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[与溶血性疾病相关的糖化血红蛋白降低的临床特征及实验室数据分析]

[Clinical features and laboratory data analysis of decreased glycosylated hemoglobin related to hemolytic disease].

作者信息

Wang Z, Sun X, Shi J, Zheng Y Z, Zhao Y P

机构信息

Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2019 Feb 14;40(2):137-140. doi: 10.3760/cma.j.issn.0253-2727.2019.02.008.

Abstract

To compare the effects of different hemolytic diseases on the level of glycosylated hemoglobin (HbA(1c)) to further explore the relationship between HbA(1c) and laboratory indexes to disclose implications of HbA(1c) in hemolytic diseases. The distribution of 192 decreased HbA(1c) cases in 4 categories of hemolytic diseases was analyzed. Laboratory indexes related to hemolysis were tested and analyzed in each kind of disease, and relationship between laboratory indexes and HbA(1)c was statistically explored. Diagnoses of decreased HbA(1c) cases mainly included erythrocyte membranopathies (88 cases), immunohemolytic anemia (72 cases), hemoglobinopathy (4 cases) and erythrocyte enzymopathy (5 cases). The distribution of HbA(2) and normal HbF subjects in immunohemolytic anemia and hemoglobinopathy was significantly different from those of HbA(2) and / or abnormal HbF subjects (41.7% 22.0%, (2)=5.574, =0.018; 0.7% 7.3%, =0.031). Compared with non-hemolytic disease patients, those who suffered from 4 categories of hemolytic diseases showed lower HbA(1c) level and higher reticulocyte percentage (Ret), indirect bilirubin (IBIL) and free hemoglobin (F-Hb). Different levels of Ret, reticulocyte hemoglobin content (Ret-He), mean corpuscular volume (MCV), IBIL and F-Hb among the 4 kinds of diseases were observed, but the causes of the differences were not the same. HbA(1c) was negatively correlated with other laboratory indexes in erythrocyte membranopathies and immunohemolytic anemia. Hemolytic disease resulted in false lower HbA(1c), but impact of difference on HbA1c between different diseases was not significant. HbA(1c) was closely connected to laboratory indexes related to hemolysis, which might have potential implications for hemolytic diseases such as erythrocyte membranopathies and immunohemolytic anemia.

摘要

比较不同溶血性疾病对糖化血红蛋白(HbA₁c)水平的影响,进一步探讨HbA₁c与实验室指标之间的关系,以揭示HbA₁c在溶血性疾病中的意义。分析了192例HbA₁c降低病例在4类溶血性疾病中的分布情况。对各类疾病中与溶血相关的实验室指标进行检测和分析,并对实验室指标与HbA₁c之间的关系进行统计学探讨。HbA₁c降低病例的诊断主要包括红细胞膜病(88例)、免疫性溶血性贫血(72例)、血红蛋白病(4例)和红细胞酶病(5例)。免疫性溶血性贫血和血红蛋白病中HbA₂和正常HbF受试者的分布与HbA₂和/或异常HbF受试者的分布有显著差异(41.7%对22.0%,χ² = 5.574,P = 0.018;0.7%对7.3%,P = 0.031)。与非溶血性疾病患者相比,患有4类溶血性疾病的患者HbA₁c水平较低,网织红细胞百分比(Ret)、间接胆红素(IBIL)和游离血红蛋白(F-Hb)较高。观察到4种疾病之间Ret、网织红细胞血红蛋白含量(Ret-He)、平均红细胞体积(MCV)、IBIL和F-Hb水平不同,但差异原因不尽相同。在红细胞膜病和免疫性溶血性贫血中,HbA₁c与其他实验室指标呈负相关。溶血性疾病导致HbA₁c假性降低,但不同疾病之间对HbA₁c的影响差异不显著。HbA₁c与溶血相关的实验室指标密切相关,这可能对红细胞膜病和免疫性溶血性贫血等溶血性疾病具有潜在意义。

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