糖尿病肥胖及非肥胖患者影响糖化血红蛋白的因素不同

目的 研究糖尿病肥胖及非肥胖患者糖化血红蛋白(HbA1c)与糖脂代谢指标的相关性.方法 收集121例2型糖尿病研究对象,以体质量指数(BMI)≥25 kg/m2为肥胖症标准,分为糖尿病合并肥胖症组(DM-OB)57例,糖尿病非肥胖症组(DM-NOB)64例,比较DM-OB组及DM-NOB组年龄、BMI、HbA1c、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h血糖(PPG)、餐后血糖波动(PPGE)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、1/高密度脂蛋白胆固醇(1/HDL-C)、血清高敏C反应蛋白(hsCRP)差别;相关分析及多因素逐步回归分析HbA1c与以上指标的相关性.结果 DM-OB组HOMA-IR、BMI、DBP、TC、hsCRP、HbA1c、LDL-C较DM-NOB组增高.在DM-OB组,Pearson相关分析显示,HbA1c与BMI、FBG、FPG、HOMA2IR、hs-CRP正相关(P均<0.05);偏相关分析显示,控制FBG、PPG、BMI后,HbA1c仍与HOMA2IR、hs-CRP正相关(P均<0.05);多因素逐步回归分析HbA1c与FPG、HOMA2IR、hs-CRP密切相关(P均<0.01).在DM-NOB组,Pearson相关分析显示,HbA1c与PPG、PPGE呈正相关(P均<0.05);偏相关分析显示,在控制PPEG后,HbA1c仍与PPG正相关(P<0.05);多因素逐步回归分析HbA1c与PPG密切相关(P<0.01).结论 2型糖尿病,胰岛素抵抗、亚临床炎症、高空腹血糖是影响肥胖患者HbA1c水平的主要因素;餐后血糖是影响非肥胖患者HbA1c水平的主要因素,提示应当研究不同的治疗措施治疗糖尿病合并肥胖与不合并肥胖的病人.     

糖尿病肥胖及非肥胖患者影响糖化血红蛋白的因素不同

目的研究糖尿病肥胖及非肥胖患者糖化血红蛋白(HbAlc)与糖脂代谢指标的相关性。方法收集121例2型糖尿病研究对象,以体质量指数(BMI)≥25 kg/m~2为肥胖症标准,分为糖尿病合并肥胖症组(DM-OB)57例,糖尿病非肥胖症组(DM-NOB)64例,比较 DM-OB 组及 DM-NOB 组年龄、BMI、HbAlc、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、餐后2 h 血糖(PPG)、餐后血糖波动(PPGE)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、1/高密度脂蛋白胆固醇(1/HDL-C)、血清高敏 C 反应蛋白(hsCRP)差别;相关分析及多因素逐步回归分析 HbAlc 与以上指标的相关性。结果 DM-OB 组 HOMA-IR、BMI、DBP、TC、hsCRP、HbAlc、LDL-C 较 DM-NOB 组增高。在 DM-OB 组,Pearson 相关分析显示,HbAlc 与 BMI、FBG、FPG、HOMA2IR、hs-CRP 正相关(P 均<0.05);偏相关分析显示,控制 FBG、PPG、BMI 后,HbAlc 仍与 HO-...     

妊娠期糖尿病患者糖化血红蛋白水平测定及意义

目的探讨糖化血红蛋白（HbA1c）水平测定在妊娠期糖尿病（GDM）筛查诊断和母婴并发症监测中的价值。方法对318例正常妊娠（对照组）者、69例妊娠期糖耐量异常（GIGT）患者（GIGT组）及105例GDM患者（GDM组）分别进行空腹血糖（FPG）、口服葡萄糖耐量试验（OGCT）和HbA1c测定,通过ROC曲线评价FPG、OGCT和HbA1c在GDM筛查中的应用价值;并比较HbA1c水平不同者母婴并发症发生情况。结果FPG、OGCT和HbA1c诊断GDM的ROC曲线下面积（AUC％）分别为84％、92％和91％,HbA1c诊断效率明显高于FPG、敏感性高于OGCT;母婴并发症发生率随HbA1c水平增高而增高。结论HbA1c可作为GDM筛查诊断和监测母婴并发症的良好指标。     

2型糖尿病糖化血红蛋白达标的影响因素

糖化血红蛋白作为反映长期血糖水平的金标准,是监测糖尿病治疗的重要指标,但目前糖尿病患者糖化血红蛋白状况仍不理想。影响糖化血红蛋白达标的因素较多并渐引起人们的关注。本文就年龄、病程、糖尿病治疗方案、糖尿病教育、文化程度和血糖自我监测等因素对糖化血红蛋白的影响作一综述。     

糖化血红蛋白诊断糖尿病：知晓影响因素，合理优化使用

《中国2型糖尿病防治指南（2020年版）》中将糖化血红蛋白（HbA 1c）≥6.5%纳入糖尿病的诊断标准。但一些生理和病理因素会通过改变红细胞寿命、血红蛋白糖基化速率或干扰HbA 1c的检测,从而独立于血糖浓度影响HbA 1c的水平。这些生理和病理因素包括贫血、慢性肾衰竭、妊娠、年龄...     

体重指数对糖化血红蛋白及糖化白蛋白影响的研究

目的分析BMI对HbA₁c及糖化白蛋白(GA)的影响。方法选取北京市平谷区代谢性疾病研究中3895名26~76岁常住居民数据。按FPG、2 hPG分层比较BMI各四分位数分组的HbA₁c、GA水平;采用多因素线性回归模型分析HbA₁c、GA的影响因素。结果调整年龄、性别、血红蛋白后,在4.0≤FPG<6.0 mmol/L(P<0.001)、6.0≤FPG<7.0 mmol/L(P=0.003)、7.0≤FPG<8.0 mmol/L(P=0.030)及所有2 hPG(P<0.001)分层中,HbA₁c随BMI四分位数升高呈递增趋势;在4.0≤FPG<6.0 mmol/L(P<0.001)、6.0≤FPG<7.0 mmol/L(P=0.032)、FPG≥8.0 mmol/L(P<0.001)、2.0≤2 hPG<6.0 mmol/L(P<0.001)、6.0≤2 hPG<8.0 mmol/L(P<0.001)和8.0≤2 hPG<10.0 mmol/L(P<0.001)时,GA随BMI四分位数升高呈递减趋势。多因素线性回归分析显示,BMI是HbA₁c、GA的影响因素(β=0.018、-0.094,R²=0.723、0.696,P<0.01)。结论在普通人群中,调整血糖因素后,当FPG<8.0 mmol/L时,HbA₁c随BMI升高而增加,当2 hPG<10.0mmol/L时,GA随BMI升高而减少。     

糖化血红蛋白水平与糖尿病合并颈动脉粥样硬化的关系

目的 探讨糖化血红蛋白(HbA1c)水平对糖尿病合并颈动脉粥样硬化(AS)的影响及其相关性.方法 选取200例糖尿病患者进行颈动脉超声检查,IMT≥0.9 mm或粥样斑块形成者设为IMT阳性组,其余为IMT阴性组,另取80例正常体检者设为正常对照组,测定三组受试者血清HbA1c水平,并分析HbA1c水平与颈动脉AS程度的相关性.结果 与对照组比较,IMT阴性组及IMT阳性组患者血清HbA1c水平明显高于对照组(P＜0.01);与IMT阴性组比较,ITM阳性组患者血清HbA1c水平较高(P＜0.05),且HbA1c水平与颈动脉AS程度呈正相关,相关系数r=0.791,P＜0.01.结论 HbA1c可能促进了AS的发生与发展,降低血液HbA1c水平对防治AS有重要意义.     

经皮冠状动脉介入治疗对非糖尿病心肌梗死患者血糖、糖化血红蛋白水平及预后的影响

直接经皮冠状动脉介入(PCI)是治疗心肌梗死患者开通梗死相关血管、恢复冠状动脉血流、提高生存率改善预后的最有效方法[1].研究表明血糖及糖化血红蛋白(HbA1c)与糖尿病并发心血管疾病有密切关系,且与冠心病病变程度有关[2],是心肌梗死临床过程与转归的预测因子.非糖尿病较糖尿病患者PCI术后有较低的再狭窄率和心脏事件发生率[3],但非糖尿病患者血糖及糖化血红蛋白指标对PCI预后的影响作用尚不明确.本文回顾性分析非糖尿病心肌梗死患者血糖及糖化血红蛋白对PCI治疗预后的影响.     

非糖尿病冠心病患者糖化血红蛋白水平测定及与冠脉病变的相关性

用放射免疫法检测96例非糖尿病冠心病患者(冠心病组)及91例与其年龄、性别及体质量指数(BMI)相匹配的健康体检者(对照组)糖化血红蛋白(HbA1c)水平.结果冠心病组血清HbA1c水平显著高于对照组,P＜0.01;随Gensini积分增加,冠心病组HbA1c水平逐渐升高(P＜0.01,rs′=0.7326).认为HbA1c在冠状动脉病变的发生及发展过程中起重要作用,血清HbA1c水平对判断冠状动脉狭窄程度有独立预测价值.     

糖化血红蛋白与糖尿病肾病

糖尿病肾病(diabetic kidney disease,DKD)是糖尿病最常见的微血管病变之一,是导致终末期肾病(end-stage renal disease,ESRD)及相关死亡的主要原因。DKD发病机制目前尚未十分明确,但糖尿病患者长期血糖控制不佳是DKD发生、发展的主要决定因素。糖化血红蛋白(glycolated hemoglobin,Hb A1c)作为反映糖尿病患者血糖控制情况的"金标准",研究表明其不仅有可能成为独立预测DKD的风险因素,而且在DKD早期筛查诊治起重要作用;Hb A1c平稳且达标是影响DKD进展及预后的重要因素。     

Glycated hemoglobin as a marker of subclinical atherosclerosis and cardiac remodeling among non-diabetic adults from the general population

Background

Elevated glycated hemoglobin (HbA1c) is associated with increased risk of cardiovascular disease (CVD) and mortality but little is known about potential mechanisms underlying the reported associations.

Methods

We used data from 1798 non-diabetic participants from the population-based cohort Study of Health in Pomerania (SHIP) to investigate cross-sectional and longitudinal associations of HbA1c with subclinical atherosclerosis (common carotid artery intima-media thickness [CCA-IMT]), cardiac structure (left ventricular mass [LVM]), and cardiac function (fractional shortening).

Results

Cross-sectional analyses revealed a positive association between HbA1c and mean CCA-IMT with a 0.02 mm (95% confidence interval: 0.01–0.04) increase in CCA-IMT per 1% increase in HbA1c, and a similar positive trend across HbA1c quartiles (overall p-value <0.01). We also observed a graded association between HbA1c and high CCA-IMT (>75th percentile) with an odds ratio of 1.42 (95% CI: 1.11–1.81) per 1% increase in HbA1c. Longitudinal analyses showed no consistent associations of baseline HbA1c with mean follow-up CCA-IMT. There were no consistent associations of HbA1c with cardiac remodeling in cross-sectional and longitudinal analyses, respectively.

Conclusions

The association between HbA1c and CCA-IMT in non-diabetic adults may be a crucial link between high-normal HbA1c levels and an increased risk of CVD and mortality.     

Prediction of near‐future glycated hemoglobin levels using glycated albumin levels before and after treatment for diabetes

Aims/Introduction: In the present study, whether near‐future glycated hemoglobin (A1C) levels could be predicted by changes in glycated albumin (GA) levels before and after treatment for diabetes was investigated. Materials and Methods: After starting diabetes treatment, GA and A1C levels are assumed to change exponentially. From this assumption, the equation for predicting near‐future GA and A1C levels was derived. A total of 54 patients with type 2 diabetes mellitus in whom diabetes treatment was initiated or altered were enrolled. By incorporating GA and A1C values before and 2–4 weeks after starting treatment (second visit) into the equation, the predicted GA and A1C levels at the third visit (5–7 weeks after treatment) were obtained. Results: A strong and positive correlation was observed between predicted GA and measured GA at the third visit (R = 0.669, P < 0.0001). Similarly, a strong and positive correlation was observed between the predicted A1C and the measured A1C at the third visit (R = 0.795, P < 0.0001). Conclusions: GA and A1C levels 1–3 months after starting diabetes treatment could be predicted using the equation developed. The prediction of near‐future A1C levels using GA levels at two points would be useful for judging the effectiveness of ongoing diabetes treatment at an earlier stage. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00107.x, 2011)     

Red cell indices in normal adults residing at altitudes from sea level to 2670 meters

Hemoglobin (Hb), packed cell volume (PCV), red blood cells (RBCs), mean cell volume (MCV), and mean cell hemoglobin concentration (MCHC) were measured by a single operator in a single laboratory by means of an electronic particle counter in 942 healthy adults (491 females and 451 males) residing at five altitudes: 0, 1000, 1860, 2220, and 2670 meters above sea level. The subjects were carefully screened clinically, and subjects with low transferrin saturation ( < 15%) were excluded. In both sexes there was a differential behavior as a function of altitude, of Hb and PCV on the one hand, and number of RBCs on the other. The findings suggest the presence of two sequential mechanisms of adaptation to progressively lower atmosphere oxygen pressure: One operating from sea level to 1860 meters, which leads to a progressively increasing number of relatively microcytic RBC; and a second one – from 1860 to 2670 meters – in which there is an increased but constant number of progressively more normocytic RBC, so that a simplistic model of equal magnitude increases in the three parameters and is seen at 2670 meters, but not at the intermediate altitudes. The middle group's comparativity, essential to these interpretations, apparently was achieved with regard to time elapsed between sampling and testing and with regard to the people integrating the groups.     

Glycated hemoglobin in ST-elevation myocardial infarction without previously known diabetes: its short and long term prognostic role

In 518 consecutive STEMI non-diabetic patients, glycated hemoglobin > 6.5% was not associated with increased short and long term mortality, but was associated with higher admission glucose values, worse in-hospital glycemic control and a higher incidence of acute insulin resistance (HOMA index).     

Glycated hemoglobin levels and intellectual activity in an aged population

OBJECTIVES: To examine the association between glycated hemoglobin (GHb) and aspects of daily activities in an elderly population. DESIGN: Cross-sectional population-based survey. SETTING: Nangai village, an agricultural community with a population of about 5,000 located in Akita prefecture in the north of Japan. PARTICIPANTS: Nine hundred thirty-five people aged 65 and older. MEASUREMENTS: GHb percentages, self-reported measures of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), intellectual activity (IA), and social role (SR). RESULTS: An exploratory analysis indicated that nondiabetic subjects in the lowest tertile of GHb tend to have lower IA than those in the middle tertile, if they were aged 70 and older. No consistent association appeared between GHb and ADLs, IADLs, or SR. Linear and logistic regression analyses, controlling for other risk factors, indicated significantly lower IA scores in the low and high GHb tertiles (P<.001 and P=.04, respectively) than in the middle in nondiabetic subjects aged 70 and older and without stroke history or IADL impairments. The value of GHb related to the maximal IA score was 5.0% to 5.2% as the middle tertile; or 5.2%, assuming a logistic regression model including a squared term with GHb as a continuous variable. A similar relationship was observed in the whole nondiabetic sample aged 70 and older but not in the younger counterpart. CONCLUSION: There is an inverted U-shaped relationship between GHb and intellectual activity in older people without diabetes mellitus. One possible interpretation is that suboptimal blood glucose could contribute to intellectual inactivity in older people.     

三种检测方法对变异血红蛋白患者糖化血红蛋白测定结果比较分析

目的 研究3种糖化血红蛋白（HbA1c）检测方法对变异血红蛋白患者HbA1c测定结果的比较分析.方法 收集2012年1月到2012年12月50例不同类型变异血红蛋白患者血样标本为研究对象,血红蛋白D、Q、G、J和E标本共25例,平均年龄（24±3）岁,男14例,女11例;血红蛋白F标本来源于新生儿,共25例,男11例,女14例;同时收集50例无变异血红蛋白标本为对照组,平均年龄（25±5）岁,男25例,女25例.使用亲和层析高效液相色谱（HPLC）法、离子交换HPLC法和免疫法三种方法检测HbA1c.用方差分析和Pearson相关分析法进行数据统计.结果 HbA1c结构正常组使用亲和层析HPLC法Ultra2、离子交换HPLC G8和VariantⅡ、免疫法DCA Vantage四种方法检测HbA1c分别为5.7％±1.1％、5.7％±1.2％、5.7％±1.2％、5.7％±1.1％,各组差异无统计学意义（F=0.023,P＞0.05）.25例变异血红蛋白F新生儿中,离子交换HPLC法和免疫法均检测不到血红蛋白F中的HbAlc值;空腹血糖与Ultra2检测HbA1c相关（r=0.647,P＜0.05）;空腹血糖与VariantⅡ和G8及DCA Vantage组的检测结果均无明显相关.亲和层析HPLC法不受血红蛋白D、Q、G、J和E的干扰,与血糖明显相关（r=0.823,P＜0.05）.离子交换HPLC法检测结果受到血红蛋白D、Q、G、J和E不同程度的干扰;免疫法测定的HbAlc与血糖相关（r=0.611,P＜0.05）.结论 亲和层析HPLC法测定的HbAlc可更准确地反映平均血糖水平.变异血红蛋白会干扰离子交换HPLC法的HbA1c的检测结果,免疫法检测结果仅受血红蛋白F的干扰.     

非糖尿病人糖化血红蛋白及血压水平与颈动脉粥样硬化的发生呈连续相关

目的分析非糖尿病患者中糖化血红蛋白与血压对于颈动脉粥样硬化的影响。方法采用回顾性横断面研究的方法,分析300名非糖尿病的心脏科病人的糖化血红蛋白、血压与颈动脉粥样硬化的关系。颈动脉粥样硬化以颈动脉超声确定,颈总动脉内膜中膜厚度(IMT)≥0.9 mm 或粥样斑块形成均认为颈动脉超声阳性。结果颈动脉超声阳性组的空腹血糖、2 h 血糖、糖化血红蛋门、收缩压(SBP)均显著高于1阴性组,而两组间舒张压(DBP)无显著差别。而随着糖基化血红蛋白 A1c(HbA1c)或 SBP 的增高,颈动脉超声阳性的患者比例也有明显的增加。在 SBP 相似的悄况下,随着 HbA1c 的增高,颈动脉超声阳性的患者比例也有显著的增加。Logistic 多元回归分析发现,HbA1c 即使有轻度增高也是颈动脉超声阳性的独立预测因子(OR=4.1,P=0.009),且其作用独立于性别、体质量指数、SBP、DBP、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、高敏 C 反应蛋白、空腹血糖、2 h 血糖。结论非糖尿病患者中糖化血红蛋白的轻度升高可能与颈动脉粥样硬化发生率的增加有关,且这种作用独立于其他血精指标及多重危险因素。SBP 与糖化血红蛋白增高对...     

Serum glycated albumin,but not glycated hemoglobin,is low in relation to glycemia in men with hypertriglyceridemia

Aims/Introduction: Serum glycated albumin (GA) and glycated hemoglobin (HbA_1c) are influenced by plasma glucose levels, and are used for monitoring chronic glycemic control in diabetic patients. Both glycated proteins are known to be influenced by various factors other than plasma glucose levels. In the present study, we examined the effects of hypertriglyceridemia on them. Materials and Methods: The present study comprised 273 non‐diabetic men. They were grouped into men with normotriglyceridemia (serum triglyceride [TG] <150 mg/dL) and those with hypertriglyceridemia (serum TG ≥150 mg/dL). Results: Body mass index (BMI) and high sensitivity C‐reactive protein (hs‐CRP) were significantly higher in the 160 men with hypertriglyceridemia than the 113 men with normotriglyceridemia. In men with hypertriglyceridemia, as compared with those with normotriglyceridemia, fasting plasma glucose, 2‐h plasma glucose after 75 g oral glucose tolerance test, and HbA_1c were significantly higher. By contrast, serum GA was significantly lower in men with hypertriglyceridemia. BMI‐adjusted serum GA was also significantly lower in these men. In a multivariate analysis, serum TG was an inverse explanatory variable for serum GA. Conclusions: Serum GA is low in relation to plasma glucose levels in men with hypertriglyceridemia. This might be caused by increased albumin metabolism associated with hypertriglyceridemic state. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00049.x, 2010)     

糖化白蛋白与糖尿病

糖化白蛋白是葡萄糖与血浆白蛋白发生非酶糖化反应的产物,其值能反映糖尿病患者近2～3周内的平均血糖水平,是反映短期血糖控制的较好指标.同时糖化白蛋白具有促动脉粥样硬化的作用,亦是评估糖尿病合并冠心病时冠状动脉病变严重程度的一项敏感指标.现对糖化白蛋白对糖尿病的诊疗价值进行综述.