Inada Shinya, Koga Masafumi
Department of Internal Medicine, Kawanishi City Hospital, Hyogo, Japan.
Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo, Japan
Ann Clin Lab Sci. 2017 Jan;47(1):52-57.
We report that glycated albumin (GA) is higher relative to HbA1c in non-diabetic, gastrectomized subjects without anemia, and thus is a sign of oxyhyperglycemia. It is known that gastrectomized subjects are prone to iron-deficiency anemia (IDA), and that the HbA1c levels of subjects with IDA are falsely high. In the present study, the HbA1c and GA levels of gastrectomized subjects with IDA were compared with gastrectomized subjects without anemia. Seven non-diabetic gastrectomized subjects with IDA were enrolled in the present study. Twenty-eight non-diabetic gastrectomized subjects without anemia matched with the subjects with IDA in terms of age, gender, and body mass index were used as the controls. Although there were no significant differences in fasting plasma glucose and OGTT 2-hour plasma glucose (2-h PG) between the two groups, the HbA1c and GA levels in gastrectomized subjects with IDA were significantly higher than the controls. For all of the gastrectomized subjects (n=35), ferritin exhibited a significant negative correlation with HbA1c and GA, and a significant positive correlation with 2-h PG. In addition, the HbA1c and GA levels exhibited a significant negative correlation with the mean corpuscular hemoglobin and hemoglobin. The HbA1c and GA levels in gastrectomized subjects with IDA were significantly higher than those in controls. The high GA levels are attributed to a tendency in which patients with total gastrectomy, who are prone to IDA, are susceptible to postprandial hyperglycemia and reactive hypoglycemia, which in turn leads to large fluctuations in plasma glucose.
我们报告称,在无贫血的非糖尿病胃切除患者中,糖化白蛋白(GA)相对于糖化血红蛋白(HbA1c)更高,因此是氧合性高血糖的一个标志。已知胃切除患者易患缺铁性贫血(IDA),且IDA患者的HbA1c水平会出现假性升高。在本研究中,将患有IDA的胃切除患者的HbA1c和GA水平与无贫血的胃切除患者进行了比较。本研究纳入了7名患有IDA的非糖尿病胃切除患者。将28名在年龄、性别和体重指数方面与IDA患者相匹配的无贫血非糖尿病胃切除患者作为对照。尽管两组之间的空腹血糖和口服葡萄糖耐量试验2小时血糖(2-h PG)无显著差异,但患有IDA的胃切除患者的HbA1c和GA水平显著高于对照组。对于所有胃切除患者(n = 35),铁蛋白与HbA1c和GA呈显著负相关,与2-h PG呈显著正相关。此外,HbA1c和GA水平与平均红细胞血红蛋白和血红蛋白呈显著负相关。患有IDA的胃切除患者的HbA1c和GA水平显著高于对照组。GA水平升高归因于全胃切除患者易患IDA,且易发生餐后高血糖和反应性低血糖,进而导致血糖大幅波动。