临床无症状血红蛋白变异体中糖化血红蛋白的测定

Determination of glycated hemoglobin in clinically silent hemoglobin variants.

作者信息

Schnedl Wolfgang J, Lahousen Theresa, Lang Thomas, Lipp Rainer W, Yonehara Satoshi, Fukunaga Satoshi, Imai Toshihiro, Little Randie R

机构信息

Department of Internal Medicine, Medical University, School of Medicine, Graz, Austria.

出版信息

Diabetes Metab Res Rev. 2004 Nov-Dec;20(6):460-5. doi: 10.1002/dmrr.483.

DOI:10.1002/dmrr.483

PMID:15386816

Abstract

BACKGROUND

Evaluation of glycated hemoglobin determination methods in patients with clinically silent hemoglobin variants.

METHODS

HbA1c results were determined with various methods, including a new enzymatic assay, a boronate affinity HPLC, immunoassays and ion-exchange HPLC in patients with the clinically silent hemoglobin variants Hb Graz, Hb Sherwood Forest, Hb D and Hb O Padova.

RESULTS

The effect of hemoglobin variants on glycated hemoglobin determination was method-dependent. The enzymatic and boronate affinity HPLC method did not interfere with any of the variants evaluated. In contrast, Hb Graz interfered with all immunoassay and ion-exchange HPLC methods evaluated. The Tosoh ion-exchange HPLC method HLC-723 did not detect the late migrating Hb O Padova in the chromatogram, but this hemoglobin variant still interfered causing artificially low HbA1c results.

CONCLUSIONS

Our study underscores the need for clinical laboratories and physicians to be aware of the limitations of their HbA1c assay methods as well as the importance of visual inspection of ion-exchange chromatograms to detect abnormalities caused by the hemoglobin variants. Samples with clinically silent Hb variants should be analyzed by a second method with a different assay principle, preferably a boronate affinity HPLC or an enzymatic assay.

摘要

背景

对临床无症状血红蛋白变异患者糖化血红蛋白测定方法的评估。

方法

采用多种方法测定HbA1c结果，包括一种新的酶法、硼酸亲和高效液相色谱法、免疫测定法和离子交换高效液相色谱法，用于检测临床无症状血红蛋白变异体Hb Graz、Hb Sherwood Forest、Hb D和Hb O Padova患者。

结果

血红蛋白变异体对糖化血红蛋白测定的影响因方法而异。酶法和硼酸亲和高效液相色谱法不受所评估的任何变异体干扰。相比之下，Hb Graz干扰了所有评估的免疫测定法和离子交换高效液相色谱法。Tosoh离子交换高效液相色谱法HLC - 723在色谱图中未检测到迁移较晚的Hb O Padova，但这种血红蛋白变异体仍产生干扰，导致HbA1c结果人为偏低。