A laboratory standpoint on the role of hemoglobin A1c for the diagnosis of diabetes in childhood: more doubts than certainties?
A laboratory standpoint on the role of hemoglobin A1c for the diagnosis of diabetes in childhood: more doubts than certainties?
复制标题
DOI：
10.1111/j.1399-5448.2010.00684.x
复制
发表时间：
2011-05-01
影响因子：
3.4
通讯作者：
Targher, Giovanni
中科院分区：
文献类型：
--
作者：
Lippi, Giuseppe;Targher, Giovanni
美国糖尿病协会最近将血红蛋白A1c（A1c）的测量纳入诊断糖尿病的标准，因此这种诊断策略也可能扩展到儿童和青少年。虽然使用A1c检测筛查甚至诊断糖尿病的可能性非常有吸引力，但A1c检测还不能被认为是“灵丹妙药”，原因有很多，包括与平均血糖的次优相关性，肾功能受损儿童或青少年的误诊风险，缺铁性贫血和红细胞周转增加，血红蛋白变体的干扰，以及不同人群之间的异质性诊断性能。其他限制包括与血糖测量相比，大多数A1c测定（尤其是床旁检测设备）的不精确度较高，以及常规用A1c测定替代血糖所产生的增量成本。综上所述，目前的局限性表明，在建议广泛实施A1c检测以诊断儿童和青少年糖尿病之前，应谨慎行事。用A1c代替血糖检测诊断糖尿病的潜在临床益处（如果有的话）仍然不确定，并且可能会一直保持下去，直到可靠的成本效益分析可用。
The American Diabetes Association has recently included the measurement of hemoglobin A1c (A1c) among the criteria for diagnosing diabetes, so that this diagnostic strategy might also be extended in childhood and adolescence. Although the possibility of using A1c testing for screening and even diagnosing diabetes is highly appealing, A1c testing cannot be considered as yet the 'panacea' for a variety of reasons that include the suboptimal correlation with the mean blood glucose, the risk of misdiagnosis in children or adolescents with impaired renal function, iron-deficiency anemia and increased red blood cell turnover, the interference from hemoglobin variants, and the heterogeneous diagnostic performance among different populations. Additional limitations include the higher imprecision of most A1c assays (especially point-of-care testing devices) when compared with plasma glucose measurement, as well as the incremental cost deriving from routinely replacing plasma glucose with A1c determination. Taken together, the current limitations would suggest a certain degree of caution before recommending the widespread implementation of the A1c assay for diagnosing diabetes in childhood and adolescence. The potential clinical benefits (if any) of replacing blood glucose testing with A1c for diagnosing diabetes are still uncertain and will probably remain so until reliable cost-effective analyses are available.