糖尿病患者非心脏手术术前血红蛋白糖化指数与术后并发症风险的相关性

doi:10.16352/j.issn.1001-6325.2026.05.0703

基础医学与临床 ›› 2026, Vol. 46 ›› Issue (5): 703-710.doi: 10.16352/j.issn.1001-6325.2026.05.0703

糖尿病患者非心脏手术术前血红蛋白糖化指数与术后并发症风险的相关性

张毅¹, 兰岭¹, 张越伦², 申乐^1*

中国医学科学院北京协和医学院北京协和医院 1.麻醉科;2.医学科学研究中心, 北京 100730

收稿日期:2026-02-14 修回日期:2026-03-24 出版日期:2026-05-05 发布日期:2026-04-28
通讯作者: ^*pumchshenle@163.com
基金资助:
中国医学科学院医学与健康科技创新工程探索研究专项(2024-I2M-TS-001);医学高层次人才计划(国家优秀青年医师)

Association of preoperative hemoglobin glycation index with postoperative complication risk in diabetic patients undergoing non-cardiac surgery

ZHANG Yi¹, LAN Ling¹, ZHANG Yuelun², SHEN Le^1*

1. Department of Anesthesiology; 2. Medical Science Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Received:2026-02-14 Revised:2026-03-24 Online:2026-05-05 Published:2026-04-28
Contact: ^*pumchshenle@163.com

摘要/Abstract

摘要： 目的探讨术前血红蛋白糖化指数(HGI)与糖尿病择期手术患者术后并发症的相关性。方法采用单中心回顾性队列研究设计,纳入2013年1月至2024年6月期间在本中心接受择期非心脏手术的成年糖尿病患者。收集术前空腹血糖(FPG)、糖化血红蛋白(HbA1c)及围术期临床资料,通过线性回归模型建立HbA1c与 FPG 的关系并计算 HGI。主要结局为住院期间术后并发症的发生。采用多因素 Logistic 回归分析评估HGI与术后并发症的独立关联,并应用限制性立方样条(RCS)探索潜在的非线性关系。结果共纳入9 249例糖尿病择期手术患者,其中761例(8.2%)发生术后并发症。多因素分析显示,术前HGI升高与术后并发症风险增加独立相关(OR:1.099,95% CI:1.029~1.171,P=0.004)。RCS 分析提示HGI与术后并发症风险呈线性正相关。结论在糖尿病择期非心脏手术患者中,术前HGI与住院期间术后并发症风险增加独立相关,且二者呈线性剂量-反应关系,可作为围术期风险分层的参考指标之一。

关键词: 血红蛋白糖化指数, 术后并发症, 糖尿病, 非心脏手术

Abstract: Objective To investigate the association between preoperative hemoglobin glycation index (HGI) and postoperative complications in diabetic patients undergoing elective surgery. Methods This single-center retrospective cohort study included adult diabetic patients who underwent elective non-cardiac surgery between January 2013 and June 2024. Preoperative fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and perioperative clinical data were collected. HGI was calculated as the difference between observed HbA1c and HbA1c predicted from FPG using a linear regression model. The primary outcome was postoperative complications during hospitalization. Multivariable logistic regression was used to evaluate the independent association between HGI and postoperative complications, and restricted cubic splines were applied to assess potential non-linear relationships. Results Total of 9 249 diabetic patients undergoing elective surgery were included, among whom 761 patients (8.2%) developed postoperative complications. Higher preoperative HGI was independently associated with an increased risk of postoperative complications (OR:1.099, 95% CI: 1.029-1.171; P=0.004). Restricted cubic spline analysis suggested a linear association between HGI and complication risk. Conclusions Preoperative HGI is an independent risk factor for in-hospital postoperative complications in diabetic patients following elective non-cardiac surgery. The linear dose-response relationship identified highlights its potential as a supplementary tool for perioperative risk assessment.

Key words: hemoglobin glycation index, postoperative complications, diabetes, non-cardiac surgery

中图分类号:

R614

张毅, 兰岭, 张越伦, 申乐. 糖尿病患者非心脏手术术前血红蛋白糖化指数与术后并发症风险的相关性[J]. 基础医学与临床, 2026, 46(5): 703-710.

ZHANG Yi, LAN Ling, ZHANG Yuelun, SHEN Le. Association of preoperative hemoglobin glycation index with postoperative complication risk in diabetic patients undergoing non-cardiac surgery[J]. Basic & Clinical Medicine, 2026, 46(5): 703-710.

参考文献 14

[1]	Underwood P, Askari R, Hurwitz S, et al. Preoperative a1c and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures[J]. Diabetes Care, 2014,37:611-616.
[2]	Wukich DK, McMillen RL, Lowery NJ, et al. Surgical site infections after foot and ankle surgery: A comparison of patients with and without diabetes[J]. Diabetes Care, 2011,34:2211-2213.
[3]	Marchant MH, Viens NA, Cook C, et al. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty[J]. J Bone Joint Surg Am, 2009,91:1621-1629.
[4]	Hempe JM, Liu S, Myers L, et al. The hemoglobin glycation index identifies subpopulations with harms or benefits from intensive treatment in the accord trial[J]. Diabetes Care, 2015,38:1067-1074.
[5]	Hare MJL, Shaw JE, Zimmet PZ. Current controversies in the use of haemoglobin a1c[J]. J Intern Med, 2012,271:227-236.
[6]	Hempe JM, Gomez R, McCarter RJ, et al. High and low hemoglobin glycation phenotypes in type 1 diabetes: a challenge for interpretation of glycemic control[J]. J Diabetes Complications, 2002,16:313-320.
[7]	Rashid R, Sohrabi C, Kerwan A, et al. The strocss 2024 guideline: Strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery[J]. Int J Surg, 2024,110:3151-3165.
[8]	Van BS, Groothuis-OK. Mice: Multivariate imputation by chained equations in r[J]. J Stat Softw, 2011,45:1-67.
[9]	Xiao Y, Sun B, Yu G, et al. Impact of hemoglobin glycation index on complications following orthopedic surgery: A retrospective comparative propensity score-matched study[J]. Orthop Surg, 2025,17:2015-2024.
	McCarter RJ, Hempe JM, Gomez R, et al. Biological variation in hba1c predicts risk of retinopathy and nephropathy in type 1 diabetes[J]. Diabetes Care, 2004,27:1259-1264.
[10]	Chang PC, Tsai SC, Jheng YH, et al. Soft-tissue wound healing by anti-advanced glycation end-products agents[J]. J Dent Res, 2014,93:388-393.
[11]	Lyu L, Yu J, Liu Y, et al. High hemoglobin glycation index is associated with telomere attrition independent of hba1c, mediated by tnfα[J]. J Clin Endocrinol Metab, 2022,107:462-473.
[12]	Kim MK, Jeong JS, Yun JS, et al. Hemoglobin glycation index predicts cardiovascular disease in people with type 2 diabetes mellitus: a 10-year longitudinal cohort study[J]. J Diabetes Complications, 2018,32:906-910.
[13]	Felipe DL, Hempe JM, Liu S, et al. Skin intrinsic fluorescence is associated with hemoglobin a(1c)and hemoglobin glycation index but not mean blood glucose in children with type 1 diabetes[J]. Diabetes Care, 2011,34:1816-1820.
[14]	Marini MA, Fiorentino TV, Succurro E, et al. Associa-tion between hemoglobin glycation index with insulin resistance and carotid atherosclerosis in non-diabetic individuals[J]. PLoS One, 2017,12:e0175547. doi: 10.1371/journal.pone.0175547.

[1]	杨雪, 程晓亮. 鸢尾素在2型糖尿病及慢性心力衰竭中的作用机制[J]. 基础医学与临床, 2026, 46(7): 1014-1018.
[2]	丰文君, 赵晓露, 李淼, 杨晓芳, 谢金洁. 下调 BIRC2 减轻高糖诱导的人肾小球系膜细胞系HGMCs损伤并促进自噬[J]. 基础医学与临床, 2026, 46(6): 830-835.
[3]	段艳茹, 阮燕萍, 陈洁, 邢媛媛. 脂联素/APPL1轴调控紧密连接减轻糖尿病血管内皮细胞损伤[J]. 基础医学与临床, 2026, 46(5): 673-680.
[4]	王乾臣, 施星驰, 郑伟英. 血清Gal-3、VASH-1、NGAL水平对妊娠期糖尿病患者早期肾功能损伤的诊断价值[J]. 基础医学与临床, 2026, 46(3): 421-426.
[5]	边亚, 郭洁, 曹卫广, 吕小棉. 尼可地尔预处理改善糖尿病合并冠心病模型大鼠心脏功能[J]. 基础医学与临床, 2026, 46(3): 388-395.
[6]	余渊, 胡艺琼, 向庆伟. miR-218-5p减轻高糖诱导的小鼠肾足细胞系MPC5损伤[J]. 基础医学与临床, 2026, 46(2): 170-176.
[7]	车彦霏, 覃东汕, 余姿漫, 王皓宇, 杨丹, 梁晓春. 筋脉通对高糖诱导RSC96细胞糖酵解重编程及RAW264.7细胞极化的调节作用[J]. 基础医学与临床, 2026, 46(2): 208-214.
[8]	阮峥, 戈欣, 廖妍媛, 张舒雅. 骨密度联合血清25-(OH)D₃和ucOC检测辅助诊断T2DN并发肌少症[J]. 基础医学与临床, 2026, 46(1): 97-102.
[9]	孙清怡, 陈果, 符晓, 孙海建, 陆清波. 肠道菌群紊乱与糖尿病心肌病[J]. 基础医学与临床, 2026, 46(1): 129-133.
[10]	何珂, 杨帆, 陆西宛, 胡蕴. GLP-1R rs2268641变异增加中国人糖尿病肾病风险[J]. 基础医学与临床, 2025, 45(9): 1190-1194.
[11]	乌兰, 魏畅, 李应桢, 栾春生. 应用OCTA评估糖尿病性视网膜病变玻璃体切割术后的临床效果[J]. 基础医学与临床, 2025, 45(8): 1078-1082.
[12]	范婷婷, 李慧莉, 郭瑞娟, 马丹旭, 王云. STAT3介导A2表型星形胶质细胞极化缓解1型糖尿病大鼠周围神经痛[J]. 基础医学与临床, 2025, 45(7): 889-896.
[13]	王瑞, 张玉萍, 李蕊, 李运龙, 李元, 张园, 刘燕萍. 妊娠期糖尿病患者血糖波动与妊娠期高血压发病相关[J]. 基础医学与临床, 2025, 45(5): 664-670.
[14]	张舒婷, 赖水青, 朱启波, 傅晓莹, 陈红梅, 关海霞. 多模态糖尿病综合管理教学在住院医师规范化培训中的探索[J]. 基础医学与临床, 2025, 45(5): 691-696.
[15]	赵青青, 程晓亮. 糖尿病肾病的生物标志物的研究进展[J]. 基础医学与临床, 2025, 45(4): 546-550.

糖尿病患者非心脏手术术前血红蛋白糖化指数与术后并发症风险的相关性

Association of preoperative hemoglobin glycation index with postoperative complication risk in diabetic patients undergoing non-cardiac surgery

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 14

相关文章 15

编辑推荐

Metrics

本文评价