HbA1c水平对2型糖尿病患者红细胞及胞内血红蛋白的影响

 目的: 探讨不同糖化血红蛋白(HbA1c)水平对2型糖尿病(T2DM)患者红细胞及胞内血红蛋白(Hb)的影响。方法: 选取健康人30名为对照组(H组),T2DM患者102例,按HbA1c水平分为3组:血糖控制良好组(A组)30例(HbA1c<7.0%);血糖控制较差组(B组)36例(7.0%≤HbA1c<9.0%);持续高血糖组(C组)36例(HbA1c≥9.0%)。利用新型静态显微图像分析技术和紫外-可见光谱技术,对各组红细胞及胞内Hb进行检测。结果: 与H组比较,A、B、C组红细胞的圆度因子明显增大(P<0.05)且与HbA1c水平呈正相关;B组红细胞的截面积和C组红细胞的全部形态参数均较H组明显增大(P<0.05);A、B、C组,除A、B组间红细胞长短轴参数无显著差异,其它组间参数比较差异有统计学显著性。与H组比较,A、B、C组Hb的紫外-可见光谱的谱型和谱峰未出现明显差异,但B、C组Hb的吸光度较H组明显下降(P<0.01),且C组Hb的吸光度也明显低于A组(P<0.05),随HbA1c水平的升高呈逐渐下降趋势。结论: 随HbA1c水平的升高,T2DM患者红细胞的形态发生改变,变形功能逐渐减弱,胞内Hb的结构可能发生改变。

Effect of HbA1c level on erythrocytes and hemoglobin in type 2 diabetics

AIM: To explore the effect of HbA1c level in the patients with type 2 diabetes mellitus(T2DM) on the rheological properties of erythrocytes and the structure of hemoglobin(Hb). METHODS: The patients with T2DM were classified into 3 groups:the patients with good glycaemic control(group A, HbA1c<7.0%), the patients with poor glycaemic control(group B, 7.0%≤HbA1c<9.0%) and the patients with persistent hyperglycemia(group C, HbA1c≥9.0%). The rheological properties of a single living erythrocyte were analyzed by the techniques of static imaging and analysis. Ultraviolet-visible spectroscopy was used to study the structure of Hb. RESULTS: Compared with group H, the roundness effect factor(REF) of erythrocytes, which was positively related with HbA1c level, was significantly increased in groups A, B and C(P<0.05). The contact area of erythrocytes in group B and all the morphological parameters of erythrocytes in group C were significantly higher than those in group H(P<0.05). There were significant differences among groups A, B and C in deformation capacity and elastic parameters of the cell membrane(P<0.05), but with no difference in the long axis and short axis between group A and group B. Compared with group H, no obvious change in the spectral pattern and spectrum peak of Hb in groups A, B and C was observed. However, the absorbance of Hb, which showed a trend of gradual decline with the increase in HbA1c level, in group B and group C was significantly decreased as compared with group H(P<0.01), and the Hb absorbance in group C were also lower than that in group A(P<0.05). CONCLUSION: With the increase in HbA1c level, the morphology along with the deformation function of erythrocytes in T2DM changes and declines gradually, and the structure of Hb may also change.