三种检测方法对变异血红蛋白患者糖化血红蛋白测定结果比较分析

Comparative analysis of glycated hemoglobin A1c values obtained by three test methods in patients with variant hemoglobin

目的 研究3种糖化血红蛋白（HbA1c）检测方法对变异血红蛋白患者HbA1c测定结果的比较分析.方法 收集2012年1月到2012年12月50例不同类型变异血红蛋白患者血样标本为研究对象,血红蛋白D、Q、G、J和E标本共25例,平均年龄（24±3）岁,男14例,女11例;血红蛋白F标本来源于新生儿,共25例,男11例,女14例;同时收集50例无变异血红蛋白标本为对照组,平均年龄（25±5）岁,男25例,女25例.使用亲和层析高效液相色谱（HPLC）法、离子交换HPLC法和免疫法三种方法检测HbA1c.用方差分析和Pearson相关分析法进行数据统计.结果 HbA1c结构正常组使用亲和层析HPLC法Ultra2、离子交换HPLC G8和VariantⅡ、免疫法DCA Vantage四种方法检测HbA1c分别为5.7％±1.1％、5.7％±1.2％、5.7％±1.2％、5.7％±1.1％,各组差异无统计学意义（F=0.023,P＞0.05）.25例变异血红蛋白F新生儿中,离子交换HPLC法和免疫法均检测不到血红蛋白F中的HbAlc值;空腹血糖与Ultra2检测HbA1c相关（r=0.647,P＜0.05）;空腹血糖与VariantⅡ和G8及DCA Vantage组的检测结果均无明显相关.亲和层析HPLC法不受血红蛋白D、Q、G、J和E的干扰,与血糖明显相关（r=0.823,P＜0.05）.离子交换HPLC法检测结果受到血红蛋白D、Q、G、J和E不同程度的干扰;免疫法测定的HbAlc与血糖相关（r=0.611,P＜0.05）.结论 亲和层析HPLC法测定的HbAlc可更准确地反映平均血糖水平.变异血红蛋白会干扰离子交换HPLC法的HbA1c的检测结果,免疫法检测结果仅受血红蛋白F的干扰.

Objective To make comparative analysis of the glycated hemoglobin A1c（HbA1c） values obtained by three HbA1c test methods in patients with variant hemoglobins.Methods Total of 50 blood samples of patients with different types of variant hemoglobin were collected from January 2012 to December 2012; 25 of them （14 males and 11 females） carried hemoglobin D,Q,G,J and E with a mean age of （24±3） years; the other 25 cases （11 males and 14 females） were blood samples with hemoglobin F from newborn infants.Meanwhile,50 blood samples（25 males and 25 females） from people without variant hemoglobins were also collected as control（mean age （25±5） years）.Three methods were used to test HbA1c,which were affinity high performance liquid chromatography （HPLC） method （Ultra 2 of American Primus）,ion exchange HPLC method （Variant Ⅱ of American Bio-Rad and G8 of Japanese Tosoh） and immunization method （DCA Vantage of German Siemens）.The statistic analysis were done with variance analysis and correlation analysis.Results The HbA1c of the group with normal HbA1c structure was 5.7％± 1.1％,5.7％± 1.2％,5.7％±1.2％ and 5.7％±1.1％ respectively when it was tested by affinity HPLC method （Ultra2）,ion exchangc HPLC method （G8）,ion exchange HPLC （Variant Ⅱ） and immunization method （DCA Vantage）,and there was no significant difference among the groups （F=0.023,P＞0.05）.In the 25 samples with hemoglobin F,HbAlc could not be detected by ion exchange HPLC or immunoassay method.The fasting blood glucose level correlated with HbA lc level tested by Ultra 2 method （r=0.647,P＜0.05）,but it didn＇t correlate with HbA1c level when tested with Variant Ⅱ and G8 as well as DCA Vantage method.The HbA1c result of affinity HPLC method was free from the disturbance of Hb D,Q,G,J and E,and had a obvious correlation with blood glucose （r=0.823,P＜0.05）.The HbA1c result of ion exchange HPLC method was disturbed by hemoglobin D,Q,G,J and E in varying degrees.The HbA1c measured by immunization method was associated with blood glucose （r=0.611,P＜0.05）.Conclusion The HbA1c value obtained by affinity HPLC method can accurately reflect the mean blood glucose level.Variant hemoglobins disturb the HbA1c result tested by ion exchange HPLC method,and the immunization test result is only disturbed by hemoglobin F.