液態(tài)酶法測(cè)定糖化白蛋白在2型糖尿病合并低血清白蛋白患者中的臨床價(jià)值
發(fā)布時(shí)間：2018-10-09 07:29
【摘要】：目的:糖尿病(Diabetes mellitus,DM)是一種慢性全身代謝性疾病,其發(fā)病率逐年升高。目前臨床最常用的血糖監(jiān)測(cè)方法為時(shí)間點(diǎn)血糖和糖化血紅蛋白(Glycated hemoglobin A1c,Hb A1c)。這兩種檢驗(yàn)雖然能滿足大部分糖尿病患者診斷和血糖監(jiān)測(cè)的需要,但在很多情況下無法準(zhǔn)確反映患者血糖變化,如爆發(fā)性1型糖尿病和缺鐵性貧血等[1]。糖化白蛋白(Glycated albumin,GA)是一種重要的糖尿病血糖水平的指示劑,它比糖化血紅蛋白對(duì)血糖變化更為敏感,能反映近2~3周的血糖控制水平[2]。本課題通過液態(tài)酶法測(cè)定GA,探討其與空腹血糖(Fasting plasma glucose,FPG)及Hb A1c的相關(guān)性及其優(yōu)勢(shì),并探討其在2型糖尿病合并低血清白蛋白患者中的臨床價(jià)值。方法:選擇2013年7月至2014年5月于我院內(nèi)分泌科及腎內(nèi)科住院的2型糖尿病患者共164例納入本研究,其中男89例,女75例,平均年齡(52.66±9.51)歲;單純2型糖尿病患者132例,2型糖尿病合并血清白蛋白降低者(血清白蛋白38g/L)32例。所有患者均符合1999年WHO糖尿病診斷和分型標(biāo)準(zhǔn),均為河北地區(qū)漢族人,彼此間無親緣關(guān)系。入選者均排除貧血、妊娠、肝功能障礙(ALT或AST超過參考范圍上限)、腎病綜合征、甲狀腺疾病、糖尿病急性并發(fā)癥及正在接受糖皮質(zhì)激素治療的患者。選取同期在我院健康體檢血糖正常者共145例納入本研究,其中男80例,女65例,平均年齡(52.51±8.24)歲,均為河北地區(qū)漢族人,彼此間無親緣關(guān)系,除外糖尿病、高血壓、心腦腎等疾病史。記錄所有入選者性別、年齡、身高、體重,并計(jì)算體重指數(shù)(Body mass index,BMI)。所有受試者均簽署知情同意書,符合醫(yī)學(xué)倫理學(xué)規(guī)定。根據(jù)是否患有2型糖尿病將所有入選者分為糖尿病組(DM組,n=164)及正常對(duì)照組(NC組,n=145),DM組患者分別于入院第2天及治療2周后測(cè)定GA、FPG及Hb A1c,研究各項(xiàng)指標(biāo)的變化并進(jìn)行相關(guān)性分析。根據(jù)血清白蛋白是否降低(ALB38g/L)將入選者分為兩組:(1)低血清白蛋白組(LA組,n=32),其中男18例,女14例,平均年齡(52.56±9.63)歲;(2)血清白蛋白組正常(NA組,n=277),其中男151例,女126例,平均年齡(52.59±8.86)歲。分別測(cè)定各組GA、FPG、Hb A1c及血清白蛋白(Albumin,ALB)水平,研究GA與各項(xiàng)指標(biāo)的相關(guān)性。統(tǒng)計(jì)學(xué)分析:應(yīng)用SPSS 22.0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、方差齊性;組內(nèi)差異比較用配對(duì)t檢驗(yàn),組間差異比較用兩獨(dú)立樣本均數(shù)t檢驗(yàn);GA與Hb A1c、FPG及ALB之間的相關(guān)性分析用直線相關(guān)與回歸分析及協(xié)方差分析,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1 DM組與NC組間各項(xiàng)指標(biāo):(1)兩組間性R%、年齡、身高、體重?zé)o統(tǒng)計(jì)學(xué)差異(均P0.05),與NC組相比,DM組BMI顯著升高(P0.05),兩組有可比性;(2)與NC組相比,DM組治療前GA、FPG及Hb A1c水平均明顯升高,差異有統(tǒng)計(jì)學(xué)意義(均P0.01);(3)在DM組,經(jīng)2周治療后患者GA、FPG及Hb A1c較治療前均明顯下降,差異有統(tǒng)計(jì)學(xué)意義(均P0.01);(4)在NC組,GA與FPG(r=0.159,P0.05)、Hb A1c(r=0.870,P0.01)呈正相關(guān);在DM組,治療前GA與FPG(r=0.694,P0.01)、Hb A1c(r=0.918,P0.01)呈正相關(guān);經(jīng)2周治療后,在DM組GA與FPG(r=0.387,P0.01)、Hb A1c(r=0.789,P0.01)仍呈正相關(guān);(5)DM組患者治療前后GA的變化值(ΔGA=治療前GA-治療后GA)與治療前GA的回歸分析方程為Y=0.45X-7.58,治療前后Hb A1c的變化值(ΔHb A1c=治療前Hb A1c-治療后Hb A1c)與治療前Hb A1c的回歸分析方程為Y=0.29X-1.77,治療前后FPG的變化值(ΔFPG=治療前FPG-治療后FPG)與治療前FPG的回歸分析方程為Y=0.91X-5.77,可見GA的斜率小于FPG(0.45vs0.91),大于Hb A1c(0.45vs0.29)。2 LA組與NA組間各項(xiàng)指標(biāo):(1)LA組與NA組相比,性R%、年齡、身高、體重、BMI均無統(tǒng)計(jì)學(xué)差異(均P0.05),兩組有可比性;(2)與NA組相比,LA組GA、FPG及Hb A1c水平明顯升高,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),ALB明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01);(3)在NA組,GA與FPG(r=0.809,P0.01)、Hb A1c(r=0.961,P0.01)呈正相關(guān);(4)在LA組,GA與FPG(r=0.722,P0.01)、Hb A1c(r=0.938,P0.01)呈正相關(guān);(5)NA組受試者GA與Hb A1c的回歸分析方程為Y=2.93X-0.16,LA組受試者GA與Hb A1c的回歸分析方程為Y=2.64X+2.18,經(jīng)交互效應(yīng)檢測(cè),兩者斜率無統(tǒng)計(jì)學(xué)差異(F=3.209,P0.05),可以進(jìn)行協(xié)方差分析;(6)用協(xié)方差分析方法分析LA組和NA組中Hb A1c與ALB對(duì)GA的影響,結(jié)果協(xié)變量Hb A1c的結(jié)果為(F=3452.150,P0.01),提示Hb A1c對(duì)GA水平有顯著的影響,ALB的結(jié)果為(F=0.241,P0.05),提示ALB水平對(duì)GA水平?jīng)]有顯著的影響。結(jié)論:1液態(tài)酶法測(cè)定GA與FPG及Hb A1c均有良好的相關(guān)性,能良好地反映受試者的血糖情況,可作為2型糖尿病患者的血糖監(jiān)測(cè)指標(biāo)。2液態(tài)酶法測(cè)定GA可反映短期內(nèi)(2-3周)血糖控制情況,其對(duì)血糖變化的靈敏性優(yōu)于Hb A1c,穩(wěn)定性優(yōu)于時(shí)間點(diǎn)血糖。3液態(tài)酶法測(cè)定GA,不受血清白蛋白水平的影響,可以準(zhǔn)確反映受試者短期血糖變化。
[Abstract]:Objective: Diabetes mellitus (DM) is a chronic systemic metabolic disease whose incidence increases year by year. At present, the most commonly used glucose monitoring methods are time-point blood glucose and glycosylated hemoglobin (Hb). Although these two tests can meet the needs of diagnosis and blood glucose monitoring in most diabetics, it is not possible to accurately reflect patient's blood glucose changes in many cases, such as explosive type 1 diabetes and iron deficiency anemia[1]. Glycated albumin (GA) is an important indicator of diabetic blood sugar level, which is more sensitive to blood sugar change than glycosylated hemoglobin, and can reflect the blood glucose control level of nearly 2 to 3 weeks. In this study, GA was determined by liquid enzyme method, and its correlation with fasting plasma glucose (FPG) and Hb concentration was studied and its clinical value in patients with type 2 diabetes mellitus complicated with low serum albumin was discussed. Methods: 164 patients with type 2 diabetes hospitalized in our hospital from July 2013 to May 2014 were included in this study, including 89 males and 75 females with an average age (52. 66, 9. 51). 132 patients with type 2 diabetes mellitus and 32 patients with type 2 diabetes mellitus complicated with serum albumin (38g/ L). All patients met the 1999 WHO criteria for diagnosis and classification of diabetes mellitus, all of which have no genetic relationship with each other in the Hebei region. Patients enrolled exclude anemia, pregnancy, liver dysfunction (ALT or AST exceeding the upper limit of the reference range), nephrotic syndrome, thyroid disease, acute complications of diabetes, and patients undergoing treatment with corticosteroids. During the same period, 145 patients were enrolled in this study, including 80 males and 65 females, with an average age (52. 51, 8. 24), all of which belong to the northern region of the Hebei region, unrelated to each other, with the exception of diabetes mellitus, hypertension, and renal disease. All incoming sex, age, height, body weight were recorded and the Body mass index (BMI) was calculated. All subjects signed informed consent to comply with the medical ethics requirements. All patients with type 2 diabetes were divided into diabetes group (DM group, n = 164) and normal control group (NC group, n = 145). Serum albumin (ALB38g/ L) was divided into two groups: (1) low serum albumin group (LA group, n = 32), among them 18 males and 14 females, mean age (52. 56, 9. 63); (2) Normal serum albumin (NA group, n = 277), among which 151 males and 126 females were females. Mean age (52. 59/ 8. 86). The levels of GA, FPG, Hb concentration and serum albumin (Albumin) in each group were measured, and the correlation between GA and various indexes was studied. Statistical analysis: Statistical analysis of the results was carried out by SPSS 10.0 statistical software. All the measured data were represented by mean square deviation (x/ s), and the positive state and homogeneity were tested. The paired t test was used for the difference in the group, and the difference between the groups was tested with two independent samples. Linear correlation and regression analysis and covariance analysis were used to analyze the correlation between GA and Hb, and the difference between FPG and Hb was statistically significant. Results: (1) There was no statistical difference between group 1 DM and NC group (P <0.05). Compared with NC group, the BMI of DM group increased significantly (P0.05). The levels of FPG and Hb were significantly higher in DM group (P <0.01); (3) In DM group, GA, FPG and Hb were significantly lower in DM group than before treatment (P <0.01); (4) in NC group, GA and FPG (r = 0.159, P0.05), Hb (r = 0.870). In DM group, GA was positively correlated with FPG (r = 0.494, P0.01), Hb (r = 0.9918, P0.01). After 2 weeks of treatment, GA was positively correlated with FPG (r = 0.387, P0.01), Hb (r = 0.789,P0.01). (5) The regression analysis equation of GA before and after treatment of patients with DM group was Y = 0.945X-7.58, and the regression analysis equation of Hb concentration before and after treatment was Y = 0.9X-1.77. The change value of FPG before and after treatment (FPG = before treatment, FPG before treatment) and the regression analysis equation of FPG before treatment were Y = 0.95X-5.77, and the slope of the visible GA was smaller than FPG (0.04572.0. 91). The indexes between group 2 LA and NA group: (1) LA group compared with NA group, sex R%, age, height, body weight, There was no statistical difference in BMI (P0.05), and the two groups were comparable; (2) Compared with NA group, the levels of GA, FPG and Hb of LA group were significantly higher, the difference was significant (P0.05), the difference was significantly lower (P <0.01), and (3) in NA group, GA and FPG (r = 0.809, P0.01). In group LA, GA and FPG (r = 0.722, P0.01), Hb (r = 0.9938, P0.01) were positively correlated; (5) The regression analysis equation of GA and Hb in NA group was Y = 2.93X-0.16.The regression analysis equation of GA and Hb in group LA was Y = 2.64X + 2.18, and was detected by interaction effect. There was no statistical difference between the two slopes (F = 3. 209, P0.05), and covariance analysis could be carried out; (6) The effect of Hb concentration in LA group and NA group on GA was analyzed by covariance analysis method. Results The results of covariate Hb relaxation were (F = 3452. 150, P 0.01), suggesting that Hb concentration had a significant effect on GA level. The results were (F = 0. 241, P0.05), suggesting that there was no significant effect on GA level. Conclusion: 1 The liquid enzymatic method has a good correlation with FPG and Hb, which can reflect the blood glucose level of the subjects, and can be used as the blood sugar monitoring index of type 2 diabetes patients. The liquid enzymatic method can reflect the control of blood glucose in short term (2-3 weeks). Its sensitivity to blood sugar change is better than Hb, stability is better than that of time point blood sugar. 3 liquid enzyme method to determine GA, not affected by serum albumin level, can accurately reflect the subject's short-term blood sugar change.
【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
本文編號(hào)：2258484
[Abstract]:Objective: Diabetes mellitus (DM) is a chronic systemic metabolic disease whose incidence increases year by year. At present, the most commonly used glucose monitoring methods are time-point blood glucose and glycosylated hemoglobin (Hb). Although these two tests can meet the needs of diagnosis and blood glucose monitoring in most diabetics, it is not possible to accurately reflect patient's blood glucose changes in many cases, such as explosive type 1 diabetes and iron deficiency anemia[1]. Glycated albumin (GA) is an important indicator of diabetic blood sugar level, which is more sensitive to blood sugar change than glycosylated hemoglobin, and can reflect the blood glucose control level of nearly 2 to 3 weeks. In this study, GA was determined by liquid enzyme method, and its correlation with fasting plasma glucose (FPG) and Hb concentration was studied and its clinical value in patients with type 2 diabetes mellitus complicated with low serum albumin was discussed. Methods: 164 patients with type 2 diabetes hospitalized in our hospital from July 2013 to May 2014 were included in this study, including 89 males and 75 females with an average age (52. 66, 9. 51). 132 patients with type 2 diabetes mellitus and 32 patients with type 2 diabetes mellitus complicated with serum albumin (38g/ L). All patients met the 1999 WHO criteria for diagnosis and classification of diabetes mellitus, all of which have no genetic relationship with each other in the Hebei region. Patients enrolled exclude anemia, pregnancy, liver dysfunction (ALT or AST exceeding the upper limit of the reference range), nephrotic syndrome, thyroid disease, acute complications of diabetes, and patients undergoing treatment with corticosteroids. During the same period, 145 patients were enrolled in this study, including 80 males and 65 females, with an average age (52. 51, 8. 24), all of which belong to the northern region of the Hebei region, unrelated to each other, with the exception of diabetes mellitus, hypertension, and renal disease. All incoming sex, age, height, body weight were recorded and the Body mass index (BMI) was calculated. All subjects signed informed consent to comply with the medical ethics requirements. All patients with type 2 diabetes were divided into diabetes group (DM group, n = 164) and normal control group (NC group, n = 145). Serum albumin (ALB38g/ L) was divided into two groups: (1) low serum albumin group (LA group, n = 32), among them 18 males and 14 females, mean age (52. 56, 9. 63); (2) Normal serum albumin (NA group, n = 277), among which 151 males and 126 females were females. Mean age (52. 59/ 8. 86). The levels of GA, FPG, Hb concentration and serum albumin (Albumin) in each group were measured, and the correlation between GA and various indexes was studied. Statistical analysis: Statistical analysis of the results was carried out by SPSS 10.0 statistical software. All the measured data were represented by mean square deviation (x/ s), and the positive state and homogeneity were tested. The paired t test was used for the difference in the group, and the difference between the groups was tested with two independent samples. Linear correlation and regression analysis and covariance analysis were used to analyze the correlation between GA and Hb, and the difference between FPG and Hb was statistically significant. Results: (1) There was no statistical difference between group 1 DM and NC group (P <0.05). Compared with NC group, the BMI of DM group increased significantly (P0.05). The levels of FPG and Hb were significantly higher in DM group (P <0.01); (3) In DM group, GA, FPG and Hb were significantly lower in DM group than before treatment (P <0.01); (4) in NC group, GA and FPG (r = 0.159, P0.05), Hb (r = 0.870). In DM group, GA was positively correlated with FPG (r = 0.494, P0.01), Hb (r = 0.9918, P0.01). After 2 weeks of treatment, GA was positively correlated with FPG (r = 0.387, P0.01), Hb (r = 0.789,P0.01). (5) The regression analysis equation of GA before and after treatment of patients with DM group was Y = 0.945X-7.58, and the regression analysis equation of Hb concentration before and after treatment was Y = 0.9X-1.77. The change value of FPG before and after treatment (FPG = before treatment, FPG before treatment) and the regression analysis equation of FPG before treatment were Y = 0.95X-5.77, and the slope of the visible GA was smaller than FPG (0.04572.0. 91). The indexes between group 2 LA and NA group: (1) LA group compared with NA group, sex R%, age, height, body weight, There was no statistical difference in BMI (P0.05), and the two groups were comparable; (2) Compared with NA group, the levels of GA, FPG and Hb of LA group were significantly higher, the difference was significant (P0.05), the difference was significantly lower (P <0.01), and (3) in NA group, GA and FPG (r = 0.809, P0.01). In group LA, GA and FPG (r = 0.722, P0.01), Hb (r = 0.9938, P0.01) were positively correlated; (5) The regression analysis equation of GA and Hb in NA group was Y = 2.93X-0.16.The regression analysis equation of GA and Hb in group LA was Y = 2.64X + 2.18, and was detected by interaction effect. There was no statistical difference between the two slopes (F = 3. 209, P0.05), and covariance analysis could be carried out; (6) The effect of Hb concentration in LA group and NA group on GA was analyzed by covariance analysis method. Results The results of covariate Hb relaxation were (F = 3452. 150, P 0.01), suggesting that Hb concentration had a significant effect on GA level. The results were (F = 0. 241, P0.05), suggesting that there was no significant effect on GA level. Conclusion: 1 The liquid enzymatic method has a good correlation with FPG and Hb, which can reflect the blood glucose level of the subjects, and can be used as the blood sugar monitoring index of type 2 diabetes patients. The liquid enzymatic method can reflect the control of blood glucose in short term (2-3 weeks). Its sensitivity to blood sugar change is better than Hb, stability is better than that of time point blood sugar. 3 liquid enzyme method to determine GA, not affected by serum albumin level, can accurately reflect the subject's short-term blood sugar change.
【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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