《中国糖尿病杂志》官方网站
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北京市西城区大红罗厂街1号
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来自：中国糖尿病杂志 编辑：刘栩晗 李国生 李欣宇等|点击数：|2016-03-06
【摘要】 目的 观察动态血糖监测(CGM)评估糖尿病合并不同阶段慢性肾脏疾病（CKD）患者HbA1c及糖化白蛋白（GA）反应血糖控制的准确性。 方法 选取血糖控制稳定的T2DM患者及合并CKD 2、3及4～5期患者,各20例，行血常规、肝肾功能、HbA1c、GA、72 hCGMS及每日7次指尖血糖检测(SMBG)，采用Pearson相关及线性回归分析CGMS的平均血糖浓度和HbA1c和GA间的相关性。 结果 T2DM组及合并CKD2、CKD3组HbA1c（r=0.452、0.512、0.642）和GA（r=0.67、0.76、0.77）均与CGMS平均血糖浓度相关(P＜0.05)，糖尿病合并CKD4～5组HbA1c与CGM无相关性（r=0.358，P=0.121）。在无低蛋白血症的情况下，T2DM合并CKD4～5组GA与CGM相关(r=0.63，P＜0.05)。CKD4～5组实测的HbA1c比根据CGMS计算出的HbA1c值低[（6.7±1.0）% vs （7.4±0.6）%，P＜0.05]。 结论 HbA1c低估糖尿病合并CKD4～5期患者的血糖控制，在无低蛋白血症的情况下，GA能更准确地反映糖尿病合并CKD4和5期患者的血糖控制。
【关键词】 糖尿病慢性肾脏疾病；动态血糖监测系统；血糖控制；糖化血红蛋白；糖化白蛋白
A study on the accuracy of glycosylated haemoglobin and glycosylated albumin in diabetic patients with chronic renal failure of different stages evaluated by continuous glucose monitoring
【Abstract】 Objective To investigate the accuracy of glycosylated haemoglobin (HbA1c) and Glycosy-lated albumin (GA) as indicators for glycemic control using continuous glucose monitoring system(CGMS). Methods A total of 80 T2DM patients with stable glycemic control were selected including 60 patients with chronic kidney disease of stages 2,3 or 4～5, 20 patients of each stage. All patients were examined blood routine, hepatic and renal function, HbA1c, GA, 72 h CGMS and capillary blood glucose for 7 times per day by self-monitoring. Pearson correlation and linear regression analysis were adopted to assess the correlation of mean blood glucose concentration detected by CGMS with HbA1c and GA. Results HbA1c and GA were correlated with the mean blood glucose concentration in T2DM patients without CKD and with CKD2 and CKD3 (r = 0.452, 0.512, 0.642; r = 0.67, 0.76, 0.77; P＜0.05) while HbA1c was not correlated with the mean blood glucose concentration in T2DM patients with CKD 4～5 (r=0.358, P=0.121). GA was correlated with the mean blood glucose concentration in T2DM patients with CKD 4～5 when serum level of albumin was normal (r=0.63, P＜0.05). The actual measured value of HbA1c in T2DM patients with CKD4～5 was significantly lower than that calculated according to the mean blood glucose concentration detected by CGMS [（6.7±1.0）% vs （7.4±0.6）%，P＜0.05]. Conclusion GA rather than HbA1c can more accurately reflect glycemic control in diabetic patients with CKD 4～5 whose serum level of albumin is normal.【Key words】 Diabetic chronic kidney disease; Continuous glucose monitoring; Glycemic control; Glycosylated albumin; Glycosylated haemoglobin
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