Chachou A, Randoux C, Millart H, Chanard J, Gillery P
Central Laboratory of Biochemistry, Robert Debré Hospital, CHU of Reims, France.
Clin Chem Lab Med. 2000 Apr;38(4):321-6. doi: 10.1515/CCLM.2000.046.
Increased carbamylated hemoglobin formed in erythrocytes during uremia may interfere with HbA1c assays, but few studies compared directly both parameters. We measured carbamylated hemoglobin by HPLC in 45 non-diabetic uremic patients (16 with acute and two with chronic renal failure, 27 with transplant recipients) as 57.8 +/- 22.3 microg carbamylvaline/g Hb (mean +/- standard deviation) vs. 31.6 +/- 5.1 in 15 controls (+83%, p < 0.001). In these samples, HbA1c was evaluated by three ion-exchange HPLC methods, 1: Diamat (BioRad), 2: A1c2.2 (Tosoh) and 3: HA8140 (Menarini), and one immunoassay method (Tinaquant II Roche). Whichever the method, mean HbA1c values obtained increased in patients with high (> 60 microg carbamylvaline/g Hb) vs. low (< 45) carbamylated hemoglobin values (+0.08 to 0.25% of total Hb), but differences were not significant. Minor peaks on the chromatograms were however increased in parallel to carbamylated hemoglobin. HbA1c values over 6% were found in 4, 1, 2 and 0 samples, with HPLC 1, 2, 3 and immunoassay, respectively. Fructosamine values were not significantly altered. Our results show that Hb adducts, whether due to carbamylation or to other chemical reactions, interfere to a variable extent with different HbA1c assay methods, and confirm that HbA1c values should be interpreted with caution in uremic patients.
尿毒症期间红细胞中形成的氨甲酰化血红蛋白增加可能会干扰糖化血红蛋白（HbA1c）检测，但很少有研究直接比较这两个参数。我们采用高效液相色谱法（HPLC）对45例非糖尿病尿毒症患者（16例急性肾衰竭、2例慢性肾衰竭、27例移植受者）进行了氨甲酰化血红蛋白检测，结果为57.8±22.3微克氨甲酰缬氨酸/克血红蛋白（均值±标准差），而15例对照者为31.6±5.1（增加83%，p<0.001）。在这些样本中，通过三种离子交换HPLC方法评估HbA1c：1. Diamat（伯乐公司）；2. A1c2.2（东曹公司）；3. HA8140（美纳里尼公司），以及一种免疫测定方法（Tinaquant II罗氏公司）。无论采用哪种方法，氨甲酰化血红蛋白值高（>60微克氨甲酰缬氨酸/克血红蛋白）的患者与值低（<45）的患者相比，所测得的平均HbA1c值均有所升高（占总血红蛋白的0.08%至0.25%），但差异不显著。然而，色谱图上的小峰与氨甲酰化血红蛋白平行增加。分别采用HPLC 1、2、3和免疫测定法时，在4、1、2和0个样本中发现HbA1c值超过6%。果糖胺值无显著变化。我们的结果表明，血红蛋白加合物，无论是由于氨甲酰化还是其他化学反应，都会对不同的HbA1c检测方法产生不同程度的干扰，并证实尿毒症患者的HbA1c值应谨慎解读。
