Rasche Franz Maximilian, Ebert Thomas, Beckmann Julia, Busch Volker, Barinka Filip, Rasche Wilma Gertrud, Lindner Tom H, Schneider Jochen G, Schiekofer Stephan
Department of Internal Medicine, Neurology, and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, Leipzig University, Leipzig, Germany.
Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, Regensburg University, Regensburg, Germany.
Exp Clin Endocrinol Diabetes. 2017 Jun;125(6):384-391. doi: 10.1055/s-0042-124577. Epub 2017 Apr 13.
HbA1c is the most accepted laboratory parameter for the long term observation of glucose control. There is still much of a debate about the use of HbA1c as a metabolic indicator in diabetic patients (DM) on haemodialysis (HD) and erythropoiesis-stimulating agent (ESA) therapy because of the altered erythrocyte turn over in patients with chronic kidney disease and haemodialysis (CKD5D). In 102 CKD5 patients with and without diabetes mellitus, we examined the dose dependent variability in HbA1c and fructosamine levels under haemodialysis and treated with epoetin α (n=48) and a new generation agent with continuous stimulation of methoxy polyethylene glycol epoetin beta (C.E.R.A.; n=54). HbA1c levels were affected by therapy with ESA treatments. ESA dose was inversely correlated with HbA1c and an escalation of 10.000 IU per week induced an estimated decrease of HbA1c of 0.6 percent. In addition, the increase of reticulocyte number as a marker for erythropoiesis was significantly inversely correlated with the increase of ΔHbA1c. ESA treatments had no such effect on the alternative metabolic parameter fructosamine. When compared, both therapeutic agents had comparable success in attaining haemoglobin (Hb) target values. C.E.R.A. showed better correlation and was more effective over a longer dose interval. Our results show that HbA1c levels in patients should be carefully interpreted based on interfering factors. Nevertheless, HbA1c is currently the most consistent parameter for use ascertaining metabolic status of patients suffering from diabetes mellitus.
糖化血红蛋白（HbA1c）是长期观察血糖控制情况时最被认可的实验室指标。对于在接受血液透析（HD）且使用促红细胞生成素（ESA）治疗的糖尿病患者（DM）中，将HbA1c用作代谢指标仍存在诸多争议，因为慢性肾脏病和血液透析（CKD5D）患者的红细胞周转率发生了改变。在102例患有和未患糖尿病的CKD5患者中，我们研究了在血液透析过程中，接受α - 促红细胞生成素治疗（n = 48）和新一代持续刺激的甲氧基聚乙二醇化促红细胞生成素β（C.E.R.A.；n = 54）治疗的患者，其HbA1c和果糖胺水平的剂量依赖性变化。HbA1c水平受ESA治疗的影响。ESA剂量与HbA1c呈负相关，每周增加10000国际单位的剂量估计会使HbA1c降低0.6%。此外，作为红细胞生成标志物的网织红细胞数量的增加与ΔHbA1c的增加显著负相关。ESA治疗对替代代谢参数果糖胺没有这种影响。相比之下，两种治疗药物在达到血红蛋白（Hb）目标值方面具有相当的成功率。C.E.R.A.显示出更好的相关性，并且在更长的剂量间隔内更有效。我们的结果表明，应根据干扰因素仔细解读患者的HbA1c水平。尽管如此，目前HbA1c仍是确定糖尿病患者代谢状态最一致的参数。
