Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c
Red cell life span heterogeneity in hematologically normal people is sufficient to alter HbA1c
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DOI：
10.1182/blood-2008-04-154112
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发表时间：
2008-11-15
期刊：
影响因子：
20.3
通讯作者：
Joiner, Clinton H.
中科院分区：
文献类型：
--
作者：
Cohen, Robert M.;Franco, Robert S.;Joiner, Clinton H.
尽管红细胞（RBC）寿命是糖化血红蛋白A1c（HbA1c）百分比的一个已知决定因素，但其变异一直被认为不足以影响血液学正常者的临床决策。然而，可以观察到HbA1c与其他血糖控制指标之间存在无法解释的不一致，这在一定程度上可能是红细胞寿命差异的结果。为了探究红细胞寿命的变异是否足以改变所测得的HbA1c从而解释部分这种不一致的假设，我们使用生物素标记测定了6名糖尿病患者和6名非糖尿病对照者的红细胞寿命。根据所有循环红细胞以及随着时间推移在多个时间点的标记红细胞的红细胞存活曲线计算平均红细胞年龄。此外，利用磁性分离的标记红细胞和分离的转铁蛋白受体阳性网织红细胞中的HbA1c来确定HbA1c的体内合成速率。糖尿病受试者循环红细胞的平均年龄为39至56天，非糖尿病对照者为38至60天。HbA1c的合成呈线性，且与全血平均HbA1c相关（R² = 0.91）。观察到的红细胞存活的变异大到足以在给定平均血糖水平下导致HbA1c出现具有临床重要性的差异。（《血液》2008年；112卷：4284 - 4291页）
Although red blood cell (RBC) life span is a known determinant of percentage hemoglobin A1c (HbA1c), its variation has been considered insufficient to affect clinical decisions in hematologically normal persons. However, an unexplained discordance between HbA1c and other measures of glycemic control can be observed that could be, in part, the result of differences in RBC life span. To explore the hypothesis that variation in RBC life span could alter measured HbA1c sufficiently to explain some of this discordance, we determined RBC life span using a biotin label in 6 people with diabetes and 6 nondiabetic controls. Mean RBC age was calculated from the RBC survival curve for all circulating RBCs and for labeled RBCs at multiple time points as they aged. In addition, HbA1c in magnetically isolated labeled RBCs and in isolated transferrin receptor-positive reticulocytes was used to determine the in vivo synthetic rate of HbA1c. The mean age of circulating RBCs ranged from 39 to 56 days in diabetic subjects and 38 to 60 days in nondiabetic controls. HbA1c synthesis was linear and correlated with mean whole blood HbA1c (R-2 = 0.91). The observed variation in RBC survival was large enough to cause clinically important differences in HbA1c for a given mean blood glucose. (Blood. 2008;112: 4284-4291)