糖化血清白蛋白、空腹血糖、糖化血红蛋白在肝源性糖尿病中的意义

目的比较肝源性糖尿病患者与肝炎肝硬化患者血清中的糖化血清白蛋白(glycosylated serum,GA)、空腹血糖(fastingblood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)浓度,评价其在监测肝源性糖尿病糖代谢过程中的意义。方法以27例肝源性糖尿病及54例肝炎肝硬化患者为研究对象,取入院患者次日晨起空腹血清分别检测GA、FBG、HbA1c。结果①肝源性糖尿病组GA值、HbA1c值均明显高于对照组,2组差异有统计学意义(P<0.01)。②肝源性糖尿病组,FBG大于7.0mmol/L者占66.7%(18/27);HbA1c大于6.5%者占22.2%(6/27);GA高于16.87%者占92.6%(25/27)。肝硬化组FBG大于7.0 mmol/L者占3.7%(2/54);HbA1c大于6.5%者占1.8%(1/54);GA高于16.87%占25.9%(14/54)。结论 FBG和HbA1c对于肝源性糖尿病诊断的特异度高,灵敏度低,GA对于肝源性糖尿病诊断的灵敏度高,但特异度低,所以对肝源性糖尿病的诊断三个检测指标结合使用更有价值。

Clinical significance of GA, FBG, HbA1c in evaluating hepatogenic diabetes carbohydrate metabolic disturbance

Objective To compare the abnormal metabolism of glucose(fasting blood glucose, FBG; hemoglobin A1c, HbA1c and glycated albumin, GA) of patients with hepatogenic diabetes(HD) and patients with liver cirrhosis(LC), to estimate their significances in evaluating hepatogenic diabetes carbohydrate metabolic disturbance. Methods Eighty-one patients from Beijing Youan Hospital were enrolled in this study, among whom 27 had definite diagnosis of hepatogenic diabetes and 54 patients with liver cirrhosis were enrolled into control group. Clinical data of the patients were collected during hospitalization, blood-test of FBG, HbA1c, GA were obtained in the next morning of admission. Results GA and HbA1c in patients with hepatogenic diabetes were significantly higher than those of patients with cirrhosis(P<0.01). In the hepatogenic diabetes group, FBG was higher than 7.0 mmol/L in 18 cases(accounting for 66.7%), HbA1c greater than 6.5% in 96 cases(accounting for 22.2%); GA was higher than 16.87% in 25 cases(accounting for 92.6%). In cirrhosis group, FBG was higher than 7.0 mmol/L in 2 cases(accounting for 3.7%), HbA1c was higher than 6.5% in 1 case(accounting for 1.85% ), GA was higher than 16.87% in 14 cases(accounting for 25.9%). Conclusion FBG and HbA1c had a high specificity in hepatogenic diabetes monitoring, but had a low sensitivity. While GA had a high sensitivity and low specificity. It would be more helpful when combining GA, FBG and HbA1c in hepatogenic diabetes monitoring.