Koga M, Morita S, Saito H, Mukai M, Kasayama S
Department of Internal Medicine, Kinki Central Hospital, Itami, Japan.
Diabet Med. 2007 Aug;24(8):843-7. doi: 10.1111/j.1464-5491.2007.02161.x. Epub 2007 Apr 21.
Although HbA(1c) is known to be affected by the lifespan of erythrocytes, any association of erythrocyte indices with HbA(1c) in subjects without anaemia is poorly understood. Pre-menopausal women may be relatively iron deficient because of menstruation. In this study, we examined the relationship between HbA(1c) and erythrocyte indices in pre- and post-menopausal women.
We determined HbA(1c), red blood cell (RBC) count, haematocrit, haemoglobin, mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) in 423 women with normal glucose tolerance who had undergone health checks. In addition, age at menopause was recorded in post-menopausal subjects.
RBC counts of the 180 pre-menopausal women were positively associated with HbA(1c), whereas haemoglobin, MCV and MCH showed a negative association. In contrast, no significant association of any indices with HbA(1c) was detected in the 243 post-menopausal women. Stepwise multivariate regression analysis in the pre-menopausal women identified fasting plasma glucose and age as positively associated and MCH as negatively associated with HbA(1c), regardless of whether or not these pre-menopausal women were anaemic.
Erythrocyte indices are associated with HbA(1c), independently of plasma glucose levels, in pre-menopausal women even when they are not anaemic. This should be appreciated when interpreting HbA(1c) in pre-menopausal patients with diabetes.
虽然已知糖化血红蛋白(HbA1c)受红细胞寿命影响,但对于无贫血受试者中红细胞指数与HbA1c之间的任何关联却知之甚少。绝经前女性可能因月经而相对缺铁。在本研究中,我们检测了绝经前和绝经后女性中HbA1c与红细胞指数之间的关系。
我们测定了423例接受健康检查且糖耐量正常的女性的HbA1c、红细胞(RBC)计数、血细胞比容、血红蛋白、平均红细胞体积(MCV)和平均红细胞血红蛋白含量(MCH)。此外,记录了绝经后受试者的绝经年龄。
180例绝经前女性的RBC计数与HbA1c呈正相关,而血红蛋白、MCV和MCH呈负相关。相比之下,在243例绝经后女性中未检测到任何指标与HbA1c有显著关联。绝经前女性的逐步多因素回归分析确定,无论这些绝经前女性是否贫血,空腹血糖和年龄与HbA1c呈正相关,MCH与HbA1c呈负相关。
在绝经前女性中,即使不贫血,红细胞指数也与HbA1c相关,且独立于血糖水平。在解释绝经前糖尿病患者的HbA1c时应认识到这一点。