本文選題：糖尿病 + 2型　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:糖化血紅蛋白(Glycated hemoglobin,Hb A1c)是評(píng)價(jià)糖尿病患者長(zhǎng)期血糖控制的金指標(biāo)。Hb A1c能夠反映2-3個(gè)月的平均血糖水平,平均血糖水平與糖尿病并發(fā)癥的發(fā)生發(fā)展密切相關(guān)。但是在一些情況下,Hb A1c不能準(zhǔn)確反映血糖變化水平,如血糖急劇變化患者及一些貧血患者(溶血性貧血、缺鐵性貧血等)。相比而言,糖化白蛋白(Glycated albumin,GA)更能準(zhǔn)確反映短期內(nèi)(2-3周)平均血糖水平及餐后血糖變化,GA也能準(zhǔn)確反映血液系統(tǒng)疾病患者的平均血糖水平。本研究通過(guò)液態(tài)試劑酶法測(cè)定糖化白蛋白(GA),評(píng)價(jià)其作為血糖控制指標(biāo)的實(shí)用性及其與空腹血糖(Fasting plasma glucose,FPG)、餐后2小時(shí)血糖(2-hours postprandial glucose,2-h PG)、糖化血紅蛋白(Hb A1c)的相關(guān)性及其優(yōu)勢(shì)。方法:糖尿病(DM)組選取2014年1月至12月在我院內(nèi)分泌科住院的2型糖尿病患者共150例,其中男78例,女72例,年齡(54.25±11.25)歲,均符合1999年WHO糖尿病診斷和分型標(biāo)準(zhǔn),為河北地區(qū)漢族人,彼此間無(wú)親緣關(guān)系。入選者均排除貧血、妊娠、肝功能障礙(ALT或AST超過(guò)參考范圍上限)、腎臟損害(血肌酐超過(guò)參考范圍上限)、低蛋白血癥、甲狀腺疾病和正在接受糖皮質(zhì)激素治療患者。分別測(cè)定其入院第2天及治療2周后的GA、FPG、2-h PG及Hb A1c,研究各項(xiàng)指標(biāo)的變化并進(jìn)行相關(guān)性分析。正常對(duì)照(NC)組選取同期在我院健康體檢血糖正常者共144例,其中男70例,女74例,年齡(52.58±9.26)歲,河北地區(qū)漢族人,無(wú)親緣關(guān)系,均無(wú)糖尿病、高血壓、心腦腎等疾病史。分別測(cè)定其GA及Hb A1c值。1臨床資料收集:記錄受檢者性別、年齡、身高、體重,計(jì)算體質(zhì)量指數(shù)(Body mass index,BMI)。2血生化指標(biāo)檢測(cè):入試者均隔夜空腹8-12小時(shí)后于次日晨起抽取靜脈血。使用葡萄糖氧化酶法在全自動(dòng)生化儀測(cè)定FPG、2-h PG,使用液態(tài)試劑酶法(日本旭化成制藥株式會(huì)社Lueica GA.L試劑盒,優(yōu)利特URIT-8020全自動(dòng)生化分析儀)測(cè)定GA,使用離子交換高效液相色譜法(美國(guó)伯樂(lè)Bio-Rad VariantⅡ高效液相色譜儀)測(cè)定Hb A1c。3統(tǒng)計(jì)學(xué)分析:應(yīng)用SPSS 17.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,所有計(jì)量資料用均值±標(biāo)準(zhǔn)差(x—±s)表示,并檢驗(yàn)正態(tài)性;組內(nèi)差異比較用配對(duì)t檢驗(yàn),組間差異比較用成組t檢驗(yàn);GA與Hb A1c、FPG及2-h PG之間的相關(guān)性分析用直線相關(guān)與回歸分析。檢驗(yàn)水準(zhǔn)P=0.05。結(jié)果:1 DM組與NC組相比,年齡、性別、身高差異無(wú)統(tǒng)計(jì)學(xué)意義;體重、BMI差異有統(tǒng)計(jì)學(xué)意義,DM組高于NC組。2 DM組GA在15%-30%之間,平均(20.04±3.18)%,Hb A1c在5%-11%之間,平均(7.39±1.17)%;NC組GA在11%-16%之間,平均(13.63±1.17)%,Hb A1c在4%-6%之間,平均(5.40±0.43)%,NC組明顯低于DM組,差異有統(tǒng)計(jì)學(xué)意義。3 DM組患者治療后與治療前相比,GA、FPG、2-h PG及Hb A1c均有不同程度下降,GA在治療2周后顯著下降[(17.82±2.44)%vs(20.04±3.18)%,P0.05],而Hb A1c在治療2周后下降不明顯[(7.39±1.17)%vs(7.38±1.11)%,P0.05]。4 DM組治療前GA與Hb A1c(r=0.992,P0.05)、FPG(r=0.911,P0.05)、2-h PG(r=0.864,P0.05)呈正相關(guān),治療后GA與Hb A1c(r=0.987,P0.05)、FPG(r=0.854,P0.05)、2-h PG(r=0.786,P0.05)呈正相關(guān)。5 DM組治療前GA與Hb A1c的回歸分析方程為Y=0.173+2.688X,治療后GA與Hb A1c的回歸分析方程為Y=1.820+2.170X。結(jié)論:1酶法測(cè)定GA與Hb A1c、FPG和2-h PG均有良好的相關(guān)性,可反映2-3周平均血糖水平,可作為2型糖尿病患者血糖觀察指標(biāo)。2對(duì)于2型糖尿病患者的短期治療效果的評(píng)估,GA效果優(yōu)于Hb A1c,較Hb A1c更敏感。
[Abstract]:Objective: Glycated hemoglobin (Hb A1c) is a golden indicator of long-term glucose control in diabetic patients..Hb A1c can reflect the average blood glucose level for 2-3 months. The average blood glucose level is closely related to the development of diabetic complications. But in some cases, Hb A1c can not accurately reflect the level of blood glucose change, such as blood. The glycated albumin (Glycated albumin, GA) can more accurately reflect the average blood glucose level and postprandial blood glucose changes in the short term (2-3 weeks), and the GA can also accurately reflect the average blood glucose level in the patients with hematological diseases. This study uses the liquid reagent enzyme. Determination of glucoglycated albumin (GA) was used to evaluate its usefulness as a blood sugar control index and its correlation with Fasting plasma glucose (FPG), 2 hours postprandial blood glucose (2-hours postprandial glucose, 2-h PG), and glycated hemoglobin (Hb A1c) and its advantages. There were 150 cases of type 2 diabetes in the hospital, of which 78 cases were male and 72 women, age (54.25 + 11.25) years old. All were in accordance with the WHO diabetes diagnosis and classification standard of 1999. There was no relationship between the Han people in Hebei region. All the participants excluded anemia, pregnancy, liver dysfunction (ALT or AST exceeding the upper limit of reference range), and renal damage (blood creatinine overload) Over the upper limit of the reference range), hypoproteinemia, thyroid disease and patients undergoing glucocorticoid treatment. GA, FPG, 2-h PG and Hb A1c were measured for second days and after 2 weeks of treatment respectively. The changes of the indexes were studied and the correlation analysis was carried out. The normal control group (NC) selected 144 cases of normal blood glucose in our hospital for the same period, which were selected in the normal control group (NC). 70 middle-aged men, 74 women, age (52.58 + 9.26) years old, Hebei Han people, no relationship, no diabetes, hypertension, heart and brain kidney disease history. Determine their GA and Hb A1c value.1 clinical data collection: record subjects sex, age, height, weight, counting body mass index (Body mass index, BMI).2 blood biochemical indicators test: Participants: Participants The venous blood was extracted from the next morning after 8-12 hours. FPG, 2-h PG were measured by the glucose oxidase method in an automatic biochemical analyzer. The GA was measured by the liquid reagent enzyme method (Lueica GA.L kit of Asahi Kasi Pharmaceutical Co., Ltd., Lueica automatic biochemical analyzer), and ion exchange high performance liquid chromatography (beauty). State Bole Bio-Rad Variant II high performance liquid chromatograph) analysis of Hb A1c.3 statistical analysis: the results were statistically analyzed with SPSS 17 statistical software, all measurement data were expressed with mean mean standard deviation (x + s), and tested in normality; the differences in groups were tested with paired t, and the differences were compared with group t test, GA and Hb A1c, and 2 -h PG correlation analysis using linear correlation and regression analysis. Test level P=0.05. results: 1 DM group compared with NC group, age, sex, height difference is not statistically significant; weight, BMI difference has statistical significance, DM group is higher than NC group.2 DM group GA between 15%-30%, average (20.04 + 3.18)%, average (7.39 + 1.17)%. GA was between 11%-16%, average (13.63 + 1.17)%, Hb A1c was between 4%-6%, average (5.40 + 0.43)%, and NC group was significantly lower than that of DM group. The difference was statistically significant in group.3 DM patients after treatment, GA, FPG, 2-h, but decreased significantly after 2 weeks of treatment [17.82 + 2.44) (20.04 + 3.18)%. After 2 weeks of treatment, the decrease is not obvious [(7.39 + 1.17)%vs (7.38 + 1.11)%. The regression analysis equation of GA and Hb A1c (r=0.992, P0.05), FPG (r=0.911, P0.05) before treatment is positive correlation. For Y=0.173+2.688X, the regression analysis equation of GA and Hb A1c after treatment is Y=1.820+2.170X. conclusion: the 1 enzyme method has good correlation between GA and Hb A1c, FPG and 2-h PG, which can reflect the average blood glucose level of 2-3 weeks, and can be used as an indicator of blood glucose in type 2 diabetes patients to evaluate the short-term therapeutic effect of type 2 diabetic patients. B A1c, more sensitive than Hb A1c.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1

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