Selvaraj N, Bobby Zachariah, Koner Bidhan Chandra, Das Ashok Kumar
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605 006, India.
Clin Chim Acta. 2005 Oct;360(1-2):108-13. doi: 10.1016/j.cccn.2005.04.015.
Glycated hemoglobin (HbA(1C)) is considered clinically useful for assessing long-term integrated control of blood glucose in diabetes. However, an increased HbA(1C) concentration has been documented in chronic renal failure (CRF) patients without any history of diabetes. Collective evidences reveal that lipid peroxidation (MDA) can modulate protein glycation. We evaluated the relationship between glycated hemoglobin (HbA(1C)) and lipid peroxidation in non-diabetic CRF patients.
Twenty-eight nondiabetic CRF and 23 age- and sex-matched healthy subjects were enrolled for this study. Plasma urea, creatinine, lipid peroxides, fasting glucose and HbA(1C) were analyzed in both the groups. The in-vitro effect of MDA on glycation of hemoglobin was studied by incubating healthy erythrocytes with either 5 or 50 mmol/l glucose concentration.
The percentage of HbA(1C) concentrations and plasma malondialdehyde (MDA) were significantly increased in CRF patients compared to control subjects. When the effects of uremia and blood glucose on the concentration of HbA(1C) was refuted by partial correlation analysis, MDA was found to be a significant determinant of HbA(1C) (r=0.41, p=0.04) in patients with renal failure. In-vitro incubation of RBC with glucose along with MDA was found to enhance the process of hemoglobin glycation.
Our results suggest that lipid peroxidation per se can contribute to glycation of hemoglobin, warranting extra-precaution in interpreting HbA(1C) as a measure of glycemic control in CRF.
糖化血红蛋白（HbA₁C）在临床上被认为有助于评估糖尿病患者血糖的长期综合控制情况。然而，已有文献记载，无糖尿病病史的慢性肾衰竭（CRF）患者的HbA₁C浓度会升高。多项证据表明，脂质过氧化（丙二醛，MDA）可调节蛋白质糖化。我们评估了非糖尿病CRF患者糖化血红蛋白（HbA₁C）与脂质过氧化之间的关系。
本研究纳入了28例非糖尿病CRF患者以及23例年龄和性别匹配的健康受试者。对两组患者的血浆尿素、肌酐、脂质过氧化物、空腹血糖和HbA₁C进行了分析。通过将健康红细胞与5或50 mmol/l葡萄糖浓度孵育，研究了MDA对血红蛋白糖化的体外作用。
与对照组相比，CRF患者的HbA₁C浓度百分比和血浆丙二醛（MDA）显著升高。当通过偏相关分析排除尿毒症和血糖对HbA₁C浓度的影响后，发现MDA是肾衰竭患者HbA₁C的一个重要决定因素（r = 0.41，p = 0.04）。发现红细胞与葡萄糖以及MDA一起进行体外孵育可增强血红蛋白糖化过程。
我们的结果表明，脂质过氧化本身可导致血红蛋白糖化，这使得在将HbA₁C解释为CRF患者血糖控制指标时需格外谨慎。
