体质指数与2型糖尿病患者糖化白蛋白及糖化白蛋白与糖化血红蛋白比值的相关性研究
|
摘要
背景糖化白蛋白(GA)及糖化白蛋白与糖化血红蛋白比值(GA/HbA1c)是反映血糖控制的临床新指标,明确两者与体质指数(BMI)的相关性有助于更加准确地评估血糖控制状况。目的分析BMI与2型糖尿病(T2DM)患者GA、GA/HbA1c的相关性。方法选取2017年11月—2018年2月合肥市第三人民医院内分泌科收治的T2DM患者170例,根据BMI分为超重肥胖组(BMI≥25 kg/m2,n=72)和非超重肥胖组(BMI<25 kg/m2,n=98)。比较两组患者实验室检验指标,包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血尿酸(SUA)、C反应蛋白(CRP)、胰岛素抵抗指数(IR)、清蛋白、血红蛋白、促甲状腺激素(TSH)、空腹血糖(FBG)、2 h血糖(2 h BG)、GA、糖化血红蛋白(HbA1c)及GA/HbA1c;BMI与T2DM患者GA、GA/HbA1c的关系分析采用Pearson相关分析/Spearman秩相关分析及多元线性回归分析。结果 (1)两组患者TC、TG、LDL-C、CRP、清蛋白、血红蛋白、TSH、FBG及HbA1c比较,差异无统计学意义(P>0.05);超重肥胖组患者HDL-C、2 h BG、GA、GA/HbA1c低于非超重肥胖组,SUA和IR高于非超重肥胖组(P<0.05)。(2)相关性分析结果显示,GA与T2DM患者FBG、2 h BG、HbA1c呈正相关,与BMI、SUA呈负相关(P<0.05);进一步行多元线性回归分析结果显示,GA与T2DM患者BMI(β=-0.301)、HbA1c(β=2.881)独立相关(P<0.05)。(3)相关性分析结果显示,GA/HbA1c与T2DM患者年龄、糖尿病病程呈正相关,与BMI、TG、SUA、IR、血红蛋白呈负相关(P<0.05);进一步行多元线性回归分析结果显示,GA/HbA1c与T2DM患者年龄(β=0.100)、BMI(β=-0.036)独立相关(P<0.05)。结论 BMI与T2DM患者GA、GA/HbA1c呈负相关,因此采用GA、GA/HbA1c评估T2DM患者血糖控制状况应考虑BMI的影响。
Background Glycated albumin(GA)and ratio of glycated albumin to glycated hemoglobin(GA/HbA1 c)are new clinical indicators reflecting blood glucose control,clear correlations of body mass index(BMI)with the above two is helpful to evaluate blood glucose control more accurately.Objective To analyze the correlations of BMI with GA and GA/HbA1 c in patients with type 2 diabetes mellitus(T2 DM).Methods From November 2017 to February 2018,a total of 170 T2 DM patients were selected in the Department of Endocrinology,the Third People's Hospital of Hefei,and they were divided into overweight and obesity group(with BMI ≥ 25 kg/m2,n=72)and non-overweight and obesity group(with BMI<25 kg/m2,n=98) according to BMI.Laboratory examination results including TC,TG,LDL-C,HDL-C,SUA,CRP,insulin resistance index(IR),albumin,hemoglobin,TSH,FBG,2 h BG,GA,HbA1 c and GA/HbA1 c were compared between the two groups;correlations of BMI with GA and GA/HbA1 c in patients with T2 DM were analyzed by Pearson correlation analysis/Spearman rank correlation analysis and multiple linear regression analysis.Results(1)There was no statistically significant difference in TC,TG,LDL-C,CRP,albumin,hemoglobin,TSH,FBG or HbA1 c between the two groups(P>0.05);HDL-C,2 h BG,GA,GA/HbA1 c in overweight and obese group were statistically significantly lower than those in non-overweight and obese group,while SUA and IR in overweight and obese group was statistically significantly higher than that in non-overweight and obese group(P<0.05).(2)Correlation analysis results showed that,GA was positively correlated with FBG,2 h BG and HbA1 c in patients with T2 DM,respectively,but was negatively correlated with BMI and SUA,respectively(P<0.05);further multiple linear regression analysis results showed that,GA was independently correlated with BMI(β=-0.301)and HbA1 c(β=2.881)in patients with T2 DM,respectively(P<0.05).(3)Correlation analysis results showed that,GA/HbA1 c was positively correlated with age and disease course in patients with T2 DM,respectively,but was negatively correlated with BMI,TG,SUA,IR and hemoglobin,respectively(P<0.05);further multiple linear regression analysis results showed that,GA/HbA1 c was independently correlated with age(β=0.100)and BMI(β=-0.036)in patients with T2 DM,respectively(P<0.05).Conclusion BMI is negatively associated with GA and GA/HbA1 c in patients with T2 DM,respectively,therefore,influence of BMI should be taken into account in evaluating blood glucose control status in patients with T2 DM by GA,GA/HbA1 c.
Background Glycated albumin(GA)and ratio of glycated albumin to glycated hemoglobin(GA/HbA1 c)are new clinical indicators reflecting blood glucose control,clear correlations of body mass index(BMI)with the above two is helpful to evaluate blood glucose control more accurately.Objective To analyze the correlations of BMI with GA and GA/HbA1 c in patients with type 2 diabetes mellitus(T2 DM).Methods From November 2017 to February 2018,a total of 170 T2 DM patients were selected in the Department of Endocrinology,the Third People's Hospital of Hefei,and they were divided into overweight and obesity group(with BMI ≥ 25 kg/m2,n=72)and non-overweight and obesity group(with BMI<25 kg/m2,n=98) according to BMI.Laboratory examination results including TC,TG,LDL-C,HDL-C,SUA,CRP,insulin resistance index(IR),albumin,hemoglobin,TSH,FBG,2 h BG,GA,HbA1 c and GA/HbA1 c were compared between the two groups;correlations of BMI with GA and GA/HbA1 c in patients with T2 DM were analyzed by Pearson correlation analysis/Spearman rank correlation analysis and multiple linear regression analysis.Results(1)There was no statistically significant difference in TC,TG,LDL-C,CRP,albumin,hemoglobin,TSH,FBG or HbA1 c between the two groups(P>0.05);HDL-C,2 h BG,GA,GA/HbA1 c in overweight and obese group were statistically significantly lower than those in non-overweight and obese group,while SUA and IR in overweight and obese group was statistically significantly higher than that in non-overweight and obese group(P<0.05).(2)Correlation analysis results showed that,GA was positively correlated with FBG,2 h BG and HbA1 c in patients with T2 DM,respectively,but was negatively correlated with BMI and SUA,respectively(P<0.05);further multiple linear regression analysis results showed that,GA was independently correlated with BMI(β=-0.301)and HbA1 c(β=2.881)in patients with T2 DM,respectively(P<0.05).(3)Correlation analysis results showed that,GA/HbA1 c was positively correlated with age and disease course in patients with T2 DM,respectively,but was negatively correlated with BMI,TG,SUA,IR and hemoglobin,respectively(P<0.05);further multiple linear regression analysis results showed that,GA/HbA1 c was independently correlated with age(β=0.100)and BMI(β=-0.036)in patients with T2 DM,respectively(P<0.05).Conclusion BMI is negatively associated with GA and GA/HbA1 c in patients with T2 DM,respectively,therefore,influence of BMI should be taken into account in evaluating blood glucose control status in patients with T2 DM by GA,GA/HbA1 c.
引文
[1]MA R C,LIN X,JIA W.Causes of type 2 diabetes in China[J].Lancet Diabetes Endocrinol,2014,2(12):980-991.DOI:10.1016/S2213-8587(14)70145-7.
[2]WANG L,GAO P,ZHANG M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.DOI:10.1001/jama.2017.7596.
[3]SCHEEN A J,VAN GAAL L F.Combating the dual burden:therapeutic targeting of common pathways in obesity and type 2diabetes[J].Lancet Diabetes Endocrinol,2014,2(11):911-922.DOI:10.1016/S2213-8587(14)70004-X.
[4]American Diabetes Association.Standards of medical care in diabetes.Diabetes Care[J].Diabetes Care,2004,27(Suppl 1):S15-35.DOI:10.2337/diacare.27.2007.s15.
[5]OGAWA A,HAYASHI A,KISHIHARA E,et al.New indices for predicting glycaemic variability[J].PLoS One,2012,7(9):e46517.DOI:10.1371/journal.pone.0046517.
[6]SAISHO Y,TANAKA K,ABE T,et al.Glycated albumin to glycated hemoglobin ratio reflects postprandial glucose excursion and relates to beta cell function in both type 1 and type 2 diabetes[J].Diabetol Int,2011,2(3):146-153.DOI:10.1007/s13340-011-0035-x.
[7]HE X,MO Y,MA X J,et al.Associations of body mass index with glycated albumin and glycated albumin/glycated hemoglobin A1c ratio in Chinese diabetic and non-diabetic populations[J].Clin Chim Acta,2018,484:117-121.DOI:10.1016/j.cca.2018.05.044.
[8]American Diabetes Association.Standards of medical care in diabetes—2010[J].Diabetes Care,2010,33(Suppl 1):S11-61.
[9]Obesity:preventing and managing the global epidemic.Report of a WHO consultation[J].World Health Organ Tech Rep Ser,2000,894:i-xii,1-253.
[10]巴建明,窦京涛,张小群,等.2型糖尿病患者液态酶法测定糖化血清白蛋白的临床观察[J].中华医学杂志,2009,89(22):1570-1572.DOI:10.3760/cma.j.issn.0376-2491.2009.22.019.
[11]YOSHIUCHI K,MATSUHISA M,KATAKAMI N,et al.Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes[J].Endocr J,2008,55(3):503-507.
[12]KOGA M.Glycated albumin;clinical usefulness[J].Clin Chim Acta,2014,433:96-104.DOI:10.1016/j.cca.2014.03.001.
[13]LEE E Y,LEE B W,KIM D,et al.Glycated albumin is a useful glycation index for monitoring fluctuating and poorly controlled type2 diabetic patients[J].Acta Diabetol,2011,48(2):167-172.DOI:10.1007/s00592-010-0242-0.
[14]SUZUKI K,YAGI K,OKA R,et al.Relationships of serum haptoglobin concentration with HbA1c and glycated albumin concentrations in Japanese type 2 diabetic patients[J].Clin Chem Lab Med,2009,47(1):70-74.DOI:10.1515/CCLM.2009.022.
[15]KIM D,KIM K J,HUH J H,et al.The ratio of glycated albumin to glycated haemoglobin correlates with insulin secretory function[J].Clin Endocrinol(Oxf),2012,77(5):679-683.DOI:10.1111/j.1365-2265.2011.04312.x.
[16]唐菲菲,陈莉丽.糖化白蛋白的影响因素及应用[J].国际内分泌代谢杂志,2013,33(6):398-401.DOI:10.3760/cma.j.issn.1673-4157.2013.06.012.
[17]NISHIMURA R,KANDA A,SANO H,et al.Glycated albumin is low in obese,non-diabetic children[J].Diabetes Res Clin Pract,2006,71(3):334-338.DOI:10.1016/j.diabres.2005.07.008.
[18]KOGA M,MATSUMOTO S,SAITO H,et al.Body mass index negatively influences glycated albumin,but not glycated hemoglobin,in diabetic patients[J].Endocr J,2006,53(3):387-391.
[19]MIYASHITA Y,NISHIMURA R,MORIMOTO A,et al.Glycated albumin is low in obese,type 2 diabetic patients[J].Diabetes Res Clin Pract,2007,78(1):51-55.DOI:10.1016/j.diabres.2007.02.021.
[20]KOGA M,HIRATA T,KASAYAMA S,et al.Body mass index negatively regulates glycated albumin through insulin secretion in patients with type 2 diabetes mellitus[J].Clin Chim Acta,2015,438:19-23.DOI:10.1016/j.cca.2014.07.035.
[21]MO Y,MA X,LI H,et al.Relationship between glycated albumin and glycated hemoglobin according to glucose tolerance status:A multicenter study[J].Diabetes Res Clin Pract,2016,115:17-23.DOI:10.1016/j.diabres.2016.03.003.
[22]KOGA M,OTSUKI M,MATSUMOTO S,et al.Negative association of obesity and its related chronic inflammation with serum glycated albumin but not glycated hemoglobin levels[J].Clin Chim Acta,2007,378(1/2):48-52.DOI:10.1016/j.cca.2006.10.013.
[23]SALAS-SALVADóJ,BULLóM,GARCíA-LORDA P,et al.Subcutaneous adipose tissue cytokine production is not responsible for the restoration of systemic inflammation markers during weight loss[J].Int J Obes(Lond),2006,30(12):1714-1720.DOI:10.1038/sj.ijo.0803348.
[24]HUH J H,KIM K J,LEE B W,et al.The relationship between BMI and glycated albumin to glycated hemoglobin(GA/A1c)ratio according to glucose tolerance status[J].PLoS One,2014,9(2):e89478.DOI:10.1371/journal.pone.0089478.
[2]WANG L,GAO P,ZHANG M,et al.Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.DOI:10.1001/jama.2017.7596.
[3]SCHEEN A J,VAN GAAL L F.Combating the dual burden:therapeutic targeting of common pathways in obesity and type 2diabetes[J].Lancet Diabetes Endocrinol,2014,2(11):911-922.DOI:10.1016/S2213-8587(14)70004-X.
[4]American Diabetes Association.Standards of medical care in diabetes.Diabetes Care[J].Diabetes Care,2004,27(Suppl 1):S15-35.DOI:10.2337/diacare.27.2007.s15.
[5]OGAWA A,HAYASHI A,KISHIHARA E,et al.New indices for predicting glycaemic variability[J].PLoS One,2012,7(9):e46517.DOI:10.1371/journal.pone.0046517.
[6]SAISHO Y,TANAKA K,ABE T,et al.Glycated albumin to glycated hemoglobin ratio reflects postprandial glucose excursion and relates to beta cell function in both type 1 and type 2 diabetes[J].Diabetol Int,2011,2(3):146-153.DOI:10.1007/s13340-011-0035-x.
[7]HE X,MO Y,MA X J,et al.Associations of body mass index with glycated albumin and glycated albumin/glycated hemoglobin A1c ratio in Chinese diabetic and non-diabetic populations[J].Clin Chim Acta,2018,484:117-121.DOI:10.1016/j.cca.2018.05.044.
[8]American Diabetes Association.Standards of medical care in diabetes—2010[J].Diabetes Care,2010,33(Suppl 1):S11-61.
[9]Obesity:preventing and managing the global epidemic.Report of a WHO consultation[J].World Health Organ Tech Rep Ser,2000,894:i-xii,1-253.
[10]巴建明,窦京涛,张小群,等.2型糖尿病患者液态酶法测定糖化血清白蛋白的临床观察[J].中华医学杂志,2009,89(22):1570-1572.DOI:10.3760/cma.j.issn.0376-2491.2009.22.019.
[11]YOSHIUCHI K,MATSUHISA M,KATAKAMI N,et al.Glycated albumin is a better indicator for glucose excursion than glycated hemoglobin in type 1 and type 2 diabetes[J].Endocr J,2008,55(3):503-507.
[12]KOGA M.Glycated albumin;clinical usefulness[J].Clin Chim Acta,2014,433:96-104.DOI:10.1016/j.cca.2014.03.001.
[13]LEE E Y,LEE B W,KIM D,et al.Glycated albumin is a useful glycation index for monitoring fluctuating and poorly controlled type2 diabetic patients[J].Acta Diabetol,2011,48(2):167-172.DOI:10.1007/s00592-010-0242-0.
[14]SUZUKI K,YAGI K,OKA R,et al.Relationships of serum haptoglobin concentration with HbA1c and glycated albumin concentrations in Japanese type 2 diabetic patients[J].Clin Chem Lab Med,2009,47(1):70-74.DOI:10.1515/CCLM.2009.022.
[15]KIM D,KIM K J,HUH J H,et al.The ratio of glycated albumin to glycated haemoglobin correlates with insulin secretory function[J].Clin Endocrinol(Oxf),2012,77(5):679-683.DOI:10.1111/j.1365-2265.2011.04312.x.
[16]唐菲菲,陈莉丽.糖化白蛋白的影响因素及应用[J].国际内分泌代谢杂志,2013,33(6):398-401.DOI:10.3760/cma.j.issn.1673-4157.2013.06.012.
[17]NISHIMURA R,KANDA A,SANO H,et al.Glycated albumin is low in obese,non-diabetic children[J].Diabetes Res Clin Pract,2006,71(3):334-338.DOI:10.1016/j.diabres.2005.07.008.
[18]KOGA M,MATSUMOTO S,SAITO H,et al.Body mass index negatively influences glycated albumin,but not glycated hemoglobin,in diabetic patients[J].Endocr J,2006,53(3):387-391.
[19]MIYASHITA Y,NISHIMURA R,MORIMOTO A,et al.Glycated albumin is low in obese,type 2 diabetic patients[J].Diabetes Res Clin Pract,2007,78(1):51-55.DOI:10.1016/j.diabres.2007.02.021.
[20]KOGA M,HIRATA T,KASAYAMA S,et al.Body mass index negatively regulates glycated albumin through insulin secretion in patients with type 2 diabetes mellitus[J].Clin Chim Acta,2015,438:19-23.DOI:10.1016/j.cca.2014.07.035.
[21]MO Y,MA X,LI H,et al.Relationship between glycated albumin and glycated hemoglobin according to glucose tolerance status:A multicenter study[J].Diabetes Res Clin Pract,2016,115:17-23.DOI:10.1016/j.diabres.2016.03.003.
[22]KOGA M,OTSUKI M,MATSUMOTO S,et al.Negative association of obesity and its related chronic inflammation with serum glycated albumin but not glycated hemoglobin levels[J].Clin Chim Acta,2007,378(1/2):48-52.DOI:10.1016/j.cca.2006.10.013.
[23]SALAS-SALVADóJ,BULLóM,GARCíA-LORDA P,et al.Subcutaneous adipose tissue cytokine production is not responsible for the restoration of systemic inflammation markers during weight loss[J].Int J Obes(Lond),2006,30(12):1714-1720.DOI:10.1038/sj.ijo.0803348.
[24]HUH J H,KIM K J,LEE B W,et al.The relationship between BMI and glycated albumin to glycated hemoglobin(GA/A1c)ratio according to glucose tolerance status[J].PLoS One,2014,9(2):e89478.DOI:10.1371/journal.pone.0089478.