Miyamoto Hiroyasu, Suzuki Harumi, Yokoyama Yusuke, Akizuki Setsuko, Hirai Noriyuki, Ohnishi Akihiro
Division of Central Laboratory Section, Daisan Hospital, Jikei University School of Medicine, Komae 201-8601, Japan.
Rinsho Byori. 2008 Sep;56(9):761-6.
To investigate how liver disease alter the serum glycated proteins as markers of diabetic control, we studied serum GA, A1c and especially GA/A1c ratio in 255 patients having over 35IU/L in ALT(transaminase) compared with those of 829 type 2 diabetes mellitus (DM) in cross sectional manner. 255 patients with liver diseases were divided into 69 patients with biopsy proven liver cirrhosis (LC), 66 patients with chronic hepatitis(CH) and 120 patients with fatty liver(FL) diagnosed by abdominal echography. The mean GA/A1c ratio (+/-SD) was significantly higher (p<0.0001) in LC group(3.71+/-1.03) than the other groups (3.03+/-0.45 for CH, 3.05+/-0.42 for DM), while the mean GA/A1c ratio in FL group was significantly lower(2.74+/-0.31) (p<0.0001)) than that of DM groups. In LC group the GA/A1c ratio increased significantly depending upon serum albumin and/or platelet reductions. The GA/A1c ratio was significantly correlated with the other laboratory data such as serum albumin, cholinesterase, total cholesterol levels and weakly correlated with serum hemoglobin level. We also followed the serum levels of GA and A1c and the GA/A1c ratio during about 13 months (5 times blood collections) in 18 patients enrolled in this study. Resultantly the coefficient of variation of GA/A1c ratio was the smaller than the others(GA, A1c). The ROC curve of GA/A1c ratio for LC versus FL group was the most reliable between four groups and the cut-off value for LC versus FL was 2.94. Theses results suggest that GA/A1c ratio could be an useful marker for different diagnosis when facing patients with abnormal serum ALT level in a clinical setting.
为了研究肝脏疾病如何改变血清糖化蛋白作为糖尿病控制指标，我们以横断面方式研究了255例谷丙转氨酶（ALT）超过35IU/L的患者与829例2型糖尿病（DM）患者的血清糖化白蛋白（GA）、糖化血红蛋白（A1c），尤其是GA/A1c比值。255例肝病患者分为69例经活检证实的肝硬化（LC）患者、66例慢性肝炎（CH）患者和120例经腹部超声诊断的脂肪肝（FL）患者。LC组的平均GA/A1c比值（±标准差）显著高于其他组（LC组为3.71±1.03，CH组为3.03±0.45，DM组为3.05±0.42）（p<0.0001），而FL组的平均GA/A1c比值显著低于DM组（2.74±0.31）（p<0.0001）。在LC组中，GA/A1c比值根据血清白蛋白和/或血小板减少而显著增加。GA/A1c比值与其他实验室数据如血清白蛋白、胆碱酯酶、总胆固醇水平显著相关，与血清血红蛋白水平弱相关。我们还对本研究纳入的18例患者在约13个月内（采集5次血样）跟踪了GA和A1c的血清水平以及GA/A1c比值。结果显示，GA/A1c比值的变异系数小于其他指标（GA、A1c）。在四组中，LC组与FL组的GA/A1c比值的ROC曲线最可靠，LC组与FL组的临界值为2.94。这些结果表明，在临床环境中面对血清ALT水平异常的患者时，GA/A1c比值可能是用于鉴别诊断的有用指标。
