糖化血红蛋白在中国高血糖人群中应用的困惑

糖化血红蛋白(Hb)A1c作为反映长期血糖水平的金标准,是监测糖尿病血糖控制情况的重要指标.美国糖尿病协会(ADA)和世界卫生组织(WHO)正式推荐HbA1c作为糖尿病的诊断标准之一,目前,在中国将HbA1c用于高血糖人群还有诸多问题未解决,如HbA1c检测方法的标准化还有困难,其筛查、诊断糖尿病前期和糖尿病切点仍存在...     

血红蛋白变异致糖化血红蛋白异常家系报道

报道一血红蛋白变异使高效液相色谱法(HPLC)测得HbA1c值与血糖监测结果不符家系。HPLC法测得先证者HbA1c值为5.6%, 与血糖监测结果不符, 而毛细管电泳法测得HbA1c值为7.8%, 符合血糖监测结果。毛细管电泳法所得Hb图谱提示, 先证者存在异常血红蛋白。Sanger法行HbA β-珠蛋白(HBB)基因序列测定, 证实先证者HBB基因存在杂合突变(HBB:c.68A>C), 支持Hb G-Coushatta变异体存在。家系资料显示, 先证者弟弟及妹妹的Hb含有与先证者相同变异体和HBB基因序列。HPLC法难以将Hb G-Coushatta变异体完全分离, 使HbA1c值与血糖监测结果不一致, 而毛细管电泳法可完全分离变异体, 得出准确HbA1c值。临床中, HbA1c值与血糖监测不一致时, 应考虑到血红蛋白病可能, 采用不同方法检测HbA1c, 为糖尿病诊断和病情监测提供精准指导。     

糖化血红蛋白在中国高血糖人群中应用的困惑

糖化血红蛋白(Hb)A1c作为反映长期血糖水平的金标准,是监测糖尿病血糖控制情况的重要指标.美国糖尿病协会(ADA)和世界卫生组织(WHO)正式推荐HbA1c作为糖尿病的诊断标准之一,目前,在中国将HbA1c用于高血糖人群还有诸多问题未解决,如HbA1c检测方法的标准化还有困难,其筛查、诊断糖尿病前期和糖尿病切点仍存在争议.HbA1c用于糖尿病个体化血糖管理目标值的设定十分重要.因此,根据糖尿病发展的病理生理机制和基于血糖范围、糖尿病并发症危险的大规模流行病学研究结果,寻找适合中国人群的HbA1c诊断、筛查和管理标准是当前亟待解决的问题.     

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,P0.05。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。     

糖化血清白蛋白在2型糖尿病监测及诊断中的应用观察

目的 研究糖化血清白蛋白(GA)与糖化血红蛋白(HbA1c)、空腹血糖(FPG)及餐后2小时血糖(2hPG)的关系,探讨GA在糖尿病的诊断及血糖监测方面的价值.方法 对796例受试者行口服葡萄糖耐量试验(OGTT),测定FPG、GA、HbA1c和2hPG,分析各指标间的相关性及GA诊断糖尿病的最佳切点.结果 (1)GA与FPG、2hPG呈显著正相关(r值分别为0.625、0.644,P＜0.01).(2)GA诊断糖尿病的最佳切点为18.55％,敏感度为75.1％,特异度为80.7％.结论 GA、HbA1c与FPG、2hPG关系密切,GA是诊断糖尿病的一种高信度指标.     

糖化血红蛋白与果糖胺在妊娠糖尿病诊断中的临床效果观察

目的观察糖化血红蛋白与果糖胺在妊娠糖尿病诊断中的临床效果。方法选择2015年1月—2016年10月期间在该院建档产前检查的45例妊娠糖尿病产妇作为观察组,另选择同期该院建档产前检查正常产妇作为对照组。两组产妇均抽取空腹静脉血5 m L,送检,测定空腹血糖(FPG)、果糖胺(FRU)和糖化血红蛋白(HbA1c),统计两组产妇FPG、FRU、HbA1c指标水平和阳性率。结果观察组FPG[(9.04±2.18)mmol/L]、FRU[(3.56±1.23)mmol/L]、Hb A1c[(7.03±1.32)%]指标水平显著高于对照组[FPG(4.49±0.86)mmol/L、FRU(1.57±0.33)mmol/L、HbA1c(5.24±0.47)%],组间差异有统计学意义(P0.05)。观察组FPG阳性率(53.33%)、FRU阳性率(88.89%)、HbA1c阳性率(95.56%)均显著高于对照组[FPG(6.67%)、FRU(6.67%)、HbA1c(0.00%)],组间差异有统计学意义(P0.05)。观察组FRU(88.89%)和HbA1c(95.56%)阳性率均显著高于FPG阳性率(53.33%),差异有统计学意义(P0.05)。结论妊娠糖尿病诊断中糖化血红蛋白与果糖胺准确性较高,具有较高的诊断价值,可为临床妊娠糖尿病诊断、治疗和监测提供参考依据。     

血清1,5-脱水-D-山梨醇对糖尿病诊断价值研究

目的探讨血清1,5-脱水-D-山梨醇(1,5-AG)在糖尿病诊断中的应用价值。方法收集50例糖尿病患者(病例组)、50例正常健康体检者(对照组)标本,ADP-HK酶法测定血清1,5-AG浓度,同时进行空腹血糖(FBG)、餐后血糖(PBG)、果糖胺(GSP)和糖化血红蛋白(HbA1c)等指标的检测,观察这几项指标在糖尿病诊断中的相关性。结果采用85.26μmol/L为诊断临界值时,血清1,5-AG在糖尿病诊断中敏感度和特异度分别为82%和94%。病例组血清1,5-AG与FBG、PBG、GSP和HbA1c均呈显著负相关。结论血清1,5-AG可作为一种新的糖尿病检测指标,结合FBG、PBG、GSP、HbA1c等指标更有利于糖尿病的监测与控制。     

联合血清糖化白蛋白、糖化血红蛋白和空腹血糖在2型糖尿病诊治的价值

探讨糖化白蛋白(GA)、糖化血红蛋白(Hb Alc)、空腹血糖(FPG)在2型糖尿病诊治中的价值。方法选取2016年4月—2017年3月在该院糖尿病科收治200例临床诊断为2型糖尿病住院患者及200名健康体检者进行GA、HbA1c、FPG的检测,并进行比较分析。结果 2型糖尿病组GA、HbA1c、FPG指标明显高于健康对照组(P0.05),2型DM组住院患者经有效的降血糖治疗后1周、2周时GA值与治疗前比较差异有统计学意义(P0.05),HbA1c值与治疗前比较,差异无统计学意义(P0.05)。GA治疗1周、2周变化率与HbA1c变化率比较差异有统计学意义(P0.05)。结论 GA与HbA1c一样,是糖尿病筛查、诊断及治疗监测的可靠指标,HbA1c、GA、FPG三者联合检测可起到互补作用,提高早期糖尿病的诊断率。但在治疗及疗效观察时,GA变化更为敏感,更能反映DM的诊治效果,指导临床用药。     

以糖化血红蛋白A1c作为糖尿病诊断和筛查的指标

糖化血红蛋白（Hb）A1c用于评价糖尿病患者的血糖控制水平已有几十年历史。尽管近年来HbA1c的检测方法、计量单位以及标准化日臻完善,但迄今为止的指南仍没有推荐使用HbA1c筛查与诊断糖尿病,而是通过检测空腹或糖负荷之后的血清葡萄糖来筛查与诊断糖尿病。鉴于现有诊断方法存在的缺陷,以及近年来HbA1c检测技术的进步,HbA1c用于糖尿病的筛查与诊断已成为一种趋势。在第69届美国糖尿病协会（ADA）年会上,由ADA、欧洲糖尿病研究学会（EASD）以及国际糖尿病联盟（IDF）组成的国际专家委员会指出,将HbA1c≥6．5％作为筛查与诊断糖尿病的标准具有合理性,其准确性、敏感性与特异性也较为满意,其与血糖联合使用,可进一步提高糖尿病诊断的敏感性,更有利于临床实践。但是,临床医生需要了解影响HbA1c检测结果的因素、HbA1c的标准化、HbA1c用于筛查与诊断糖尿病的循证医学证据、基于HbA1c与血糖检测的糖尿病筛查标准等诸多问题。     

糖化血红蛋白和空腹血糖水平测定在糖尿病临床诊断中的实用价值

目的 探讨糖化血红蛋白(HbA1c)和空腹血糖(FPG)水平测定在糖尿病临床诊断中的实用意义.方法 选择自2013年6月-2014年1月之间该院FPG＞6.1 mmol/L的住院患者320例为A组,检测并记录其HbA1c含量;随机抽取同期HbA1c含量＞6.3％的住院患者300例为B组,检测记录其FPG水平.对二者进行数据分析.结果 A组标本中,124例HbA1c含量超标,占该组的38.75％;B组标本中,290患者空腹血糖不同程度升高,占该组的96.67％.结论 糖化血红蛋白含量高者几乎全部空腹血糖升高,这表明糖化血红蛋白在糖尿病的诊断中起着更准确的表达,二者联合监测对糖尿病早期的预防、诊断和控制有着重要的意义.     

Racial and ethnic differences in the relationship between HbA1c and blood glucose: implications for the diagnosis of diabetes

Hemoglobin A1c (HbA1c) is widely used as an index of mean glycemia in diabetes, as a measure of risk for the development of diabetic complications, and as a measure of the quality of diabetes care. In 2010, the American Diabetes Association recommended that HbA1c tests, performed in a laboratory using a method certified by the National Glycohemoglobin Standardization Program, be used for the diagnosis of diabetes. Although HbA1c has a number of advantages compared to traditional glucose criteria, it has a number of disadvantages. Hemoglobinopathies, thalassemia syndromes, factors that impact red blood cell survival and red blood cell age, uremia, hyperbilirubinemia, and iron deficiency may alter HbA1c test results as a measure of average glycemia. Recently, racial and ethnic differences in the relationship between HbA1c and blood glucose have also been described. Although the reasons for racial and ethnic differences remain unknown, factors such as differences in red cell survival, extracellular-intracellular glucose balance, and nonglycemic genetic determinants of hemoglobin glycation are being explored as contributors. Until the reasons for these differences are more clearly defined, reliance on HbA1c as the sole, or even preferred, criterion for the diagnosis of diabetes creates the potential for systematic error and misclassification. HbA1c must be used thoughtfully and in combination with traditional glucose criteria when screening for and diagnosing diabetes.     

HbA1c �C ein Allesk?nner?

The HbA1c value is an important clinical parameter for assessment of the accuracy of the diabetes adjustment and the development or progression of secondary complications of diabetes. An essential condition for such a criterion is high measurement accuracy. Therefore some comments on the accuracy of measurement of glucose and HbA1c values are made at the beginning of this article. Particular emphasis is placed on the fact that despite standardization of HbA1c measurement there are a number of indications where the long-term average glucose level will be overestimated or underestimated by HbA1c_. Some information will be given on the question to what extent usable values for the average glucose level can be estimated from HbA1c followed by some epidemiological findings in particular on the dependence of the prevalence of diabetes on the diagnosis criterion selected. With respect to a number of open questions an algorithm proposed by the German Diabetes Society (DDG) is recommended which integrates both diagnostic criteria.     

HbA1C和空腹血糖在糖尿病筛查中的应用价值

目的探索HbA1c及FPG筛查糖尿病（DM）的应用价值。方法南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA1c,予标准化早餐后测定餐后2小时血糖（2hPG）,用受试者工作特征曲线（ROC）评价FPG和HbA1C筛查糖尿病的效果。结果按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6．8％。采用ROC曲线判断,与DM状态相关的FPG临界点为6．1mmol／L,敏感性和特异性分别为81．3％和96．3％;HbA1c临界点为6．1％,敏感性和特异性分别为83,5％和88．8％。当采用FPG≥6．1mmol／L或HhA1c≥6．1％作为标准时,敏感性达到92．3％,同时有较好的特异性81．2％。结论单独使用FPG较HbA1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6．1mmol／L≤FPG≤7．0mmol／L或HbA1c≥6．1％的患者行OGTT以明确有无糖尿病。     

Diagnostic significance of determining glycosylated hemoglobin in the detection of early forms of diabetes mellitus

In order to determine the diagnostic value of glycolytic hemoglobin (HbA1c) in early forms of diabetes mellitus its content was studied in 62 individuals with disturbed glucose tolerance, then used as a kind of screening for examination of 357 workers employees at a factory with a subsequent glucose tolerance test (GTT). The level of HbA1c was raised almost in all persons with disturbed carbohydrate metabolism. There was correlation between HbA1c and GTT results in the diagnosis of disturbed glucose tolerance. The highest was the correlation between the HbA1c and glycemia in 2 hours during a GTT (r = +0.91). A conclusion was made that the level of HbA1c can serve as a diagnostic criterion of early forms of diabetes mellitus; HbA1c determination taking into account its lesser dependence on the conditions of investigation as compared to GTT, can be used as a method for mass screening and prophylactic medical examination.     

Are the ADA Hemoglobin A1c Criteria Relevant for the Diagnosis of Type 2 Diabetes in Youth?

Diagnostic criteria for diabetes in children have not been established with nearly the rigor as that employed in adults. Recently revised American Diabetes Association (ADA) criteria allowed utilization of hemoglobin A_1c (HbA1c) ≥6.5 % for diagnosis of diabetes. A recent series of pediatric studies appear to show that HbA1c has lower sensitivity than Fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT). However, FPG and OGTT have themselves never been validated in children. Studies to validate diagnostic thresholds in children appear unlikely to take place. Thus, accepting the major ADA diagnostic criteria appears to be the best course of action for the pediatric community. One area in which correlation studies between HbA1c and FPG or OGTT might shed light is in the definition of criteria for intervention in ‘pre-diabetes,’ as the Diabetes Prevention Program Trial did not use HbA1c. However, such treatment, and the exact diagnostic thresholds at which it should be initiated in children, remains unproven.     

A new look at screening and diagnosing diabetes mellitus

OBJECTIVE: Diabetes is underdiagnosed. About one third of people with diabetes do not know they have it, and the average lag between onset and diagnosis is 7 yr. This report reconsiders the criteria for diagnosing diabetes and recommends screening criteria to make case finding easier for clinicians and patients. PARTICIPANTS: R.M.B. invited experts in the area of diagnosis, monitoring, and management of diabetes to form a panel to review the literature and develop consensus regarding the screening and diagnosis of diabetes with particular reference to the use of hemoglobin A1c (HbA1c). Participants met in open session and by E-mail thereafter. Metrika, Inc. sponsored the meeting. EVIDENCE: A literature search was performed using standard search engines. CONSENSUS PROCESS: The panel heard each member's discussion of the issues, reviewing evidence prior to drafting conclusions. Principal conclusions were agreed on, and then specific cut points were discussed in an iterative consensus process. CONCLUSIONS: The main factors in support of using HbA1c as a screening and diagnostic test include: 1) HbA1c does not require patients to be fasting; 2) HbA1c reflects longer-term glycemia than does plasma glucose; 3) HbA1c laboratory methods are now well standardized and reliable; and 4) errors caused by nonglycemic factors affecting HbA1c such as hemoglobinopathies are infrequent and can be minimized by confirming the diagnosis of diabetes with a plasma glucose (PG)-specific test. Specific recommendations include: 1) screening standards should be established that prompt further testing and closer follow-up, including fasting PG of 100 mg/dl or greater, random PG of 130 mg/dl or greater, or HbA1c greater than 6.0%; 2) HbA1c of 6.5-6.9% or greater, confirmed by a PG-specific test (fasting plasma glucose or oral glucose tolerance test), should establish the diagnosis of diabetes; and 3) HbA1c of 7% or greater, confirmed by another HbA1c- or a PG-specific test (fasting plasma glucose or oral glucose tolerance test) should establish the diagnosis of diabetes. The recommendations are offered for consideration of the clinical community and interested associations and societies.     

Hemoglobin A1c and diagnosis of diabetes

The prevalence of diabetes is increasing markedly worldwide, especially in China. Hemoglobin A1c is an indicator of mean blood glucose concentrations and plays an important role in the assessment of glucose control and cardiovascular risk. In 2010, the American Diabetes Association included HbA1c ≥6.5% into the revised criteria for the diagnosis of diabetes. However, the debate as to whether HbA1c should be used to diagnose diabetes is far from being settled and there are still unanswered questions regarding the cut‐off value of HbA1c for diabetes diagnosis in different populations and ethnicities. This review briefly introduces the history of HbA1c from discovery to diabetes diagnosis, key steps towards using HbA1c to diagnose diabetes, such as standardization of HbA1c measurements and controversies regarding HbA1c cut‐off points, and the performance of HbA1c compared with glucose measurements in the diagnosis of diabetes.