糖化白蛋白、糖化白蛋白/糖化血红蛋白与2型糖尿病合并冠心病相关性的研究

目的 探讨T2DM合并冠心病(CAD)与糖化白蛋白(GA)、HbA₁c、GA/HbA₁c的相关性。方法 选取2018年1月至2021年12月于承德医学院附属医院内分泌科住院的T2DM患者596例,根据是否合并CAD分为单纯T2DM组(n=304)和T2DM合并CAD组(CAD,n=292)。比较两组一般资料、生化指标、GA、HbA₁c、GA/HbA₁c。Pearson相关分析GA/HbA₁c、GA与其他指标的相关性。Logistic回归分析T2DM合并CAD的影响因素。结果 CAD组男性比例、年龄、DM病程、吸烟史比例、CAD家族史比例、SBP、FPG、2 hPG、GA、GA/HbA₁c高于T2DM组(P<0.05或P<0.01)。Pearson相关分析显示,GA与2 hPG、HbA₁c、GA/HbA₁c呈正相关(P<0.05),与BMI呈负相关(P<0.05)。GA/HbA_1<...     

老年2型糖尿病患者糖化白蛋白及糖化血红蛋白与血糖波动的相关性

目的：分析住院老年2型糖尿病患者糖化血清白蛋白（GA）、糖化血红蛋白（HbA1c）与平均血糖波动幅度（MAGE）、血糖标准差（SDBG）的相关性,为临床全面评价GA和HbA1c提供理论依据。方法研究对象来源于上海交通大学附属第六人民医院内分泌代谢科2013年2月至2014年2月住院的660例老年2型糖尿病患者,入院后第2天测定静脉空腹血糖（FPG）、HbA1c、GA、空腹C肽（FCP）及餐后2h血糖（2hPBG）、餐后2hC肽（2hCP）等。采用动态血糖监测系统（CGMS）对研究对象进行连续3d的血糖监测。采用MAGE和SDBG评估研究对象的血糖波动程度,采用CGM中连续48h的平均血糖水平（MBG）评估整体血糖水平。结果（1）660例研究对象中男346例、女314例。年龄（66±6）岁,糖尿病病程[8.0（4.0～13.8）]年,HbA1c为[8.2（6.7～9.6）]%,GA为[21.1（17.6～25.9）]%,MAGE为[5.3（3.9～7.2）]mmol/L,SDBG为[2.1（1.6～2.7）]mmol/L,MBG为[8.6（7.3～10.1）]mmol/L。（2）单相关分析GA与HbA1c之间有良好的相关性（r＝0.836,P＜0.01）。GA与FPG、2hPBG、MBG呈正相关（r分别为0.604,0.670,0.650,均P＜0.01）;HbA1c与FPG、2hPBG、MBG呈正相关（r分别为0.603,0.634,0.661,均P＜0.01）。（3）单相关分析GA与MAGE、SDBG呈正相关（r分别为0.485,0.529,均P＜0.01）;HbA1c与MAGE、SDBG呈正相关（r分别为0.417、0.495,均P＜0.01）。（4）逐步多元回归分析显示,GA水平与血糖波动参数MAGE和SDBG水平独立相关。结论与HbA1c相比,GA能更好地反映餐后血糖的水平及血糖的波动情况。     

餐后高血糖与糖化血红蛋白及尿白蛋白的关系

餐后高血糖是引起糖化血红蛋白 (ＨｂＡ1ｃ)升高的主要原因 ,而糖化血红蛋白又是反映慢性并发症的重要指标。我们将慢性并发症以尿白蛋白排泄率 (ＵＡＥＲ )作为观察指标 ,探讨了餐后高血糖与糖化血红蛋白及慢性并发症的关系。对象与方法1.对象 :1995年 5月～ 2 0 0 0年 5月期间符合 1985年ＷＨＯ糖尿病诊断标准的住院病人 98例 ,男性 5 8例 ,女性 40例。年龄 (48.2± 10 .7)岁。所有病人均满足下列条件 :(1)病程 10～15年 ;(2 )无心、脑、肾器质性损害 ;(3 )血压正常者或轻度高血压者经严格控制≤ 14 0 /90ｍｍＨｇ在 1年以上 ;(4)口服降糖…     

糖化血红蛋白水平与微量白蛋白尿的相关性研究

目的探讨青岛市人群中糖化血红蛋白(glycosylated hemoglobin,HbAlc)水平与微量白蛋白尿(microalbuminuria MAU)之间的关系,并确定其最佳切点。方法选取青岛市3 506人年龄在20～70岁、无明确糖尿病病史的研究对象,应用高压液相色谱分析法(HPLC)测定血HbAlc,采用放射免疫分析法(RIA)测定尿微量白蛋白排泄率(UAER),运用受试者工作特征曲线(ROC)确定血HbAlc预测MAU发生的最佳切点。结果 (1)不同血HbAlc水平患者的UAER水平之间存在显著差异(P0.01),且随着血HbAlc水平的增高,其UAER水平亦随之升高(P0.01);(2)HbAlc水平与UAER水平之间呈明显的正相关,差异有统计学意义(P0.01);(3)由ROC曲线得到HbAlc预测微量白蛋白尿发生的切点为6.3%,敏感性和特异性分别为85.7%和75.3%。结论 (1)HbAlc水平与微量白蛋白尿密切相关,可作为预测、评估微量白蛋白尿患病风险的指标;(2)HbAlc≥6.3%作为预测微量白蛋白尿发生的最佳切点。     

糖化血红蛋白、糖化白蛋白及空腹血糖在糖尿病诊断中的价值

目的：评估糖化血红蛋白（HbA1c）、血清糖化白蛋白（Glycated Albumin,GA）及空腹血糖（Fasting Plasma Glucose, FPG）在糖尿病（ Diabetes Mellitus,DM）患者早期诊断中的价值。方法收集2010～2013年浙江省台州医院同时检测HbA1c、GA及FPG的人群的相关数据,分为糖尿病组和非糖尿病组,进行受试者工作特征曲线（ Receiver Operator Character-istic curve,ROC曲线）分析以得出3种指标诊断DM的cut-off值、曲线下面积（ Area Under the Curve,AUC）其灵敏度、特异性,再进一步计算3种指标联合诊断DM的灵敏度及特异性。结果①DM组的HbA1c、GA及FPG均高于非DM 组（ HbA1c：9．14％vs．5．84％, P ＝0．000;GA：24．8mmol/Lvs．13．8mmol/L, P ＝0．000;FPG：9．65mmol/L vs．5．77mmol/L, P ＝0．000）。②HbA1c诊断DM的cut-off值为6．85％,AUC为0．911,灵敏度为84．2％,特异性为96．2％;GA诊断DM的cut-off值为17．5,AUC为0．881,灵敏度为71．6％,特异性为93．6％;FPG诊断DM的cut-off值为7．52mmol/L,AUC为0．836,灵敏度为70．2％,特异性为82．1％。③HbA1c、GA及FPG联合诊断DM的灵敏度及特异性分别为91．1％,76．3％。结论HbA1c、GA及FPG对DM皆有诊断价值,其中HbA1c的诊断DM效能最大。 HbA1c、GA及FPG联合诊断可提高DM诊断的灵敏度,在DM筛查中具有重要价值。     

血清总胆红素、糖化白蛋白、糖化血红蛋白与糖尿病血管并发症的关系

目的探讨血清总胆红素(TBIL)、糖化白蛋白(GA)、糖化血红蛋白(Hb A1c)与糖尿病血管并发症的关系。方法选取糖尿病患者176例,根据是否有血管并发症分为血管病变组和无血管病变组。测定两组TBIL、GA、Hb A1c等生物化学指标。采用Logistic二元回归分析糖尿病患者血管并发症的影响因素。结果最终纳入血管病变组的有120例,纳入无血管病变组的有56例。两组性别、年龄、体质指数(BMI)比较差异无统计学意义(P0. 05)。与无血管病变组比较,血管病变组患者的病程更长,总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、TBIL数值更低,GA、Hb A1c、甘油三酯(TG)和低密度脂蛋白胆固醇(LDLC)数值更高,差异具有统计学意义(P0. 05);进一步二元Logistic回归分析结果显示,Hb A1c水平高、TBIL水平低和病程长是糖尿病血管并发症的独立危险因素(P0. 05)。结论临床应积极关注糖尿病患者的Hb A1c和TBIL水平,注意血管病变的筛查并积极干预,避免严重并发症的发生。     

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.     

糖化白蛋白的临床应用价值

糖化白蛋白(GA)是血液中白蛋白与葡萄糖通过非酶促糖基化反应形成的产物,与血糖水平密切相关。GA水平与白蛋白代谢周期相关,反映近2~3周的平均血糖水平。GA可作为糖尿病诊断、血糖监测、疗效评估的辅助指标,同时对慢性肾脏病变、DR等糖尿病并发症风险具有一定的预测作用。在特定的临床条件下,如接受血液透析治疗的糖尿病、GDM患者,GA的临床应用价值优于HbA1c。     

糖耐量、糖化血红蛋白、糖化白蛋白联合C肽检测应用于糖尿病诊断中价值分析

目的探讨糖耐量、糖化血红蛋白、糖化白蛋白联合C肽应用于糖尿病诊断中的价值,为临床诊疗提供参考价值。方法选取该院2018年1月—2019年1月所收治2型糖尿病患者315例为研究组,另选同期健康体检者255例为对照组。分别进行糖耐量、糖化血红蛋白、糖化白蛋白、C肽检测,比较组间差异。结果在4个时间点,研究组糖耐量均高于对照组,差异有统计学意义(P<0.05);在T0、T2、T3,研究组C肽水平均高于对照组,差异有统计学意义(P<0.05);在T1时,研究组C肽水平为(2.2±0.5)mmol/L,低于对照组的(8.4±1.6)mmol/L,差异有统计学意义(P<0.05)。研究组患者中,糖化白蛋白为(18.6±4.9)mmol/L、糖化血红蛋白为(8.1±1.9)mmol/L,均高于对照组(P<0.05)。结论糖耐量、糖化血红蛋白、糖化白蛋白及C肽联合检测可全面反应血糖控制及胰岛素分泌情况,有利于鉴别有无糖尿病、胰岛素水平及长短期治疗效果,对临床诊疗具有积极意义,值得临床推广应用。     

Association between fat mass index,fat‐free mass index and hemoglobin A1c in a Japanese population: The Tohoku Medical Megabank Community‐based Cohort Study

Aims/IntroductionFat mass and fat‐free mass affect glycated hemoglobin A1c (HbA1c) levels and blood glucose levels, respectively. The aim of the present study was to examine the association between the fat mass index and fat‐free mass index with HbA1c.Materials and MethodsWe carried out a cross‐sectional study that included 3,731 men and 9,191 women aged ≥20 years, living in Miyagi Prefecture, Japan, who were not treated for diabetes. The fat mass index and fat‐free mass index were calculated as fat mass and fat‐free mass divided by the height squared, respectively. The indices were classified into sex‐specific quartiles and combined into 16 groups. An analysis of covariance was used to assess associations between the combined fat mass index and fat‐free mass index with HbA1c adjusted for potential confounders. The linear trend test was carried out by stratifying the fat mass index and fat‐free mass index, entering the number as a continuous term in the regression model.ResultsIn multivariable models, a higher fat mass index was related to higher HbA1c levels in men and women in all fat‐free mass index subgroups (P < 0.001 for linear trend). When we excluded the participants who had been identified as having diabetes, the fat‐free mass index was also related to higher HbA1c levels in most fat mass index subgroups (P < 0.05 for linear trend).ConclusionsFat mass index was positively related to HbA1c levels. The fat‐free mass index was also related to HbA1c levels when we excluded participants who had been identified as having have diabetes.     

Association of time in range with hemoglobin A1c,glycated albumin and 1,5-anhydro-d-glucitol

Aims/IntroductionHemoglobin A1c (HbA1c), glycated albumin (GA) and 1,5‐anhydro‐d‐glucitol (1,5‐AG) are used as indicators of glycemic control, whereas continuous glucose monitoring (CGM) is used to assess daily glucose profiles. The aim of this study was to investigate the relationships between CGM metrics, such as time in range (TIR), and glycemic control indicators.Materials and MethodsWe carried out retrospective CGM and blood tests on 189 outpatients with impaired glucose tolerance (n = 22), type 1 diabetes mellitus (n = 67) or type 2 diabetes mellitus (n = 100).ResultsIn type 1 diabetes mellitus and type 2 diabetes mellitus patients, HbA1c and GA were negatively correlated with TIR, whereas 1,5‐AG was positively correlated with TIR. In type 1 diabetes mellitus patients, a TIR of 70% corresponded to HbA1c, GA and 1,5‐AG of 6.9% (95% confidence interval [CI] 6.5–7.2%), 20.3% (95% CI 19.0–21.7%) and 6.0 µg/mL (95% CI 5.1–6.9 µg/mL), respectively. In type 2 diabetes mellitus patients, a TIR of 70% corresponded to HbA1c, GA and 1,5‐AG of 7.1% (95% CI 7.0–7.3%), 19.3% (95% CI 18.7–19.9%) and 10.0 µg/mL (95% CI 9.0–11.0 µg/mL), respectively. TIR values corresponding to HbA1c levels of 7.0% were 56.1% (95% CI 52.3–59.8%) and 74.2% (95% CI 71.3–77.2%) in type 1 diabetes mellitus and type 2 diabetes mellitus patients, respectively.ConclusionsThe results of this study showed that the estimated HbA1c corresponding to a TIR of 70% was approximately 7.0% for both type 1 diabetes mellitus and type 2 diabetes mellitus patients, and that the estimated 1,5‐AG calculated from the TIR of 70% might be different between type 1 diabetes mellitus and type 2 diabetes mellitus patients.     

我国糖化血红蛋白参考区间和切值调查与分析

目的 分析目前我国糖化血红蛋白（HbA1c）参考区间的来源、上下限分布及决定限（切值）的现状情况.方法 本次调查覆盖了全国31个省市,向参加2014年HbA1c室间质量评价的1 250家临床实验室发放调查表,通过网络上报方式收集各实验室HbA1c的参考区间上下限值、切值、来源情况、方法原理、仪器和试剂等相关信息,并对切值分别按照仪器系统和省市区域进一步分组.采用SPSS 19.0和微软Excel 2007软件,按照来源、上下限及切值情况进行单因素方差分析,组间比较采用LSD检验.结果 共953家实验室回报了结果.参考区间来源中所占比例最高的3项依次为：试剂和仪器厂家说明书约70％,《全国临床检验操作规程》接近17％,实验室自己确定为7.0％.参考区间上下限及切值的最小值和最大值差异较大,而中位数与平均值较为接近,且上下限出现了交叉情况,不同仪器系统组间第2.5％和97.5％百分数（P2.5和P97.5）分布差异大.HbA1c参考区间下限分布范围为0％～6.4％,上限分布范围为5.2％～18.5％,切值分布在5.1％～17.0％.各仪器组及区域组内切值的均值水平相比较差异无统计学意义（均P＞0.05）.结论 全国有40％以上的实验室将HbA1c参考区间设置为4.0％～6.0％,切值为6.5％,但总体不统一.应建立适应我国多数地区和主要检测系统的参考区间及切值,为HbA1c标准化工作提供数据参考.     

Estimation of HbA1c response to sitagliptin by change in glycated albumin level for 2 weeks

Aims/Introduction: Since glycated albumin (GA) reflects shorter‐term (about 2 weeks) control of plasma glucose levels compared with HbA1c, GA is thought to be a useful glycemic control indicator for the early period following commencement of the treatment of diabetes. In this study, we attempted to estimate HbA1c using the change in GA level before and after the first 2 weeks (ΔGA2w) of administration of sitagliptin, a dipeptidyl peptidase‐4 (DPP‐4) inhibitor. Materials and Methods: The study included 28 patients with type 2 diabetes who were administered sitagliptin at a dose of 50 mg/day for 12 weeks. Results: At 2 weeks after administration of sitagliptin, GA markedly decreased, while HbA1c had only slightly decreased. A significant positive correlation was observed between the ΔGA2w and the change in HbA1c before and after the first 12 weeks of administration of sitagliptin (ΔHbA1c12w) (R = 0.793, P < 0.0001). The latter was about 0.6 times the former. The estimated HbA1c after 12 weeks of therapy was calculated by adding ΔGA2w × 0.6 to the baseline HbA1c. A significant positive correlation was observed between the estimated HbA1c and the measured HbA1c after 12 weeks (R = 0.735, P < 0.0001) and both were similar levels. Conclusions: HbA1c in the first 12 weeks after administration of sitagliptin could be estimated from the formula using the ΔGA2w. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00167.x, 2011)     

糖化血红蛋白和血清胱抑素C与中青年高血压患者早期肾损害的关系

摘要 目的 探讨中青年原发性高血压患者糖化血红蛋白(HbA1c)和血清胱抑素C(Cys-C)与早期肾损害的关系。方法 选择2013年5月2015年3月北京市利康医院门诊就诊的中青年原发性高血压患者318例,选取同时期的健康体检人群320例作为对照。据HbA1c水平将高血压患者分为HbA1c正常组(HbA1c<6％,176例) 和HbA1c升高组(HbA1c≥6％,142例)。分别比较三组肾功能相关指标及生化指标的的关系。结果 HbA1c正常组和HbA1c升高组与对照组相比,肱动脉收缩压及舒张压相对较高,且差异具有统计学意义（P<0.05）;而三组间,在年龄、性别、吸烟、高血压家族史、高血压病程、体质指数、TG、TCHO、HDL-C、LDL-C、BUN、Scr、UA及FPG水平上差异无统计学意义。HbA1c升高组与HbA1c正常组和对照组相比,Cys-C和血微量白蛋白(UAlb)水平显著性升高(P<0.05)。UAlb与HbA1c、血糖(FPG)及Cys-C呈正相关。 HbA1c、FPG及Cys-C水平是UAlb的独立的危险因素(P<0.05)。 结论 在中青年原发性高血压患者中,HbA1c及Cys-C水平是早期肾功能损害的独立危险因素,是预测早期肾功能损害的重要指标。     

Correlation of glycated albumin but not hemoglobin A1c with endogenous insulin secretion in fulminant type 1 diabetes mellitus

Aims/Introduction: Fulminant type 1 diabetes mellitus (FT1DM) develops as a result of very rapid and almost complete pancreatic β‐cell destruction. We hypothesized that in patients with FT1DM who have less endogenous insulin secretion, disease progression is more rapid, and thus glycated albumin (GA) levels are lower. This study was designed to prove this hypothesis. Materials and Methods: The present study included 42 patients with FT1DM (24 men, 18 women) in whom glycated hemoglobin (HbA_1c), GA and daily urinary C‐peptide (CPR) were measured at the time of diagnosis. Patients with complications, such as liver disease, kidney disease, anemia, or who were pregnant were excluded. Results: Urinary CPR (log transformed) was not correlated with HbA_1c (R = 0.168, P = 0.287), but was positively correlated with GA (R = 0.336, P = 0.030). It was weakly, but not significantly, correlated with GA/HbA_1c ratio (R = 0.281, P = 0.072). In patients with GA < 24.0%, urinary CPR was significantly lower than in patients with GA ≥ 24.0%. In addition, in patients with GA/HbA_1c ratio <3.8, urinary CPR was significantly lower than in patients with GA/HbA_1c ratio ≥ 3.8. Conclusions: Our findings suggest that in patients with FT1DM, GA at the time of diagnosis was correlated with endogenous insulin secretion. GA < 24.0% at the time of diagnosis is predictive for less endogenous insulin secretion in patients with FT1DM. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00050.x, 2010)     

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.     

血清糖化血红蛋白水平与急性脑梗死早期神经功能恶化的相关性分析

目的探讨血清糖化血红蛋白(Hb A1c)水平对急性脑梗死患者早期神经功能恶化(END)的预测价值。方法回顾性连续纳入2014年6月至2016年1月于宿迁市人民医院神经内科住院,且起病至入院时间间隔3 d的缺血性卒中急性期患者。入院当天采用美国国立卫生研究院卒中量表(NIHSS)对所有患者行神经功能缺损情况评估,入院7 d内多次对患者神经功能缺损症状进行复评,任意1次评分较入院时增加≥2分定义为END。对符合入组和排除标准的226例患者按急性脑梗死后是否发生END分为END组50例(22.1%)和非END组176例(77.9%)。采用单因素分析组间各因素差异,多因素Logistic回归分析血清Hb A1c水平与END的相关性。结果与非END组相比,END组患者年龄、糖尿病患病率、NIHSS评分、超敏C反应蛋白水平、ASPECT评分0~7分患者比例及血清Hb Alc水平均明显升高,差异有统计学意义(均P0.05)。Logistic回归分析结果示,超敏C反应蛋白和血清Hb A1c水平升高是急性脑梗死END的独立危险因素(OR值分别为1.048、1.809,95%CI分别为1.008~1.089、1.429~2.292;P值分别为0.018、0.002)。结论血清Hb A1c水平升高是急性脑梗死END的危险因素,对END具有一定预测价值。     

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)