糖化血红蛋白在糖代谢异常患者中的改变及其与血糖的关系

目的探讨糖化血红蛋白（HbAlc）检测在不同糖代谢异常状态的临床价值。方法选取254名受试者（其中男149人，女105人）进行口服糖耐量试验（OGYr）和HbAlc检测。根据OGTY结果分为正常糖耐量（NGT）、单纯空腹血糖受损（I-IFG））、单纯糖耐量受损（I-IGT）、IFG合并IGT（IFG／IGT）和糖尿病（DM）5组，通过单因素方差分析比较各组HbAlc值，对各组HbAlc与空腹血糖（FPG）和OGTr2h血糖（2hPG）进行线性相关和回归分析。结果①HbAlc水平（％，下同）DM组（7．41±1．94）明显高于其余4组（以上P均〈0．01），I-IFG组（6．06±0．37）、I-IGT组（5．91±0．39）、IFG／IGT组（6．12±0．38）3组间差异无统计学意义（P〉0．05），但分别明显高于NGT组（P〈0．05）。②DM组HbAlc分别与FPG（r=0．934，P〈0．01）和2hPG（r=0．760，P〈0．01）存在着明显的正相关，回归方程为：HbAlc=2．957＋0．458（FPG）＋0．05（2hPG）；IFG／IGT组（r=0．326，P〈0．01）、I-IGT组（r=0．254，P〈0．05）HbAlc只与2hPG存在正相关；I-IFG组HbAlc只与FPG存在正相关（r=0．404，P〈0．01）；NGT组HbAlc与FPG（r=0．157）和2hPG（r=-0．006）均不存在相关性。结论糖化血红蛋白水平能够正确地反映正常糖代谢、糖调节受损和糖尿病3种不同糖代谢状态的血糖水平，是区分3种糖代谢状态的有用指标。

Clinical Significance of HbAlc Level in Different Kinds of Glycometabolism Disorders

Objective To explore the clinical significance of glucosylated hemoglobin Alc （HbAlc） determination in different kinds of glycometabolism disorders. Methods 254 subjects （149 men, 105 women） underwent an oral glucose tolerance test（OGTT） as well as HbAlc determination. According to the results of OGTT, all subjects were divided into five groups as follows： normal glucose tolerance （NGT）, isolated impaired fasting glucose （I-IFG）, isolated impaired glucose tolerance （I-IGT）, IFG combined with IGT （IFG/IGT） and diabetes mellitus （DM）. Then levels of HbAlc were compared one another among 5 groups by using one-way ANOVA. In every group, linear correlation and regression analysis for between HbAlc and either fasting plasma glucose （FPG） or postchallenge 2 hour plasma glucose（2hPG） were performed. Results （1）Level of HbAlc（%） in DM （7.41±1.94） was statistically higher（P〈0.01） than that in any one of the other four groups. Among I-IFG group（6.06±0.37）, I-IGT group（5.91± 0.39） and IFG/IGT group （6.12±0.38） the HbAlc levels showed no statistical significant difference, while they were statistical significantly higher than that of NGT group （5.68±0.31,P〈0.05）. （2）In DM group, highly significant correlations were found between HhAlc and either FPG （r=0.934,P〈0.01）or 2hPG（r=0.760,P〈0.01）.The regression equation was obtained as follow：HbAlc=2.957＋0.458（FPG）＋0.05 （2hPG）.Significant correlations were found between HbAlc and 2hPG in both I-IGT group （r=0.254,P〈0.05） and IFG/IGT group （r=0.326,P〈0.01）. In I-IFG group, significant correlation was found between HbAle and FPG（r=0.404, P〈0.01 ）. While in NGT group, no significant correlations were found between HbAlc and either FPG（r=0.157） or 2hPG（r=-0.006）.Conclusions The level of HbAle represents blood glucose level of different stages of glycometabolism conditions such as NGT, impaired glucose regulation and DM. It may be a useful index in discriminating them.