糖化白蛋白在CKD 3~5期非透析和血液透析合并糖尿病患者中的血糖评估价值

目的：探讨糖化白蛋白在CKD 3~5期非透析和血液透析合并糖尿病患者中的血糖评估价值.方法：入选187例糖尿病患者,其中CKD 1~2期68例,CKD 3~5期ND患者89例,CKD 5期HD患者30例,比较各组患者空腹血糖与糖化白蛋白、糖化血红蛋白的相关性,应用多因素回归分析方法分析影响终末期肾脏病合并糖尿病患者糖化白蛋白、糖化血红蛋白的因素.结果：HbAlc与GA在每组均显著相关（CKD 1~2期：r=0.632,P〈0.001、CKD 3~5 ND期：r=0.647,P〈0.05、CKD 5 HD期：r=0.585,P〈0.001）,但血液透析患者直线回归方程的斜率显著高于CKD 1~2期及CKD 3~5期非透析患者（4.14 vs 1.84、2.12,P〈0.05）.CKD 5 HD组GA/HbAlc的值显著低于非透析组（3.01±0.75 vs 2.48±0.58、2.48±0.59）.多因素回归分析提示在透析组仅空腹血糖是影响GA的因素.结论：GA与HbAlc在CKD 3~5期非透析合并糖尿病患者的血糖评估价值差异无统计学意义,而在血液透析合并糖尿病患者,HbAlc明显低估了血糖的真实水平,GA较HbAlc更能反映真实的血糖水平.

The Use of Glycemic Control of Glycated Albumin in CKD 3~5 Non-dialysis and Hemodialysis Patients with Diatebes

Objective：To test wheater glycated albummin is a better glycemic control parameter in HD patients with diabetes compared to HbAlc. Methods ：A total of 187 diabetic patients were enrolled in this study, including 30 cases on hemodialysis. The cor- relation between FBG and GA ,HbAlc were examined. Multiple regression analysis were investigated to find the independent factors as- sociated with GA and HbAlc both in HD patients and CKD 1 ~ 5 with diatebes. Results：GA and HbAlc was correlated significantly in all groups ,while the regression slope in dialysis patients was more shallow than CKD 1 ~ 2 groups and CKD 3 ~ 5 NHD patients, while there was no significant difference between CKD 3 -5 NHD patients and CKD 1 ~ 2 patients. The GA to HbAlc ratio was significantly increased in dialysis patients compared with CKD1 - 2 groups. Multiple regression analysis indicated that only glocose was the indepent factor for GA in dialysis patients. Conclusion：Our results show that in diabetic hemodialysis patients, hemoglobin Alc levels signifi- cantly underestimate glycemic control while those of glycated albumin more accurately reflect this control.