Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: Effect of anemia and erythropoietin injection
Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: Effect of anemia and erythropoietin injection
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DOI：
10.1681/asn.2006070772
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发表时间：
2007-03-01
影响因子：
13.6
通讯作者：
Nishizawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Inaba, Masaaki;Okuno, Senji;Nishizawa, Yoshiki
糖化白蛋白（GA）与血浆葡萄糖（PG）和糖化血红蛋白（HbA(1c)）相比，作为血液透析（HD）糖尿病患者血糖控制状态的指标进行了评估。合并糖尿病的HD患者（n = 538）的PG、GA和HbA（1c）、c的平均水平分别为164.5 +/- 55.7 mg/dl、22.5 +/- 7.5%和5.85 +/- 1.26%，与无糖尿病的HD患者（n = 828）相比，分别增加了51.5、31.6和17.7%。与无肾功能障碍的糖尿病患者（n = 365）相比，这些患者的HbA（1c）、c水平明显低于同时存在的PG和GA值，这可以从HbA（1c）与PG或GA之间的回归线斜率明显较浅体现出来。HD合并糖尿病患者GA与血清白蛋白呈显著负相关（r = -0.131, P = 0.002），而HbA（1c）、c分别与血红蛋白（r = 0.090, P = 0.036）、周促红细胞生成素注射剂量（r = -0.159, P < 0.001）呈正相关和负相关。虽然PG和GA在合并糖尿病的HD患者和注射或不注射促红细胞生成素的患者之间没有显著差异，但未注射促红细胞生成素的患者的HbA（1c）水平明显较高。根据HbA（1c）水平将血糖控制分为任意四分位数，与GA评估相比，HD合并糖尿病患者的血糖控制明显更好。多元回归分析显示，除PG外，每周促红细胞生成素剂量是与HD合并糖尿病患者HbA（1c）相关的独立因素，尽管PG而非白蛋白是与GA相关的独立因素。综上所述，我们认为GA为评估糖尿病合并HD患者的血糖控制提供了更好的测量方法，而在这些患者中，通过HbA（1c）评估血糖控制可能会导致低估，因为使用促红细胞生成素增加了年轻红细胞的比例。
The significance of glycated albumin (GA), compared with casual plasma glucose (PG) and glycated hemoglobin (HbA(1c)), was evaluated as an indicator of the glycemic control state in hemodialysis (HD) patients with diabetes. The mean PG, GA, and HbA(1c),c levels were 164.5 +/- 55.7 mg/dl, 22.5 +/- 7.5%, and 5.85 +/- 1.26%, respectively, in HD patients with diabetes (n = 538), which were increased by 51.5, 31.6, and 17.7%, respectively, compared with HD patients without diabetes (n = 828). HbA(1c),c levels were significantly lower than simultaneous PG and GA values in those patients in comparison with the relationship among the three parameters in patients who had diabetes without renal dysfunction (n = 365), as reflected by the significantly more shallow slope of regression line between HbA(1c) and PG or GA. A significant negative correlation was found between GA and serum albumin (r = -0.131, P = 0.002) in HD patients with diabetes, whereas HbA(1c),c correlated positively and negatively with hemoglobin (r = 0.090, P = 0.036) and weekly dose of erythropoietin injection (r = -0.159, P < 0.001), respectively. Although PG and GA did not differ significantly between HD patients with diabetes and with and without erythropoietin injection, HbA(1c) levels were significantly higher in patients without erythropoietin. Categorization of glycemic control into arbitrary quartile by HbA(1c), level led to better glycemic control in a significantly higher proportions of HD patients with diabetes than those assessed by GA. Multiple regression analysis demonstrated that the weekly dose of erythropoietin, in addition to PG, emerged as an independent factor associated with HbA(1c) in HD patients with diabetes, although PG but not albumin was an independent factor associated with GA. In summary, it is suggested that GA provides a significantly better measure to estimate glycemic control in HD patients with diabetes and that the assessment of glycemic control by HbA(1c) in these patients might lead to underestimation likely as a result of the increasing proportion of young erythrocyte by the use of erythropoietin.