在看診過程中,總是有一些患者的醣化血色素(HbA1C),與他平常所驗的血糖,對不起來,明明血糖機裡的數值都200-300,可是醣化血色素卻是正常甚至偏低。
哪一個才是對的?
影響醣化血色素的因素有哪些呢?先從這個名詞解釋開始,顧名思義,血中醣份過高,而使得血色素(存在紅血球中)被附加了一個醣基上去(glycosylated),故稱為醣化血色素(HbA1C)。因此,你可以想像,紅血球從骨髓中被製造出來後,泡在醣血中越久,就越有機會被醣分子纏上去,這就不難想像最常影響醣化血色素的原因,就是紅血球的壽命長短。
當血色素壽命,因為某種疾病而變的比較短,這樣醣化血色素就會變低,因為它們不夠老,所以醣分子還不夠時間黏上去,或者血色素的結構改變,使得醣分子比較難黏上去。這樣的疾病有:慢性腎衰竭所造成的貧血、地中海型貧血、溶血性貧血等等。相反的,當血色素的壽命變長了,如:再生不良性貧血(aplastic anemia),這樣醣化血色素就會變多。缺鐵性貧血則是因為不明原因,可能會讓糖化血色素增加約0.2%。
醣化血色素也會因種族而有所不同,也可能受人的年紀影響,而沒有貧血的人,也可能因為上面所述:血色素結構(體質遺傳的)較不容易被醣分子黏上,而結果測起來偏低。
因此,結論是:
當糖化血色素的數值,與血糖機的平均數值,實在不符合時,除了要思考上述影響因子之外,只要正確校正血糖機,你得要相信血糖機的數據!
{2147300:SIBR3MBJ};{2147300:SIBR3MBJ},{2147300:67VNQBDU};{2147300:WBC4AJ8T};{2147300:67VNQBDU};{2147300:H6B5QQKJ}pediatricsdefaultascno504%7B%22status%22%3A%22success%22%2C%22updateneeded%22%3Afalse%2C%22instance%22%3A%22zotpress-3553a0bf5502d1e0b9dd2a0d1671bcd0%22%2C%22meta%22%3A%7B%22request_last%22%3A0%2C%22request_next%22%3A0%2C%22used_cache%22%3Atrue%7D%2C%22data%22%3A%5B%7B%22key%22%3A%22WBC4AJ8T%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Coban%20et%20al.%22%2C%22parsedDate%22%3A%222004%22%2C%22numChildren%22%3A1%7D%2C%22bib%22%3A%22%3Cdiv%20class%3D%5C%22csl-bib-body%5C%22%20style%3D%5C%22line-height%3A%201.35%3B%20%5C%22%3E%5Cn%20%20%3Cdiv%20class%3D%5C%22csl-entry%5C%22%20style%3D%5C%22clear%3A%20left%3B%20%5C%22%3E%5Cn%20%20%20%20%3Cdiv%20class%3D%5C%22csl-left-margin%5C%22%20style%3D%5C%22float%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%5C%22%3E1.%20%3C%5C%2Fdiv%3E%3Cdiv%20class%3D%5C%22csl-right-inline%5C%22%20style%3D%5C%22margin%3A%200%20.4em%200%201.5em%3B%5C%22%3ECoban%20E%2C%20Ozdogan%20M%2C%20Timuragaoglu%20A.%20Effect%20of%20iron%20deficiency%20anemia%20on%20the%20levels%20of%20hemoglobin%20A1c%20in%20nondiabetic%20patients.%20%3Ci%3EActa%20Haematol%3C%5C%2Fi%3E.%202004%3B112%283%29%3A126-128.%20%3Ca%20href%3D%27http%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1159%5C%2F000079722%27%3Ehttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.1159%5C%2F000079722%3C%5C%2Fa%3E%3C%5C%2Fdiv%3E%5Cn%20%20%3C%5C%2Fdiv%3E%5Cn%3C%5C%2Fdiv%3E%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Effect%20of%20iron%20deficiency%20anemia%20on%20the%20levels%20of%20hemoglobin%20A1c%20in%20nondiabetic%20patients%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Erkan%22%2C%22lastName%22%3A%22Coban%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Mustafa%22%2C%22lastName%22%3A%22Ozdogan%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Aysen%22%2C%22lastName%22%3A%22Timuragaoglu%22%7D%5D%2C%22abstractNote%22%3A%22The%20major%20form%20of%20glycohemoglobin%20is%20hemoglobin%20A1c%20%28HbA1c%29.%20The%20HbA1c%20fraction%20is%20abnormally%20elevated%20in%20chronic%20hyperglycemic%20diabetic%20patients%20and%20correlates%20positively%20with%20glycemic%20control.%20Previous%20studies%20suggest%20that%20iron%20deficiency%20anemia%20%28IDA%29%20affects%20the%20levels%20of%20HbA1c.%20The%20aim%20of%20this%20study%20was%20to%20determine%20the%20effect%20of%20IDA%20on%20HbA1c%20levels%20in%20nondiabetic%20patients.%20The%20population%20studied%20consisted%20of%2050%20patients%20%2830%20women%2C%2020%20men%2C%20mean%20age%2035.7%20%2B%5C%2F-%2011.9%20years%29%20with%20IDA%20and%2050%20healthy%20subjects%20that%20were%20matched%20for%20age%20and%20sex.%20Patients%20who%20had%20glucose%20tolerance%20abnormalities%20%28impaired%20glucose%20tolerance%20or%20diabetes%20mellitus%29%2C%20hemoglobinopathies%2C%20hemolytic%20anemia%2C%20chronic%20alcohol%20ingestion%20and%20chronic%20renal%20failure%20were%20excluded%20from%20the%20study.%20Hematologic%20investigations%2C%20fasting%20and%20postprandial%20glucose%20and%20HbA1c%20levels%20were%20measured%20in%20all%20subjects%20before%20iron%20therapy.%20All%20patients%20with%20IDA%20were%20treated%20with%20iron%20100%20mg%5C%2Fday%20for%203%20months.%20We%20repeated%20the%20laboratory%20investigation%20after%20iron%20therapy.%20Before%20iron%20treatment%2C%20the%20mean%20HbA1c%20%287.4%20%2B%5C%2F-%200.8%25%29%20level%20in%20patients%20with%20IDA%20was%20higher%20than%20in%20a%20healthy%20group%20%285.9%25%20%2B%5C%2F-%200.5%29%20%28p%20%3C%200.001%29.%20In%20patients%20with%20IDA%2C%20HbA1c%20decreased%20significantly%20after%20iron%20treatment%20from%20a%20mean%20of%207.4%25%20%2B%5C%2F-%200.8%20to%206.2%25%20%2B%5C%2F-%200.6%20%28p%20%3C%200.001%29.%20Iron%20deficiency%20must%20be%20corrected%20before%20any%20diagnostic%20or%20therapeutic%20decision%20is%20made%20based%20on%20HbA1c.%22%2C%22date%22%3A%222004%22%2C%22language%22%3A%22eng%22%2C%22DOI%22%3A%2210.1159%5C%2F000079722%22%2C%22ISSN%22%3A%220001-5792%22%2C%22url%22%3A%22%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-06T13%3A31%3A00Z%22%7D%7D%2C%7B%22key%22%3A%2267VNQBDU%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Hinzmann%20et%20al.%22%2C%22parsedDate%22%3A%222012-09-29%22%2C%22numChildren%22%3A2%7D%2C%22bib%22%3A%22%3Cdiv%20class%3D%5C%22csl-bib-body%5C%22%20style%3D%5C%22line-height%3A%201.35%3B%20%5C%22%3E%5Cn%20%20%3Cdiv%20class%3D%5C%22csl-entry%5C%22%20style%3D%5C%22clear%3A%20left%3B%20%5C%22%3E%5Cn%20%20%20%20%3Cdiv%20class%3D%5C%22csl-left-margin%5C%22%20style%3D%5C%22float%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%5C%22%3E1.%20%3C%5C%2Fdiv%3E%3Cdiv%20class%3D%5C%22csl-right-inline%5C%22%20style%3D%5C%22margin%3A%200%20.4em%200%201.5em%3B%5C%22%3EHinzmann%20R%2C%20Schlaeger%20C%2C%20Tran%20CT.%20What%20Do%20We%20Need%20beyond%20Hemoglobin%20A1c%20to%20Get%20the%20Complete%20Picture%20of%20Glycemia%20in%20People%20with%20Diabetes%3F%20%3Ci%3EInt%20J%20Med%20Sci%3C%5C%2Fi%3E.%202012%3B9%288%29%3A665-681.%20%3Ca%20href%3D%27http%3A%5C%2F%5C%2Fdoi.org%5C%2F10.7150%5C%2Fijms.4520%27%3Ehttp%3A%5C%2F%5C%2Fdoi.org%5C%2F10.7150%5C%2Fijms.4520%3C%5C%2Fa%3E%3C%5C%2Fdiv%3E%5Cn%20%20%3C%5C%2Fdiv%3E%5Cn%3C%5C%2Fdiv%3E%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22What%20Do%20We%20Need%20beyond%20Hemoglobin%20A1c%20to%20Get%20the%20Complete%20Picture%20of%20Glycemia%20in%20People%20with%20Diabetes%3F%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Rolf%22%2C%22lastName%22%3A%22Hinzmann%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Christof%22%2C%22lastName%22%3A%22Schlaeger%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Cam%20Tuan%22%2C%22lastName%22%3A%22Tran%22%7D%5D%2C%22abstractNote%22%3A%22Hemoglobin%20A1c%20%28HbA1c%29%20is%20currently%20the%20most%20commonly%20used%20marker%20for%20the%20determination%20of%20the%20glycemic%20status%20in%20people%20with%20diabetes%20and%20it%20is%20frequently%20used%20to%20guide%20therapy%20and%20especially%20medical%20treatment%20of%20people%20with%20diabetes.%20The%20measurement%20of%20HbA1c%20has%20reached%20a%20high%20level%20of%20analytical%20quality%20and%2C%20therefore%2C%20this%20biomarker%20is%20currently%20also%20suggested%20to%20be%20used%20for%20the%20diagnosis%20of%20diabetes.%20Nevertheless%2C%20it%20is%20crucial%20for%20people%20with%20diabetes%20and%20their%20treating%20physicians%20to%20be%20aware%20of%20possible%20interferences%20during%20its%20measurement%20as%20well%20as%20physiological%20or%20pathological%20factors%20that%20contribute%20to%20the%20HbA1c%20concentration%20without%20being%20related%20to%20glycemia%2C%20which%20are%20discussed%20in%20this%20review.%20We%20performed%20a%20comprehensive%20review%20of%20the%20literature%20based%20on%20PubMed%20searches%20on%20HbA1c%20in%20the%20treatment%20and%20diagnosis%20of%20diabetes%20including%20its%20most%20relevant%20limitations%2C%20glycemic%20variability%20and%20self-monitoring%20of%20blood%20glucose%20%28SMBG%29.%20Although%20the%20high%20analytical%20quality%20of%20the%20HbA1c%20test%20is%20widely%20acknowledged%2C%20the%20clinical%20relevance%20of%20this%20marker%20regarding%20risk%20reduction%20of%20cardiovascular%20morbidity%20and%20mortality%20is%20still%20under%20debate.%20In%20this%20respect%2C%20we%20argue%20that%20glycemic%20variability%20as%20a%20further%20risk%20factor%20should%20deserve%20more%20attention%20in%20the%20treatment%20of%20diabetes.%22%2C%22date%22%3A%222012-9-29%22%2C%22language%22%3A%22%22%2C%22DOI%22%3A%2210.7150%5C%2Fijms.4520%22%2C%22ISSN%22%3A%221449-1907%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fwww.ncbi.nlm.nih.gov%5C%2Fpmc%5C%2Farticles%5C%2FPMC3465850%5C%2F%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-06T13%3A28%3A50Z%22%7D%7D%2C%7B%22key%22%3A%22H6B5QQKJ%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Wai%22%2C%22parsedDate%22%3A%222014%22%2C%22numChildren%22%3A1%7D%2C%22bib%22%3A%22%3Cdiv%20class%3D%5C%22csl-bib-body%5C%22%20style%3D%5C%22line-height%3A%201.35%3B%20%5C%22%3E%5Cn%20%20%3Cdiv%20class%3D%5C%22csl-entry%5C%22%20style%3D%5C%22clear%3A%20left%3B%20%5C%22%3E%5Cn%20%20%20%20%3Cdiv%20class%3D%5C%22csl-left-margin%5C%22%20style%3D%5C%22float%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%5C%22%3E1.%20%3C%5C%2Fdiv%3E%3Cdiv%20class%3D%5C%22csl-right-inline%5C%22%20style%3D%5C%22margin%3A%200%20.4em%200%201.5em%3B%5C%22%3EWai%20KK.%20Kee%20KW.%202014.%20When%20paired%20HbA1c%20and%20fasting%20glucose%20don%26%23x2019%3Bt%20match%2C%20which%20is%20telling%20the%20truth%3F%2C%20Singapore.%20The%20Singapore%20Family%20Physician%2C%2040%282%29%3A%2077-80.%20Published%20online%202014.%3C%5C%2Fdiv%3E%5Cn%20%20%3C%5C%2Fdiv%3E%5Cn%3C%5C%2Fdiv%3E%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22Kee%20KW.%202014.%20When%20paired%20HbA1c%20and%20fasting%20glucose%20don%5Cu2019t%20match%2C%20which%20is%20telling%20the%20truth%3F%2C%20Singapore.%20The%20Singapore%20Family%20Physician%2C%2040%282%29%3A%2077-80%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Kee%20Kok%22%2C%22lastName%22%3A%22Wai%22%7D%5D%2C%22abstractNote%22%3A%22%22%2C%22date%22%3A%222014%22%2C%22language%22%3A%22%22%2C%22DOI%22%3A%22%22%2C%22ISSN%22%3A%22%22%2C%22url%22%3A%22%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-06T13%3A17%3A36Z%22%7D%7D%2C%7B%22key%22%3A%22SIBR3MBJ%22%2C%22library%22%3A%7B%22id%22%3A2147300%7D%2C%22meta%22%3A%7B%22creatorSummary%22%3A%22Saudek%20and%20Brick%22%2C%22parsedDate%22%3A%222009-07%22%2C%22numChildren%22%3A2%7D%2C%22bib%22%3A%22%3Cdiv%20class%3D%5C%22csl-bib-body%5C%22%20style%3D%5C%22line-height%3A%201.35%3B%20%5C%22%3E%5Cn%20%20%3Cdiv%20class%3D%5C%22csl-entry%5C%22%20style%3D%5C%22clear%3A%20left%3B%20%5C%22%3E%5Cn%20%20%20%20%3Cdiv%20class%3D%5C%22csl-left-margin%5C%22%20style%3D%5C%22float%3A%20left%3B%20padding-right%3A%200.5em%3B%20text-align%3A%20right%3B%20width%3A%201em%3B%5C%22%3E1.%20%3C%5C%2Fdiv%3E%3Cdiv%20class%3D%5C%22csl-right-inline%5C%22%20style%3D%5C%22margin%3A%200%20.4em%200%201.5em%3B%5C%22%3ESaudek%20CD%2C%20Brick%20JC.%20The%20Clinical%20Use%20of%20Hemoglobin%20A1c.%20%3Ci%3EJ%20Diabetes%20Sci%20Technol%3C%5C%2Fi%3E.%202009%3B3%284%29%3A629-634.%20Accessed%20March%206%2C%202015.%20%3Ca%20href%3D%27http%3A%5C%2F%5C%2Fwww.ncbi.nlm.nih.gov%5C%2Fpmc%5C%2Farticles%5C%2FPMC2769940%5C%2F%27%3Ehttp%3A%5C%2F%5C%2Fwww.ncbi.nlm.nih.gov%5C%2Fpmc%5C%2Farticles%5C%2FPMC2769940%5C%2F%3C%5C%2Fa%3E%3C%5C%2Fdiv%3E%5Cn%20%20%3C%5C%2Fdiv%3E%5Cn%3C%5C%2Fdiv%3E%22%2C%22data%22%3A%7B%22itemType%22%3A%22journalArticle%22%2C%22title%22%3A%22The%20Clinical%20Use%20of%20Hemoglobin%20A1c%22%2C%22creators%22%3A%5B%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Christopher%20D.%22%2C%22lastName%22%3A%22Saudek%22%7D%2C%7B%22creatorType%22%3A%22author%22%2C%22firstName%22%3A%22Jessica%20C.%22%2C%22lastName%22%3A%22Brick%22%7D%5D%2C%22abstractNote%22%3A%22Hemoglobin%20A1c%20%28HbA1c%29%20has%20been%20accepted%20as%20an%20index%20of%20glycemic%20control%20since%20the%20mid-1970s%20and%20is%20the%20best%20marker%20for%20diabetic%20microvascular%20complications.%20Clinically%2C%20it%20is%20now%20used%20to%20assess%20glycemic%20control%20in%20people%20with%20diabetes.%20Assays%20are%20most%20reliable%20when%20certified%20by%20the%20National%20Hemoglobin%20Standardization%20Program%20but%20are%20subject%20to%20confounders%20and%20effect%20modifiers%2C%20particularly%20in%20the%20setting%20of%20hematologic%20abnormalities.%20Other%20measures%20of%20chronic%20glycemic%20control%5Cu2014fructosamine%20and%201%2C5-anhydroglucitol%5Cu2014are%20far%20less%20widely%20used.%20The%20relationship%20of%20HbA1c%20to%20average%20blood%20glucose%20was%20intensively%20studied%20recently%2C%20and%20it%20has%20been%20proposed%20that%20this%20conversion%20can%20be%20used%20to%20report%20an%20%5Cu201cestimated%20average%20glucose%2C%20eAG%5Cu201d%20in%20milligrams%5C%2Fdeciliter%20or%20millimolar%20units%20rather%20than%20as%20per%20cent%20glycated%20hemoglobin.%20Finally%2C%20HbA1c%20has%20been%20proposed%20as%20a%20useful%20method%20of%20screening%20for%20and%20diagnosing%20diabetes.%22%2C%22date%22%3A%222009-7%22%2C%22language%22%3A%22%22%2C%22DOI%22%3A%22%22%2C%22ISSN%22%3A%221932-2968%22%2C%22url%22%3A%22http%3A%5C%2F%5C%2Fwww.ncbi.nlm.nih.gov%5C%2Fpmc%5C%2Farticles%5C%2FPMC2769940%5C%2F%22%2C%22collections%22%3A%5B%5D%2C%22dateModified%22%3A%222015-03-06T13%3A03%3A01Z%22%7D%7D%5D%7D 1.
Coban E, Ozdogan M, Timuragaoglu A. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients.
Acta Haematol. 2004;112(3):126-128.
http://doi.org/10.1159/000079722 1.
Hinzmann R, Schlaeger C, Tran CT. What Do We Need beyond Hemoglobin A1c to Get the Complete Picture of Glycemia in People with Diabetes?
Int J Med Sci. 2012;9(8):665-681.
http://doi.org/10.7150/ijms.4520 1.
Wai KK. Kee KW. 2014. When paired HbA1c and fasting glucose don’t match, which is telling the truth?, Singapore. The Singapore Family Physician, 40(2): 77-80. Published online 2014.