CAJ | 학술논문

目的分析糖化血红蛋白(HbA1c)测定结果与血糖结果不相符的原因,探讨不同血红蛋白变异体对离子交换高效液相色谱法(IE-HPLC法)检测HbA1c的干扰程度及实验室应采取的处理措施.方法方法学比较.收集IE-HPLC法检测HbA1c测定结果与血糖结果不相符的患者4例,采用血红蛋白毛细管电泳法对全血样本进行血红蛋白电泳分析,采用双脱氧链终止法进行血红蛋白基因测序,采用免疫抑制比浊法(TINIA法)对HbA1c进行重新检测.结果 4例患者中,2例为HbJ-Bangkok,血红蛋白基因型分别为β41-42/βJ-Bangkok和βN/βJ-Bangkok,Hb J-Bangkok含量各占93.9％和52.4％.1例为Hb E,血红蛋白基因型为βN/βE,Hb E含量占23.6％.1例为Hb G-Taipei,血红蛋白基因型为βN/β C-Taipei,Hb G-Taipei含量占39.4％.其中β-地贫合并Hb J-Bangkok(血红蛋白基因型为β41-42/βJ-Bangkok)患者IE-HPLC法和TINIA法HbA1c测定结果均受干扰,另外3例患者IE-HPLC法HbA1c测定结果受干扰,而TINIA法HbA1c测定结果不受干扰.结论 β-地贫合并Hb J-Bangkok、HbJ-Bangkok、Hb E和Hb G-Taipei等血红蛋白变异体对IE-HPLC法检测HbA1c存在不同程度的干扰,此类患者应采用其他不受干扰的方法检测HbA1c,或选用其他替代指标对血糖水平进行监测.
목적 분석당화혈홍단백(HbA1c)측정결과여혈당결과불상부적원인,탐토불동혈홍단백변이체대리자교환고효액상색보법(IE-HPLC법)검측HbA1c적간우정도급실험실응채취적처리조시.방법 방법학비교.수집IE-HPLC법검측HbA1c측정결과여혈당결과불상부적환자4례,채용혈홍단백모세관전영법대전혈양본진행혈홍단백전영분석,채용쌍탈양련종지법진행혈홍단백기인측서,채용면역억제비탁법(TINIA법)대HbA1c진행중신검측.결과 4례환자중,2례위HbJ-Bangkok,혈홍단백기인형분별위β41-42/βJ-Bangkok화βN/βJ-Bangkok,Hb J-Bangkok함량각점93.9％화52.4％.1례위Hb E,혈홍단백기인형위βN/βE,Hb E함량점23.6％.1례위Hb G-Taipei,혈홍단백기인형위βN/β C-Taipei,Hb G-Taipei함량점39.4％.기중β-지빈합병Hb J-Bangkok(혈홍단백기인형위β41-42/βJ-Bangkok)환자IE-HPLC법화TINIA법HbA1c측정결과균수간우,령외3례환자IE-HPLC법HbA1c측정결과수간우,이TINIA법HbA1c측정결과불수간우.결론 β-지빈합병Hb J-Bangkok、HbJ-Bangkok、Hb E화Hb G-Taipei등혈홍단백변이체대IE-HPLC법검측HbA1c존재불동정도적간우,차류환자응채용기타불수간우적방법검측HbA1c,혹선용기타체대지표대혈당수평진행감측.
Objective To analyze the causes of the HbA1c.results discordant with blood glucose measurements,evaluate the interference degree of hemoglobin variants on the HbA1c results achieved by the method of ion exchange high performance liquid chromatography (IE-HPLC),and discuss the measures should be taken by the lab.Methods Four cases with inconsistency between the results of HbA1c with IEHPLC method and those of blood glucose were collected.The dideoxy chain termination method was used for hemoglobin gene sequencing and immunoturbidimetric method (TINIA method) for detection of HbAc Hemoglobin electrophoresis analysis of whole blood samples was conducted with hemoglobin capillary electrophoresis method.Results There were 2 patients with Hb J-Bangkok.The genotypes were β41-42/βJ-Baogkok and βN/βJ-Bangkok,the accounts of Hb J-Bangkok were 93.9％ and 52.4％,respectively.Three was one patient with Hb E.The genotype was βN/βE,the accounts of Hb E was 23.6％.There was one patient with Hb G-Taipei.The genotype was βN/βG-Taipei,the accounts of Hb G-Taipei was 39.4％.In the Hb J-Bangkok patients,the interferences of HbA1c results were found in both IE-HPLC method and TINIA method.In the rest 2 patients,the interferences were found in IE-HPLC method,but not in TINIA method.Conclusions β-thalassemia combined with hemoglobin variants including Hb J-Bangkok,Hb J-Bangkok,Hb E and Hb G-Taipei has interference to varying degrees on the detection of HbA1c with IE-HPLC.In these cases,the lab should use other methods not affected by Hb variants for HbA1c detection or alternative indicators to monitor glucose levels.