U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy Sezione di Endocrinologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Verona, Italy.
Pediatr Diabetes. 2011 May;12(3 Pt 1):183-6. doi: 10.1111/j.1399-5448.2010.00684.x. Epub 2010 Dec 5.
Lippi G, Targher G. A laboratory standpoint on the role of hemoglobin A1c for the diagnosis of diabetes in childhood: more doubts than certainties? The American Diabetes Association has recently included the measurement of hemoglobin A1c (A1c) among the criteria for diagnosing diabetes, so that this diagnostic strategy might also be extended in childhood and adolescence. Although the possibility of using A1c testing for screening and even diagnosing diabetes is highly appealing, A1c testing cannot be considered as yet the 'panacea' for a variety of reasons that include the suboptimal correlation with the mean blood glucose, the risk of misdiagnosis in children or adolescents with impaired renal function, iron-deficiency anemia and increased red blood cell turnover, the interference from hemoglobin variants, and the heterogeneous diagnostic performance among different populations. Additional limitations include the higher imprecision of most A1c assays (especially point-of-care testing devices) when compared with plasma glucose measurement, as well as the incremental cost deriving from routinely replacing plasma glucose with A1c determination. Taken together, the current limitations would suggest a certain degree of caution before recommending the widespread implementation of the A1c assay for diagnosing diabetes in childhood and adolescence. The potential clinical benefits (if any) of replacing blood glucose testing with A1c for diagnosing diabetes are still uncertain and will probably remain so until reliable cost-effective analyses are available.
李皮 G，塔尔赫 G。从实验室角度看血红蛋白 A1c 在儿童糖尿病诊断中的作用：疑虑多于确定？美国糖尿病协会最近将血红蛋白 A1c（A1c）的测量纳入糖尿病诊断标准，因此这种诊断策略也可能扩展到儿童和青少年。尽管 A1c 测试用于筛查甚至诊断糖尿病的可能性非常有吸引力，但由于多种原因，A1c 测试不能被视为“万能药”，包括与平均血糖的相关性不佳、肾功能受损的儿童或青少年误诊的风险、缺铁性贫血和红细胞周转率增加、血红蛋白变异的干扰以及不同人群之间诊断性能的异质性。其他限制因素包括与血浆葡萄糖测量相比，大多数 A1c 检测（尤其是即时检测设备）的不精确性更高，以及从常规上用 A1c 测定替代血浆葡萄糖所产生的增量成本。总的来说，在推荐广泛应用 A1c 检测诊断儿童和青少年糖尿病之前，需要一定程度的谨慎。用 A1c 替代血糖检测诊断糖尿病的潜在临床益处（如果有的话）仍不确定，可能在有可靠的具有成本效益的分析之前仍然如此。
