血红蛋白病和葡萄糖-6-磷酸脱氢酶缺乏对坦桑尼亚有和没有艾滋病毒的成年人通过糖化血红蛋白诊断糖尿病的影响：一项横断面研究。
Influence of hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency on diagnosis of diabetes by HbA1c among Tanzanian adults with and without HIV: A cross-sectional study.
作者信息
Kweka Belinda, Lyimo Eric, Jeremiah Kidola, Filteau Suzanne, Rehman Andrea M, Friis Henrik, Manjurano Alphaxard, Faurholt-Jepsen Daniel, Krogh-Madsen Rikke, PrayGod George, Heimburger Douglas C
机构信息
Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
出版信息
PLoS One. 2020 Dec 31;15(12):e0244782. doi: 10.1371/journal.pone.0244782. eCollection 2020.
INTRODUCTION
Hemoglobin A1c (HbA1c) is recommended for diagnosing and monitoring diabetes. However, in people with sickle cell disease (SCD), sickle cell trait (SCT), α-thalassemia or glucose-6-phosphate dehydrogenase (G6PD) deficiency, HbA1c may underestimate the prevalence of diabetes. There are no data on the extent of this problem in sub-Saharan Africa despite having high prevalence of these red blood cell disorders.
METHODS
Blood samples from 431 adults in northwestern Tanzania, randomly selected from the prospective cohort study, Chronic Infections, Comorbidities and Diabetes in Africa (CICADA), were analysed for SCT/SCD, α-thalassemia and G6PD deficiency and tested for associations with the combined prevalence of prediabetes and diabetes (PD/DM) by HbA1c, using the HemoCue 501 HbA1c instrument, and by 2-hour oral glucose tolerance test (OGTT).
RESULTS
The mean age of the participants was 40.5 (SD11.6) years; 61% were females and 71% were HIV-infected. Among 431 participants, 110 (25.5%) had SCT and none had SCD. Heterozygous α-thalassemia (heterozygous α+ AT) was present in 186 (43%) of the participants, while 52 participants (12%) had homozygous α-thalassemia (homozygous α+ AT). Furthermore, 40 (9.3%) participants, all females, had heterozygous G6PD deficiency while 24 (5.6%) males and 4 (0.9%) females had hemizygous and homozygous G6PD deficiency, respectively. In adjusted analysis, participants with SCT were 85% less likely to be diagnosed with PD/DM by HbA1c compared to those without SCT (OR = 0.15, 95% CI: 0.08, 0.26, P < 0.001). When using OGTT, in adjusted analysis, SCT was not associated with diagnosis of PD/DM while participants with homozygous α+ AT and hemizygous G6PD deficiency were more likely to be diagnosed with PD/DM.
CONCLUSIONS
HbA1c underestimates the prevalence of PD/DM among Tanzanian adults with SCT. Further research using other HbA1c instruments is needed to optimize HbA1c use among populations with high prevalence of hemoglobinopathies or G6PD deficiency.
引言
糖化血红蛋白（HbA1c）被推荐用于糖尿病的诊断和监测。然而，对于患有镰状细胞病（SCD）、镰状细胞性状（SCT）、α地中海贫血或葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症的人，HbA1c可能会低估糖尿病的患病率。尽管撒哈拉以南非洲这些红细胞疾病的患病率很高，但尚无关于该问题严重程度的数据。
方法
从坦桑尼亚西北部的431名成年人的血液样本中进行分析，这些样本是从非洲慢性感染、合并症和糖尿病前瞻性队列研究（CICADA）中随机选取的，检测SCT/SCD、α地中海贫血和G6PD缺乏症，并使用HemoCue 501 HbA1c仪器通过HbA1c以及2小时口服葡萄糖耐量试验（OGTT）来检测与糖尿病前期和糖尿病（PD/DM）合并患病率的关联。
结果
参与者的平均年龄为40.5（标准差11.6）岁；61%为女性，71%感染了艾滋病毒。在431名参与者中，110人（25.5%）有SCT，无人患有SCD。186名（43%）参与者存在杂合子α地中海贫血（杂合子α+ AT），而52名参与者（12%）患有纯合子α地中海贫血（纯合子α+ AT）。此外，40名（9.3%）参与者（均为女性）患有杂合子G6PD缺乏症，而24名（5.6%）男性和4名（0.9%）女性分别患有半合子和纯合子G6PD缺乏症。在调整分析中，与没有SCT的参与者相比，有SCT的参与者通过HbA1c诊断为PD/DM的可能性降低了85%（比值比=0.15，95%置信区间：0.08，0.26，P<0.001）。当使用OGTT时，在调整分析中，SCT与PD/DM诊断无关，而患有纯合子α+ AT和半合子G6PD缺乏症的参与者更有可能被诊断为PD/DM。
结论
HbA1c低估了坦桑尼亚患有SCT的成年人中PD/DM的患病率。需要使用其他HbA1c仪器进行进一步研究，以优化在血红蛋白病或G6PD缺乏症患病率高的人群中HbA1c的使用。
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