糖化血红蛋白检测的临床循证2.docVIP

糖化血红蛋白检测的临床循证 学生：王福安 指导老师：王梅华 【摘要】 目的 了解3269份我实验室接收标本的糖化血红蛋白（HbA1c）检测结果的频数分布；并对62例糖尿病患者同一天检测HbA1c，空腹血糖（FBG）及餐后两小时血糖（2hPG），探讨其相关性，进一步明确糖化血红蛋白在糖尿病治疗上的监测价值。方法 BIO-RAD VARIANT II 糖化血红蛋白分析仪，采用高效液相色谱法测定标本的糖化血红蛋白含量；BECKMAN LX20自动生化分析仪及配套试剂，葡萄糖氧化酶电极法检测标本中的葡萄糖含量。 结果 3269份HbA1c结果的频数分布P50对应的HbA1c含量为6.5%。位于正常范围内的HbA1c 4.0%～6.0%，有961例，占总人数29.5%；HbA1c在6.0%～8.0%控制范围内，有1611例；HbA1c含量8.0%以上，属糖尿病患者血糖控制未达到标准，有697例，占总人数21.3%。同一天HbA1c与餐后两小时血糖的相关性更密切。结论 我院临床医生能较合理利用该检测项目，来我院接受治疗的糖尿病患者HbA1c大都控制在较好的水平。餐后两小时血糖检测在DM疗效观察上优于空腹血糖。 【关键词】糖尿病 糖化血红蛋白 分析 Evidence-Based Medicine of Glycosylated Hemoglobin in Diabetes 【Abstract】objective To evaluate the frequency of 3269 HbA1c in our laboratory. To investigate the relationship between HbA1c and fasting blood glucose, and between HbA1c and 2hPG, identify the HbA1c value in diabetes monitoring further. Methods HbA1c were measured by BIO- RAD VARIANT II Glycosylated Hemoglobin analyzer, adopted high efficiently liquid phase chromatography; the glucose were measured by BECKMAN LX20 automatic biochemistry analyzer with Glucose- Oxidase Electrode. Results The frequency of 3269 HbA1c showed the P50 HbA1c is 6.5%. 961 HbA1c located in 4.0%～6.0%, the percentile is 29.5%; 1611 HbA1c located in 6.0%～ 8.0%;697 HbA1c located in 8.0%, the percentile is 21.3%. The correlativity between HbA1c and 2hPG is more significant in one day. Conclusion Application of HbA1c test is reasonable in diabetes monitoring in our hospital, and the treatment also is reasonable in general. 2hPG is better than FBG in diabetes monitoring. 【Key words】 Diabetes; HbA1c; Analysis 血红蛋白(hemoglobin ,Hb)β链N 末端缬氨酸的氨基与葡萄糖的羰基缩合形成不稳定的Shiff′s 碱,继而通过Amadori 转位,分子重排形成稳定的酮胺即糖化血红蛋白HbA1c (hemoglobin A1c , HbA1c) 。Hb与葡萄糖发生缓慢、非酶促反应形成的复合物称为糖化血红蛋白(glycated hemoglobin ,GHb) 。GHb 生成率与红细胞外的葡萄糖浓度成比例, HbA1c 是GHb中研究最广泛的一种[1]。糖化血红蛋白含量越高表示血糖与血红蛋白的结合越多，糖尿病病情也越重，血糖是通过弥散的方式进入细胞内的，无须胰岛素参与。血糖与血红蛋白的结合过程在红细胞死亡之前一直存在，故体内衰老红细胞比新生红细胞的糖化血红蛋白，含量约高出1.5倍，每一个红细胞内都有血红蛋白，而红细胞的寿命为120天，半衰期为60天，所以糖化血红蛋白比例，能反映测定前1-2个月的平均血糖水平。因而已将糖