Mcebula V, Crowther N J, Nagel S E, George J A
Department of Chemical Pathology, National Health Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa.
Department of Chemical Pathology, National Health Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa, Department of Chemical Pathology, National Health Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa.
Int J Tuberc Lung Dis. 2017 Feb 1;21(2):208-213. doi: 10.5588/ijtld.15.0831.
Primary health care clinics.
To determine the prevalence of diabetes mellitus (DM) in tuberculosis (TB) patients using glycated haemoglobin (HbA1c), and to compare the performance of laboratory and point-of-care (POC) HbA1c measurement.
This was a cross-sectional study of 325 patients. Screening was at POC using laboratory HbA1c methods; DM was confirmed by the oral glucose tolerance test (OGTT). Multivariate regression analysis was performed to determine predictors of HbA1c.
Mean laboratory-derived HbA1c was significantly higher than mean POC HbA1c (P = 0.007). Of 83 subjects who underwent OGTT, 2 (2.4%) were diagnosed with DM, 3 (3.60%) with impaired fasting glucose and 15 (18.1%) with impaired glucose tolerance. Twelve (14.5%) had an HbA1c of 6.50% using POC HbA1c and 21 (25.3%) using laboratory HbA1c. In multivariate regression analysis, age and weight were positively associated with both laboratory and POC HBA1c, while duration of anti-tuberculosis treatment was negatively associated with both.
Glucose and HbA1c levels fell with increased duration of anti-tuberculosis treatment, suggesting that the optimal time for DM screening in this population was at least 5 months after TB was first diagnosed. Our data suggest that the use of HbA1c is inappropriate for testing glycaemia in patients with TB.
基层医疗诊所。
使用糖化血红蛋白（HbA1c）测定结核病（TB）患者中糖尿病（DM）的患病率，并比较实验室检测和即时检测（POC）HbA1c的性能。
这是一项对325名患者的横断面研究。采用实验室HbA1c方法在即时检测点进行筛查；通过口服葡萄糖耐量试验（OGTT）确诊DM。进行多变量回归分析以确定HbA1c的预测因素。
实验室检测得出的平均HbA1c显著高于即时检测的平均HbA1c（P = 0.007）。在83名接受OGTT的受试者中，2人（2.4%）被诊断为DM，3人（3.60%）空腹血糖受损，15人（18.1%）糖耐量受损。使用即时检测HbA1c时，12人（14.5%）的HbA1c≥6.50%，使用实验室HbA1c时为21人（25.3%）。在多变量回归分析中，年龄和体重与实验室检测和即时检测的HbA1c均呈正相关，而抗结核治疗时间与两者均呈负相关。
随着抗结核治疗时间的延长，血糖和HbA1c水平下降，这表明该人群中DM筛查的最佳时间是在首次诊断TB后至少5个月。我们的数据表明，HbA1c不适用于结核病患者的血糖检测。
