Medical Molecular Biology Center, Department of Clinical Pathology, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand.
Department of Internal Medicine, Khon Kaen Hospital, Ministry of Public Health, Khon Kaen 40000, Thailand.
Med Sci (Basel). 2021 Jun 7;9(2):43. doi: 10.3390/medsci9020043.
Hemoglobin A1c (HbA1c) is widely used for the monitoring and management of diabetes mellitus. The aim of this study is to investigate the influence of hemoglobin (Hb) variants on the measurement of HbA1c.
HbA1c levels of 845 blood samples obtained from diabetic patients with various hemoglobin types were measured using a turbidimetric inhibition immunoassay and capillary electrophoresis.
Of 845 patients with diabetes, 65.7% (555/845) have the normal hemoglobin type (AA) and 34.3% (290/845) have various abnormal hemoglobin types, including heterozygous HbE 30.2% (255/845), homozygous HbE 1.9 % (16/845), Hb Constant Spring (CS) trait 1.4% (12/845), CSEA Bart's 0.2% (2/845), and beta-thalassemia trait 0.6% (5/845). In most of the patients with diabetes, HbA1c levels determined by two different methods, inhibition immunoassay and capillary electrophoresis, gave strong positive correlation ( = 0.901, < 0.001), except for those with homozygous HbE ( = 16) and CSEA Bart's ( = 2). In all 18 patients with homozygous HbE and CSEA Bart's, the HbA1c was undetectable by capillary electrophoresis, meaning that their estimated average glucose was undeterminable, although their HbA1c levels could be measured using an inhibition immunoassay. The discrepancy of HbA1c results obtained from two different methods is noted in patients without HbA.
We have demonstrated the erroneous nature of HbA1c measurement in patients with hemoglobin variants, especially in those without HbA expression. Therefore, in the population with a high prevalence of hemoglobinopathies, hemoglobin typing should be considered as basic information prior to HbA1c measurement.
血红蛋白 A1c（HbA1c）广泛用于糖尿病的监测和管理。本研究旨在探讨血红蛋白变异体对 HbA1c 测定的影响。
采用比浊抑制免疫法和毛细管电泳法测定 845 例不同血红蛋白类型糖尿病患者的 HbA1c 水平。
845 例糖尿病患者中，65.7%（555/845）为正常血红蛋白类型（AA），34.3%（290/845）为各种异常血红蛋白类型，包括杂合子 HbE 30.2%（255/845）、纯合子 HbE 1.9%（16/845）、Hb Constant Spring（CS）特征 1.4%（12/845）、CSEA Bart's 0.2%（2/845）和β-地中海贫血特征 0.6%（5/845）。在大多数糖尿病患者中，两种不同方法（抑制免疫法和毛细管电泳法）测定的 HbA1c 水平呈强正相关（ = 0.901， < 0.001），但纯合子 HbE（ = 16）和 CSEA Bart's（ = 2）除外。在所有 18 例纯合子 HbE 和 CSEA Bart's 的患者中，毛细管电泳法均无法检测到 HbA1c，这意味着无法确定其平均估计血糖，尽管可以使用抑制免疫法测量其 HbA1c 水平。在没有 HbA 的患者中，两种不同方法获得的 HbA1c 结果存在差异。
本研究表明，血红蛋白变异体患者的 HbA1c 测量存在误差，尤其是无 HbA 表达的患者。因此，在血红蛋白病高发人群中，在进行 HbA1c 测量之前，应考虑血红蛋白分型作为基本信息。
