血红蛋白变异体对糖化血红蛋白测定结果的干扰及处理

摘要

目的 分析糖化血红蛋白(HbA1c)测定结果与血糖结果不相符的原因,探讨不同血红蛋白变异体对离子交换高效液相色谱法(IE-HPLC法)检测HbA1c的干扰程度及实验室应采取的处理措施.方法 方法学比较.收集IE-HPLC法检测HbA1c测定结果与血糖结果不相符的患者4例,采用血红蛋白毛细管电泳法对全血样本进行血红蛋白电泳分析,采用双脱氧链终止法进行血红蛋白基因测序,采用免疫抑制比浊法(TINIA法)对HbA1c进行重新检测.结果 4例患者中,2例为HbJ-Bangkok,血红蛋白基因型分别为β41-42/βJ-Bangkok和βN/βJ-Bangkok,Hb J-Bangkok含量各占93.9％和52.4％.1例为Hb E,血红蛋白基因型为βN/βE,Hb E含量占23.6％.1例为Hb G-Taipei,血红蛋白基因型为βN/β C-Taipei,Hb G-Taipei含量占39.4％.其中β-地贫合并Hb J-Bangkok(血红蛋白基因型为β41-42/βJ-Bangkok)患者IE-HPLC法和TINIA法HbA1c测定结果均受干扰,另外3例患者IE-HPLC法HbA1c测定结果受干扰,而TINIA法HbA1c测定结果不受干扰.结论 β-地贫合并Hb J-Bangkok、HbJ-Bangkok、Hb E和Hb G-Taipei等血红蛋白变异体对IE-HPLC法检测HbA1c存在不同程度的干扰,此类患者应采用其他不受干扰的方法检测HbA1c,或选用其他替代指标对血糖水平进行监测.%Objective To analyze the causes of the HbA1c.results discordant with blood glucose measurements,evaluate the interference degree of hemoglobin variants on the HbA1c results achieved by the method of ion exchange high performance liquid chromatography (IE-HPLC),and discuss the measures should be taken by the lab.Methods Four cases with inconsistency between the results of HbA1c with IEHPLC method and those of blood glucose were collected.The dideoxy chain termination method was used for hemoglobin gene sequencing and immunoturbidimetric method (TINIA method) for detection of HbAc Hemoglobin electrophoresis analysis of whole blood samples was conducted with hemoglobin capillary electrophoresis method.Results There were 2 patients with Hb J-Bangkok.The genotypes were β41-42/βJ-Baogkok and βN/βJ-Bangkok,the accounts of Hb J-Bangkok were 93.9％ and 52.4％,respectively.Three was one patient with Hb E.The genotype was βN/βE,the accounts of Hb E was 23.6％.There was one patient with Hb G-Taipei.The genotype was βN/βG-Taipei,the accounts of Hb G-Taipei was 39.4％.In the Hb J-Bangkok patients,the interferences of HbA1c results were found in both IE-HPLC method and TINIA method.In the rest 2 patients,the interferences were found in IE-HPLC method,but not in TINIA method.Conclusions β-thalassemia combined with hemoglobin variants including Hb J-Bangkok,Hb J-Bangkok,Hb E and Hb G-Taipei has interference to varying degrees on the detection of HbA1c with IE-HPLC.In these cases,the lab should use other methods not affected by Hb variants for HbA1c detection or alternative indicators to monitor glucose levels.