【摘要】 目的 探讨果糖胺（fructosamine，FMN）与血糖、糖化血红蛋白（HbA1c）的关系。 方法 2009年5月-2009年8月，以75例糖尿病患者作为糖尿病组，36例健康志愿者作为正常对照组，进行口服糖耐量试验，检测其空腹血糖及餐后2 h血糖水平，并同时检测FMN与HbA1c水平。 结果 糖尿病组空腹血糖、餐后2 h血糖、FMN、HbA1c均高于正常对照组（Plt;0.05）。FMN与HbA1c、空腹血糖、餐后2 h血糖均呈正相关关系（Plt;0.05）。FMN与空腹血糖的相关系数高于HbA1c与空腹血糖的相关系数，FMN与餐后血糖的相关系数也高于HbA1c与餐后血糖的相关系数。 结论 果糖胺与HbA1c相比有一定的优势，可作为监测糖尿病患者血糖控制的良好指标。【Abstract】Objective To investigate the association among fructosamine (FMN) and blood glucose, glycated hemoglobin (HbA1c). Methods From May 2009 to April 2009, 75 diabetes and 36 health subjects were recruited for this study. Blood samples was collected and assayed for FMN, HbA1C, and fasting glucose.The 2-hour oral glucose tolerance test (OGTT-2h) was given. Results Fasting glucose, OGTT-2h glucose, FMN and HbA1c were all higher in diabetes group than in healthy control group (Plt;0.05) .There was positive correlation between FMN and fasting glucose, OGTT-2h glucose, and HbA1c (Plt;0.05). The correlation coefficients between FMN and glucose were higher than those between HbA1c and glucose. Conclusion Compared with HbA1c, FMN has advantage in monitoring blood glucose in diabetes and be regarded as a suitable index for blood glucose control.
ObjectiveTo observe and analyze the correlation between time within target glucose range (TIR) and hemoglobin A1c (HbA1c) and the risk of diabetic retinopathy (DR). MethodsA retrospective clinical study. From March 2020 to August 2021, 91 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Weifang Medical University, were included in the study. All patients underwent Oburg's no-dilatation ultra-wide-angle laser scan ophthalmoscopy, HbA1c and continuous glucose monitoring (CGM) examinations. According to the examination results and combined with the clinical diagnostic criteria of DR, the patients were divided into non-DR (NDR) group and DR group, with 50 and 41 cases respectively. The retrospective CGM system was used to monitor the subcutaneous interstitial fluid glucose for 7 to 14 consecutive days, and the TIR was calculated. Binary logistic regression was used to analyze the correlation between TIR, HbAlc and DR in patients with T2DM0. At the same time, a new indicator was generated, the predicted probability value (PRE_1), which was generated to represent the combined indicator of TIR and HbA1c in predicting the occurrence of DR. The receiver operating characteristic curve (ROC curve) was used to analyze the value of TIR, HbAlc and PRE_1 in predicting the occurrence of DR. ResultsThe TIR of patients in the NDR group and DR group were (81.58±15.51)% and (67.27±22.09)%, respectively, and HbA1c were (8.03±2.16)% and (9.01±2.01)%, respectively. The differences in TIR and HbA1c between the two groups of patients were statistically significant (t=3.501,－2.208; P=0.001, 0.030). The results of binary logistic regression analysis showed that TIR, HbA1c and DR were significantly correlated (odds ratio=0.960, 1.254; P=0.002, 0.036). ROC curve analysis results showed that the area under the ROC curve (AUC) of TIR, HbA1c and PRE_1 predicting the risk of DR were 0.704, 0.668, and 0.707, respectively [95% confidence interval (CI) 0.597-0.812, P=0.001; 95%CI 0.558-0.778, P=0.006; 95%CI 0.602-0.798, P=0.001]. There was no statistically significant difference between TIR, HbA1c and PRE_1 predicting the AUC of DR risk (P>0.05). The linear equation between HbAlc and TIR was HbAlc (%) = 11.37－0.04×TIR (%). ConclusionsTIR and HbA1c are both related to DR and can predict the risk of DR. The combined use of the two does not improve the predictive value of DR. There is a linear correlation between TIR and HbAlc.
ObjectiveTo systematically review the diagnosis value of glycosylated hemoglobin (HbA1c) in diagnosis of gestational diabetes mellitus (GDM).MethodsThe diagnostic studies concerning glycosylated hemoglobin in gestational diabetes were electronically searched in EMbase, PubMed, The Cochrane Library, CNKI, WanFang Data and VIP from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by RevMan 5.3 and Meta-Disc 1.4 software.ResultsA total of 33 studies involving 16 622 persons were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive predictive value, negative predictive value, the pooled DOR of HbA1c were 0.75 (95%CI 0.74 to 0.77), 0.91 (95%CI 0.90 to 0.91), 8.21 (95%CI 5.41 to 12.46), 0.18 (95%CI 0.11 to 0.28), 45.10 (95%CI 29.70 to 68.48), respectively. The AUC of SROC was 0.933 5. Subgroup analysis by different HbA1c measurements indicated that little variations between different measurements in sensitivity and specificity.ConclusionHbA1c in GDM diagnosis has high sensitivity and specificity. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (Emean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve Emean and VEGF-B/HbA1c. Results The Emean values of the left and right median nerves, Emean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The Emean values of the left and right median and tibial nerves, Emean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve Emean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve Emean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.
High performance liquid chromatography (HPLC) is currently the mainstream technology for detecting hemoglobin. Glycated hemoglobin (HbA1c) is a gold indicator for diagnosing diabetes, however, the accuracy of HbA1c test is affected by thalassemia factor hemoglobin F (HbF)/hemoglobin A2 (HbA2) and variant hemoglobin during HPLC analysis. In this study, a new anti-interference hemoglobin analysis system of HPLC is proposed. In this system, the high-pressure three-gradient elution method was improved, and the particle size and sieve plate aperture in the high-pressure chromatography column and the structure of the double-plunger reciprocating series high-pressure pump were optimized. The system could diagnose both HbA1c and thalassemia factor HbF/HbA2 and variant hemoglobin, and the performance of the system was anti-interference and stable. It is expected to achieve industrialization. In this study, the HbA1c and thalassemia factor HbF/HbA2 detection performance was compared between this system and the world’s first-line brand products such as Tosoh G8, Bio-Rad Ⅶ and D10 glycosylated hemoglobin analysis system. The results showed that the linear correlation between this system and the world-class system was good. The system is the first domestic hemoglobin analysis system by HPLC for screening of HbA1c and thalassemia factor HbF/HbA2 rapidly and accurately.
ObjectiveTo explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery.MethodsA total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used.Results Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events.ConclusionHbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.
Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.