EMBase，The Cochrane Library were searched to collect case-
control studies，prospective or retrospective cohort studies on the association between preoperative HbA 1c and prognosis in adults
undergoing cardiac surgery from January 1st，2000 to September 10th，2021. Studies screening，data extraction，and risk of
bias assessment were performed by two researchers independently. RevMan 5.4.1 was used to perform the Meta-analysis. Results
A total of 35 cohort studies involving 35 826 adult cardiac surgery patients were included. The prognosis of these cases was
analyzed by the control level of preoperative HbA 1c . Meta-analysis revealed that adults with preoperative HbA 1c < 5.5% had lower
early postoperative mortality than those with preoperative HbA 1c ≥ 5.5%〔RR=0.39，95%CI（0.18，0.84），P=0.02〕. A lower
rate of postoperative sternal wound infection was found in those with preoperative HbA 1c < 6.0% rather than those with preoperative
HbA 1c ≥ 6.0%〔RR=0.47，95%CI（0.24，0.91），P=0.02〕，in those with preoperative HbA 1c <6.5% rather than those with
preoperative HbA 1c ≥ 6.5%〔RR=0.48，95%CI（0.34，0.69），P<0.000 1〕，in those with preoperative HbA 1c <7.0% rather
than those with preoperative HbA 1c ≥ 7.0%〔RR=0.37，95%CI（0.26，0.52），P<0.000 01〕，in those with preoperative
HbA 1c < 7.5% rather than those with preoperative HbA 1c ≥ 7.5%〔RR=0.22，95%CI（0.13，0.35），P<0.000 01〕，or in
those with preoperative HbA 1c <8.0% rather than those with preoperative HbA 1c ≥ 8.0%〔RR=0.23，95%CI（0.14，0.38），
P<0.000 01〕. A lower incidence of postoperative cerebrovascular events was observed in those with preoperative HbA 1c < 6.5%
rather than those with preoperative HbA 1c ≥ 6.5%〔RR=0.70，95%CI（0.52，0.94），P=0.02〕，in those with preoperative
HbA 1c <7.0% rather than those with preoperative HbA 1c ≥ 7.0%〔RR=0.52，95%CI（0.39，0.69），P<0.000 01〕，in
those with preoperative HbA 1c <7.5% rather than those with preoperative HbA 1c ≥ 7.5%〔RR=0.50，95%CI（0.32，0.80），
P=0.003〕，or in those with preoperative HbA 1c <8.0% tather than those with preoperative HbA 1c ≥ 8.0% 〔RR=0.47，95%CI
（0.29，0.75），P=0.002〕. A lower incidence of postoperative acute kidney injury was found in those with preoperative HbA 1c < 6.0%
rather than those with preoperative HbA 1c ≥ 6.0%〔RR=0.40，95%CI（0.18，0.92），P=0.03〕，in those with preoperative
HbA 1c <6.5% rather than those with preoperative HbA 1c ≥ 6.5%〔RR=0.78，95%CI（0.71，0.84），P<0.000 01〕，in those with
preoperative HbA 1c <7.0% rather than those with preoperative HbA 1c ≥ 7.0%〔RR=0.66，95%CI（0.55，0.78），P<0.000 01〕，
in those with preoperative HbA 1c <7.5% rather than those with preoperative HbA 1c ≥ 7.5%〔RR=0.73，95%CI（0.65，0.82），
P<0.000 01〕，or in those with preoperative HbA 1c <8.0% rather than those with preoperative HbA 1c ≥8.0%〔RR=0.75，95%CI（0.67，
0.84），P<0.000 01〕. A shorter mean length of stay was found in those with preoperative HbA 1c < 6.0% rather than those with
preoperative HbA 1c ≥ 6.0%〔MD=-0.61，95%CI（-1.23，0.00），P=0.05〕，in those with preoperative HbA 1c <6.5% rather
than those with preoperative HbA 1c ≥ 6.5%〔MD=-0.93，95%CI（-1.58，-0.29），P=0.005〕，or in those with preoperative
HbA 1c <7.0% rather than those with preoperative HbA 1c ≥ 7.0%〔MD=-0.81，95%CI（-1.11，-0.51），P<0.000 01〕.
Conclusion Existing evidence shows that preoperative HbA 1c less than 5.5% can effectively reduce early postoperative mortality
of adult cardiac surgery patients. Better control of preoperative HbA 1c level may be associated with reduced risk of postoperative
complications and improved prognosis. Therefore，attention should be paid to the patient's HbA 1c before cardiac surgery. For those
with high HbA 1c ，it is suggested to take interventions to reduce blood glucose preoperatively in accordance with clinical manifestations
and functions of organs if it is necessary.
【Keywords】 Glycated hemoglobin A；Cardiac surgical procedures；Diabetes Mellitus；Prognosis；Meta-analysis

据报道，2020 年中国心血管外科年手术总量已超 22 万 指标 ［4］ 。《中国 2 型糖尿病防治指南（2020 年版）》 ［5］ 首
例 ［1］ ，在需要行心脏手术的患者中 20%~30% 合并糖尿病 ［2］ 。 次将 HbA 1c ≥ 6.5% 作为确诊糖尿病的诊断依据；美国糖尿病
研究指出，围术期血糖控制不佳会增加术后发生主要不良事 协会（ADA）诊疗指南 ［6］ 指出，当 HbA 1c ≤ 7.0％时，可降
件的风险，且无论患者是否确诊糖尿病，术前血糖异常均可 低患者出现糖尿病相关并发症的风险。目前部分学者明确了
作为心脏外科术后不良结局的危险因素 ［3］ 。糖化血红蛋白 HbA 1c 在接受心脏手术的糖尿病和非糖尿病群体中具有临床应
（HbA 1c ）不同于测得即刻血糖的空腹血糖（FPG）和餐后 2 h 用价值，但均存在一定局限性，如各研究 HbA 1c 分界值没有
血糖（PPG），其反映受试者近 2~3 个月的血糖整体控制情 统一标准、研究多采用回顾性观察性设计、单个研究样本量
况，因此术前 HbA 1c 被推荐用作具有高血糖风险患者的诊断 较小导致缺乏足够统计效能等。针对以上问题，本研究通过