慢性肾衰竭、血液透析及其他疾病患者中糖化血红蛋白（HbA1c）值及其评估可能存在的差异。
Possible discrepancy of HbA1c values and its assessment among patients with chronic renal failure, hemodialysis and other diseases.
作者信息
Inoue Kaori, Goto Atsushi, Kishimoto Miyako, Tsujimoto Tetsuro, Yamamoto-Honda Ritsuko, Noto Hiroshi, Kajio Hiroshi, Terauchi Yasuo, Noda Mitsuhiko
机构信息
Department of Endocrinology, Diabetes, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, 162-8655, Japan.
Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
出版信息
Clin Exp Nephrol. 2015 Dec;19(6):1179-83. doi: 10.1007/s10157-015-1110-6. Epub 2015 Apr 1.
BACKGROUND
Glycated hemoglobin (HbA1c) and glycated albumin (GA) are frequently used as glycemic control markers. However, these markers are influenced by alterations in hemoglobin and albumin metabolism. Thus, conditions such as anemia, chronic renal failure, hypersplenism, chronic liver diseases, hyperthyroidism, hypoalbuminemia, and pregnancy need to be considered when interpreting HbA1c or GA values. Using data from patients with normal albumin and hemoglobin metabolism, we previously established a linear regression equation describing the GA value versus the HbA1c value to calculate an extrapolated HbA1c (eHbA1c) value for the accurate evaluation of glycemic control. In this study, we investigated the difference between the measured HbA1c and the eHbA1c values for patients with various conditions.
METHODS
Data sets for a total of 2461 occasions were obtained from 731 patients whose HbA1c and GA values were simultaneously measured. We excluded patients with missing data or changeable HbA1c levels, and patients who had received transfusions or steroids within the previous 3 months. Finally, we included 44 patients with chronic renal failure (CRF), 10 patients who were undergoing hemodialysis (HD), 7 patients with hematological malignancies and a hemoglobin level of less than 10 g/dL (HM), and 12 patients with chronic liver diseases (CLD).
RESULTS
In all the groups, the eHbA1c values were significantly higher than the measured HbA1c values. The median difference was 0.75 % (95 % CI 0.40-1.10 %, P for the difference is <0.001) in the CRF group, 0.80 % (95 % CI 0.30-1.65 %, P for the difference is 0.041) in the HD group, 0.90 % (95 % CI 0.90-1.30 %, P for the difference is 0.028) in the HM group, and 0.85 % (95 % CI 0.40-1.50 %, P for the difference is 0.009) in the CLD group.
CONCLUSIONS
We found that the measured HbA1c values were lower than the eHbA1c values in each of the groups.
背景
糖化血红蛋白（HbA1c）和糖化白蛋白（GA）常被用作血糖控制指标。然而，这些指标会受到血红蛋白和白蛋白代谢变化的影响。因此，在解读HbA1c或GA值时，需要考虑诸如贫血、慢性肾衰竭、脾功能亢进、慢性肝病、甲状腺功能亢进、低白蛋白血症和妊娠等情况。我们之前利用白蛋白和血红蛋白代谢正常的患者数据，建立了一个描述GA值与HbA1c值关系的线性回归方程，以计算外推HbA1c（eHbA1c）值，用于准确评估血糖控制情况。在本研究中，我们调查了不同病情患者实测HbA1c值与eHbA1c值之间的差异。
方法
从731例同时检测HbA1c和GA值的患者中获取了总共2461次的数据集。我们排除了有缺失数据或HbA1c水平可变的患者，以及在过去3个月内接受过输血或使用过类固醇的患者。最终，我们纳入了44例慢性肾衰竭（CRF）患者、10例正在接受血液透析（HD）的患者、7例血液系统恶性肿瘤且血红蛋白水平低于10 g/dL的患者（HM）以及12例慢性肝病（CLD）患者。
结果
在所有组中，eHbA1c值均显著高于实测HbA1c值。CRF组的中位数差异为0.75%（95%CI 0.40 - 1.10%，差异的P值<0.001），HD组为0.80%（95%CI 0.30 - 1.65%，差异的P值为0.041），HM组为0.90%（95%CI 0.90 - 1.30%，差异的P值为0.028），CLD组为0.85%（95%CI 0.4
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