Division of Nephrology, Department of Medicine, Shuang-Ho Hospital, Taipei Medical University, Taipei, Taiwan.
Clin Chim Acta. 2012 Oct 9;413(19-20):1555-61. doi: 10.1016/j.cca.2012.04.025. Epub 2012 May 10.
Chronic hyperglycemia results in a non-enzymatic glycation of proteins, and produces Amadori products, such as glycated albumin (GA), glycosylated hemoglobin (HbA1c), and fructosamine. In current clinical practice, long-term glycemic control is assessed by quarterly measurements of HbA1c. Since the degree of hemoglobin glycosylation depends not only on the level of glycemic control, but also on the lifespan of red blood cells, patients with hemoglobin disorders or anemia of any cause may have erroneous HbA1c levels, and consequently receive insufficient treatment. Patients with chronic kidney disease (CKD) often suffer from various types of anemia, and consequently, they are frequently treated with iron and/or erythropoietin therapy or frequent blood transfusion. Thus, serum GA is a potentially useful glycemic index in diabetic patients with CKD, since it is not influenced by anemia and associated treatments. GA may also reflect the status of blood glucose more rapidly (2-3 weeks) than HbA1c (2-3 months), and is beneficial in those with wide variations in blood glucose or at higher risk for hypoglycemia. If clinical investigations support its utility, it may be applicable as a screening tool for all patients with diabetes during routine health examinations. Serum GA levels are also associated with AGE-related fluorescence and the number of glycation sites, and it may influence the structural and functional changes inalbumin. Since end-stage renal disease is an extreme microvascular complication of diabetic nephropathy, CKD patients with diabetes should be carefully managed to prevent disease progression. In this review, the clinical aspects of GA were discussed, including a comparison of GA with other glycated proteins, the utility and limitations of GA as a glycemic index, its influence on the therapeutic effects of hypoglycemic agents, its correlations with vascular complications, and its potential role in pathogenesis, specifically in diabetic patients with CKD.
慢性高血糖导致蛋白质的非酶糖基化，并产生 Amadori 产物，如糖化白蛋白 (GA)、糖化血红蛋白 (HbA1c) 和果糖胺。在当前的临床实践中，通过每季度测量 HbA1c 来评估长期血糖控制情况。由于血红蛋白糖基化的程度不仅取决于血糖控制水平，还取决于红细胞的寿命，因此血红蛋白异常或任何原因引起的贫血患者可能会出现错误的 HbA1c 水平，从而导致治疗不足。患有慢性肾脏病 (CKD) 的患者常患有各种类型的贫血，因此经常接受铁和/或促红细胞生成素治疗或频繁输血。因此，血清 GA 是 CKD 糖尿病患者潜在有用的血糖指标，因为它不受贫血和相关治疗的影响。GA 可能比 HbA1c（2-3 个月）更快地反映血糖状态（2-3 周），并且对于血糖波动较大或低血糖风险较高的患者有益。如果临床研究支持其效用，它可能适用于所有糖尿病患者在常规健康检查期间作为筛查工具。血清 GA 水平也与 AGE 相关荧光和糖基化位点数量相关，并且可能影响白蛋白的结构和功能变化。由于终末期肾病是糖尿病肾病的极端微血管并发症，因此应仔细管理患有 CKD 的糖尿病患者，以防止疾病进展。在这篇综述中，讨论了 GA 的临床方面，包括与其他糖化蛋白的比较、GA 作为血糖指标的实用性和局限性、它对降血糖药物治疗效果的影响、与血管并发症的相关性以及它在发病机制中的潜在作用，特别是在患有 CKD 的糖尿病患者中。
