河北医科大学学报 ›› 2024, Vol. 45 ›› Issue (12): 1439-1444.doi: 10.3969/j.issn.1007-3205.2024.12.014

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肾性贫血对糖尿病和非糖尿病患者糖化血红蛋白的影响

  

  1. 1.天津医科大学总医院医学检验科，天津 300070；2.天津医科大学总医院内分泌代谢科，天津 300070

  • 出版日期:2024-12-25 发布日期:2025-01-03
  • 作者简介:史东沙(1989-),女,河北保定人,天津医科大学总医院主管技师,医学硕士,从事内分泌疾病诊治研究。
  • 基金资助:
    天津市科技计划项目（23JCQNJC00680）

Impact of renal anemia on HbA1c in diabetic and non-diabetic patients

  1. 1.Department of Clinical Laboratory, General Hospital of Tianjin Medical University, Tianjin 300052, China; 2.Department of  Endocrinology and Metabolism, General Hospital of Tiangjin Medical University, Tianjin 300070, China

  • Online:2024-12-25 Published:2025-01-03

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摘要： 目的 探讨肾性贫血对糖尿病和非糖尿病患者糖化血红蛋白（glycosylated hemoglobin A1c，HbA1c）的影响。
方法 回顾性分析天津医科大学总医院确诊为肾性贫血的住院患者165例，其中单纯肾性贫血组67例，糖尿病合并肾性贫血患者98例；相应对照组分别为健康对照组160例和单纯糖尿病组272例。收集4组就诊对象的血常规、空腹血糖和HbA1c数据，并将结果进行统计学分析。
结果 单纯糖尿病组和糖尿病合并肾性贫血组的空腹血糖水平分别为6.80（2.90）mmol/L、6.30（3.40）mmol/L，2组空腹血糖水平差异无统计学意义（Z=-1.420， P=0.156）；单纯糖尿病组和糖尿病合并肾性贫血患者的HbA1c水平分别为7.50（2.10）%和6.50（1.80）%，糖尿病合并肾性贫血患者的HbA1c显著低于单纯糖尿病组（Z=-6.195， P＜0.001），绝对值降低约1.0％。且在所有糖尿病患者中HbA1c与血红蛋白水平呈正相关（r=0.294,P＜0.001）。单纯肾性贫血组的空腹血糖、HbA1c水平均显著低于健康对照组（P均＜0.05），2组空腹血糖与HbA1c比值差异无统计学意义（Z=-0.835，P=0.404）。进一步分析显示，中重度贫血组空腹血糖和HbA1c之间的相关性（r=0.718，P＜0.001）低于健康对照组（r=0.682，P＜0.001），而轻度贫血未降低空腹血糖和HbA1c之间的相关性。
结论 肾性贫血可引起糖尿病患者HbA1c水平降低，使HbA1c不能真实反映患者的血糖水平，应慎重看待糖尿病合并肾性贫血患者的HbA1c检测结果；非合并糖尿病的肾性贫血患者存在体内血糖水平较健康体检人群偏低的现象，而使用HbA1c监测其长期血糖水平并没有使结果不可靠。


关键词: 糖尿病, 肾性贫血, 糖化血红蛋白

Abstract: Objective To determine the effect of renal anemia on the glycosylated hemoglobin A1c (HbA1c)in patients with diabetes mellitus (DM) and patients without DM. 
Methods A total of 165 patients with renal anemia treated in General Hospital of Tianjin Medical University to including 67 patients with simple renal anemia and 98 with DM and renal anemia, were respectively analyzed. Correspondingly, the control group included 160 healthy controls and 272 patients with simple DM. Blood routine, fasting plasma glucose (FPG) and HbA1c of the four groups were collected and statistically explored. 
Results The FPG of the simple DM group and the DM and renal anemia group was 6.80(2.90) mmol/L and 6.30(3.40) mmol/L respectively, showing no significant difference (Z=-1.420, P=0.156). The HbA1c levels of the simple DM group and DM and renal anemia group were 7.50(2.10%) and 6.50(1.8)% respectively. The HbA1c of the DM complicated with renal anemia were significantly lower than that of the simple DM (Z=-6.195, P<0.001) and absolute difference was 1.0%. In addition, there was a positive correlation between HbA1c and hemoglobin levels in DM patients (r=0.294, P<0.001). Both the FPG and the HbA1c levels were significantly lower in the simple renal anemia group than in the healthy control group (both P<0.05). There was no significant difference in the ratio of FPG to HbA1c between the two groups (Z=-0.835, P=0.404). Furthermore, the correlation between FPG and HbA1c (r=0.618, P<0.001) was significantly lower in the moderate to severe anemia group than in the healthy control group (r=0.718, P＜0.001), while the correlation did not decrease in the mild anemia group. 
Conclusion Renal anemia can significantly decrease the HbA1c in DM patients, so that HbA1c cannot truly reflect the blood glucose level of patients. Therefore, the results of HbA1c detection in patients with DM and renal anemia should be treated with caution. Renal anemia patients without DM have lower blood glucose levels than normal people, and monitoring their long-term blood glucose levels with HbA1c does not make the results unreliable. 


Key words: diabetes mellitus, renal anemia, glycosylated hemoglobin

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