糖化血红蛋白测定对妊娠期糖尿病的诊断价值研究

目的探究妊娠期糖尿病孕妇接受糖化血红蛋白检测的诊断价值。方法从2018年1月—2019年12月,该文将该院接收的29例妊娠期糖尿病孕妇与29名正常妊娠期孕妇选为观察组与对照组,均接受糖化血红蛋白测定,对比孕妇的血糖水平与糖化血红蛋白水平差异;统计血糖、糖化血红指标的敏感度与特异度差异;对比孕妇组间并发症差异。结果观察组孕妇空腹血糖(8.21±1.89)mmol/L、1 h血糖(12.32±3.18)mmol/L、2 h血糖(9.87±1.96)mmol/L、3 h血糖(8.08±1.77)mmol/L、糖化血红蛋白(7.76±2.46)%,均高于对照组,差异有统计学意义(t=11.111、7.055、11.778、10.280、6.613,P<0.05)。HbA1c的灵敏度与特异度分别为83.41%与89.63%,均高于空腹血糖与餐后2 h血糖,差异有统计学意义(χ²=8.124、6.412,P<0.05)。观察组孕妇发生妊高症、羊水过多等并发症12例,发生率41.38%,多于对照组,差异有统计学意义(P<0.05)。结论糖化血红蛋白测定对妊娠期糖尿病诊断价值较高,可为妊娠期糖尿病孕妇提供诊断与治疗依据。     

糖化血红蛋白监测在妊娠期糖尿病中的诊断价值

目的探讨糖化血红蛋白（Hb A1c）监测在妊娠期糖尿病（GDM）患者中的诊断意义。方法选择自2013年1月—2014年1月之间该院住院分娩妊娠糖尿病孕妇62例,为GDM组,与正常分娩孕妇60例为观察组,两组病人分别监测空腹血糖（FPD）、Hb A1c、葡萄糖耐量试验（GCT）,对其监测数值进行对比分析。结果 GDM组各项指标测定结果均明显高于观察组,对比有统计学意义,P〈0.05。结论 Hb A1c可以做为早期诊断GDM的生化指标,在孕妇的早期监测中应引起临床足够的重视。     

非糖尿病人群糖化血红蛋白水平与冠心病发病的关系

目的研究非糖尿病人群糖化血红蛋白（HbA1c）水平与冠心病（CHD）发病之间的关系。方法选择非糖尿病拟诊CHD患者386例，按WHO诊断标准分为：非CHD组90例，CHD组296例。CHD组再分为单支病变组128例，两支病变组85例，3支病变组83例。按HbA1c水平分为HbA1c〈5％者131例，HbA1c5％～5，9％者167例，HbAlc6％～6．9％者88例。结果（1）CHD组HbAlC、Fins、FPG、2hPG、尿酸（UA）、HDL-C等与非CHD组差异有统计学意义（P〈0．05-0．01）；（2）多支病变组HbA1c水平显著高于单支病变组（P〈0．01）；（3）HbA，c6％～6．9％时，CHD发生率93．2％，显著增高（P〈0．05）；（4）Logistic回归分析：HbA。c、HDL-C是CHD独立危险因素（P〈0．05）；（5）HbAlc、吸烟、LDL-C、HDL-C与CHD病变程度相关（P〈0．05）。结论在非糖尿病人群中，HbA1c是CHD的独立危险因素，且与CHD病变程度正相关。     

中国人群平均血糖与糖化血红蛋白转换关系的初步分析

目的 采用动态血糖监测（CGM）技术探讨不同糖代谢人群24 h平均血糖水平（MBG）与糖化血红蛋白（HbA1c）的关系,并初步建立不同HbA1c水平其相对应的MBG值.方法 选取2007年8月至2010年1月于上海交通大学附属第六人民医院门诊及病房进行口服葡萄糖耐量试验（OGTT）的受试者318人,其中正常糖调节组115名、糖调节受损组57例、新诊断2型糖尿病患者组146例.糖尿病、糖调节受损的诊断采用2003年美国糖尿病学会（ADA）糖尿病诊断标准.测量各组生化指标,并行OGTT,测定糖负荷后2 h血糖（2 h PG）.采用CGM系统估算MBG水平,高压液相法测定HbA1c水平,分析MBG与HbA1c间的关系.统计学采用单因素ANOVA方差分析、Kruskal-Wallis检验、χ^2检验、Spearman相关分析及线性模型进行数据统计.结果 318例研究对象中总体HbA1c水平为（6.6±1.5）%,MBG水平为（7.3±2.3）mmol/L.（2）MBG与HbA1c呈显著正相关（r=0.848,P〈0.01）,其回归方程为MBG=1.252×HbA1c-0.992（R^2= 0.718,P〈0.01）,即HbA1c每升高1%,MBG相应升高1.252 mmol/L.HbA1c=6.5%时,对应的MBG值为7.1 mmol/L.HbA1c=7.0%时,对应的MBG值为7.8 mmol/L.（3）仅包括146例新诊断2型糖尿病患者的MBG和HbA1c之间的关系与总人群的结果一致（r=0.788,P〈0.01）,线性回归方程为MBG=1.255×HbA1c-0.886（R2=0.621,P〈0.01）.当HbA1c= 6.5%时,MBG对应值为7.3 mmol/L.HbA1c=7.0%时,对应的MBG值为7.9 mmol/L.结论 初步建立了各HbA1c水平其相应的MBG值,为深入开展中国人群平均血糖与HbA1c转换关系研究提供了线索.     

糖化血红蛋白测定在糖尿病诊断中的临床意义分析

目的 分析探究糖化血红蛋白测定在糖尿病诊断的临床意义.方法 将2018年4月—2019年4月进入该院进行体检的136名健康人群划分为对照组,将同期该院收治的136例糖尿病患者划分为观察组,两组均实行免疫抑制投射比浊法测定糖化血红蛋白(HbA1c)指标水平,利用葡萄糖氧化酶法测定其空腹血糖(FPG)水平,进一步比较两组诊...     

新诊断2型糖尿病患者葡萄糖耐量试验与糖化血红蛋白水平的相关分析

目的 对比分析新诊断2型糖尿病及糖尿病前期患者口服葡萄糖耐量试验(OGTT)与糖化血红蛋白(HbAIc)水平变化的特点及影响因素. 方法 按照OGTT结果将受检者分为糖耐量正常组(正常组):31例,年龄29～75岁,平均(48.4±15.3)岁;空腹血糖受损组(血糖受损组):33例.年龄38～72岁,平均(50.8±9.8)岁;糖耐量受损组:34例,年龄33～74岁,平均(54.5±11.4)岁;2型糖尿病组(T2DM组):117例,年龄29～75岁,平均(54.3±14.1)岁.采用OGTT试验、HbAlc结果评价糖代谢状态,胰岛β细胞功能指数(HOMA-E)、OGTT 30 min胰岛素分泌增值与血糖增值比值(△I30/△G330)、胰岛素分泌曲线下面积(AUCINS)及胰岛素抵抗指数(HOMA-IR)分别反映胰岛β细胞分泌功能和胰岛素抵抗情况. 结果 (1)T2DM、糖耐量受损组和正常组HbAlc分别为7.41%、5.85%和5.21%,差异有统计学意义(P<0.01),T2DM、糖耐量受损组和血糖受损组HOMA-β指数与正常组比较,分别下降了53.1%(P<0.01)、29.3%(P<0.01)和23.4%(P<0.05),T2DM组HOMA-IR分别是正常组的1.66倍(P<0.01)、血糖受损组的1.29倍(P<0.001)和糖耐量受损组的1.44倍(P<0.05);(2)HbAIc与糖负荷后3 h血糖水平相关性最高(r=0.71,P<0.01),且独立相关;△I30/△G330与糖负荷后1 h和2 h血糖水平独立负相关(P<0.01);AUCINS只与糖负荷后3 h血糖水平独立负相关(P<0.01);HOMA-β与2 h以外的其他各点血糖独立负相关(P<0.01);HOMA-IR与OGTT各点血糖水平均呈正相关(P<0.01或P<0.05);三酰甘油与空腹血糖独立正相关(P<0.05),腰围与1/2 h血糖独立正相关(P<0.01).OGTT试验血糖水平变化的独立相关因素依次为△I30/△G330、AUCINS、HOMA-β、HOMA-IR和腰围.HbAlc水平的独立相关因素是OGTT 3 h血糖变化. 结论 在2型糖尿病、糖耐量低减及正常等不同糖代谢状态人群中,HbAlc水平存在差异,当HbAlc>8.0%时,OGTT试验、血糖、胰岛素水平或曲线下面积均不能反映出病情差别和变化的显著性.     

糖化血红蛋白检测在糖尿病诊断中的价值

对120例糖尿病患者(糖尿病组)和50例健康人员(对照组)进行空腹血糖(FPG)和HbA1c,比较两组测定值,并比较糖尿病组不同FPG患者的HbA1c检测值,分析二者的相关性。结果糖尿病组FPG、HbA1c均高于对照组,差异有统计学意义(P<0.05);不同FPG水平的糖尿病患者HbA1c差异有统计学意义(F=12.682,P<0.05),糖尿病组患者HbA1c含量随着FPG的升高而升高,二者呈显著正相关(r=0.428,P<0.05)。结论 HbA1c在糖尿病的诊断和病情判断方面具有重要意义。     

用糖化血红蛋白诊断糖尿病——WHO咨询报告

此报告是对2006年世界卫生组织／国际糖尿病联盟（WHO／IDF）发布的“糖尿病及中间高血糖状态的定义及诊断”的诊断标准的更新。更新版本的主要变化是考虑将糖化血红蛋白（HbA1c）用于糖尿病诊断。     

老年2型糖尿病患者七时点血糖与糖化血红蛋白的相关性分析

目的评价老年2型糖尿病患者不同时间点的毛细血管血糖对评估血糖控制的相对价值。方法检测30例老年2型糖尿病患者的7个时点毛细血管血糖（3餐前、3餐后2hN睡前），分析糖化血红蛋白（HbA1c）与血糖的关系。结果对平均血糖和HbA1c进行直线回归分析，平均血糖和7个时点血糖与HbA1c均明显相关（r值分别为0．87及0．50～0．86，均为P〈0．01），午餐后2h血糖、晚餐后2h血糖和睡前血糖与HbA1c具有更好的相关性。结论午餐后2h、晚餐后2h及睡前血糖在预测血糖控制方面优于其他时间点的血糖，在评价老年2型糖尿病患者血糖控制时，可作为HbA1c的一个补充指标。     

Implications of using hemoglobin A1C for diagnosing diabetes mellitus

Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.     

糖化血红蛋白与血浆致动脉粥样硬化指数对中老年2型糖尿病发生风险的联合预测价值

目的:探讨糖化血红蛋白（HbA 1c）和血浆致动脉粥样硬化指数（AIP）对中老年2型糖尿病（T2DM）发生风险的联合预测价值。 方法:本研究依托中国T2DM患者肿瘤发生风险的流行病学研究（REACTION）,对2011至2014年在大连社区40周岁及以上人群中开展的流行病学调查资料进行回顾性分析,...     

Energy consumption for the formation of hemoglobin A1c: a reappraisal and implication on the poor-control diabetes mellitus patients

Diabetes mellitus (DM) is a frequent disorder affecting individuals of all ages. Glycohemoglobin has a key role in the assessment of glycemic control in diabetic patients. Several studies have clearly shown that improved glycemic control is strongly associated with decreased development and/or progression of diabetic complications. The chemical reaction of glycosylation in formation of hemoglobin A_1c (HbA_1c) has been described for decades. Here, the author performed a reappraisal on the bonding energy based on quantum chemical analysis. The author calculated the bonding energy of the reaction and found that the reaction is a type of “energy-consuming reaction.” In addition, the author gives further implication of the findings on the poor-control DM patients. The author hereby proposed that the nature of energy-consuming reaction in formation of hemoglobin A_1c (HbA_1c) is a main underlying for the energy loosing in poorly controlled DM patients. Gathering of the energy from the nearby cellular compartment during formation of HbA_1c might be an important pathological process.     

糖化血红蛋白A1c在糖尿病监测和诊断中的应用

近年来,糖化血红蛋白(Hb)A1c在糖尿病监测和诊断中的应用方面有许多进展,主要包括:(1)其测定的标准化.(2)估计的平均血糖概念的提出,其与HbA1c的转换关系及其在糖尿病监测中的作用.(3)提出以HbA1c≥6.5%作为糖尿病诊断标准.但因HbA1c的测定受众多因素影响,且其与糖尿病并发症的关系尚未有定论,将Hb...     

五例暴发性1型糖尿病临床分析

分析5例暴发性1型糖尿病的临床资料.本组病例以起病急骤和严重的糖尿病酮症酸中毒为特征,平均病程3.4 d,入院时平均血糖47.7 mmol/L,而平均HbA_(1C) 6.8%,平均空腹C肽和餐后2 h C肽分别为40.0 pmol/L和68.0 pmol/L.随访3～26个月后胰岛β细胞功能无改善.     

Ⅰ型糖尿病患者外周血NK细胞活性降低

以改良铬（５１Ｃｒ）释放法检测３４例Ⅱ型糖尿病（ＮＩＤＤＭ）、２３例Ｉ型糖尿病（ＩＤＤＭ）和２８例正常人外周血ＮＫ细胞对Ｋ５６２靶细胞的杀伤活性。结果显示：①ＩＤＤＭ组患者ＮＫ细胞活性显著低于ＮＩＤＤＭ组及正常对照组，经正规治疗血糖控制以后，ＮＫ细胞活性恢复正常。②ＮＩＤＤＭ组患者血ＮＫ细胞活性在血糖控制前后无显著变化，与正常对照组比较亦无统计学差异。提示ＩＤＤＭ与机体免疫异常密切关联。     

Discordance between fasting glucose-based and hemoglobin A1c-based diagnosis of diabetes mellitus in Koreans

We analyzed data of 35,624 non-diabetic Koreans using fasting plasma glucose (FPG) criteria and HbA1c criteria in screening for diabetes. Among the 1,491 subjects newly diagnosed with diabetes, 473 (31.6%) met the FPG criteria only (≥7.0 mmol/l), 350 (23.5%) met HbA1c criteria only (≥6.5%), and 668 (44.9%) met both criteria. The DM-by-HbA1c group had significantly older age, higher proportion of women, and lower hemoglobin concentration. The DM-by-FPG group had higher systolic and diastolic blood pressure, fasting serum insulin, and HOMA-IR. Further studies are needed to determine which of these criteria is superior in predicting the risks of long-term vascular complications of diabetes.     

Diabetes mellitus defined by hemoglobin A1c value: Risk characterization for incidence among Japanese subjects in the JPHC Diabetes Study

Aims/Introduction: Although several risk factors for type 2 diabetes have been identified, most of them have been identified in studies on Western populations, and they should be evaluated in a Japanese population. In 2010, new diagnostic criteria for diabetes mellitus using hemoglobin A1c (HbA_1c) were released and its use in epidemiological studies has many advantages. The aim of the present study was to evaluate risk factors for type 2 diabetes defined based on HbA_1c values in a Japanese population. Materials and Methods: A total of 9223 subjects (3076 men and 6147 women) were followed up for 5 years. Diabetes was defined based on self‐report or HbA_1c value. Risk factors for diabetes were evaluated as odds ratios adjusted for potential confounding factors by logistic regression. Results: During the 5‐year follow‐up period, we documented 518 incident cases of diabetes (232 men and 286 women). Of the 518 incident cases, 310 cases were diagnosed by HbA_1c alone. Among the men, age, smoking (both past smoking and current smoking) and family history of diabetes significantly increased the risk of diabetes. Among the women, body mass index, family history of diabetes and hypertension significantly increased the risk of diabetes. These results did not change markedly after adjustment for the baseline HbA_1c values, and the baseline HbA_1c value itself was a significant risk factor for diabetes mellitus. Conclusions: Known risk factors for diabetes established in Western populations also increased the risk of diabetes in a Japanese population defined on the basis of HbA_1c values. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00119.x, 2011)     

Optimal hemoglobin A1C cutoff value for diabetes mellitus and pre-diabetes in Pudong New Area,Shanghai, China

Aims

Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia.