血红蛋白变异体对糖化血红蛋白测定结果的干扰及处理  

Interference and disposition of hemoglobin variants on HbA1c testing results

作　　者：温冬梅[1] 张秀明[1] 索明环[1] 王伟佳[1] 陈亚琼[1] 徐全中[1] 吴剑杨[1] 李曼[1] 萧金丽[1] 阚丽娟[1] 周甲思 

机构地区：[1]中山大学附属中山医院检验医学中心,中山市528403

出　　处：《中华检验医学杂志》2014年第2期123-126,共4页Chinese Journal of Laboratory Medicine

基　　金：中山市科技计划项目资助课题（20122A034,20132A091）

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β^41-42/β^J-Bangkok和βN／β^J-Bangkok，Hb J-Bangkok含量各占93．9％和52．4％。1例为HbE，血红蛋白基因型为βN／βE，HbE含量占23．6％。1例为HbG—Taipei，血红蛋白基因型为βN／β^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β^41-42／β^J-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Hh J—Bangkok、HbJ-Bangkok、HbE和HbG．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。（中华检验医学杂志，2014,37：123－126）Objective To analyze the causes of the HbAlo results discordant with blood glucose measurements, evaluate the interference degree of hemoglobin variants on the HbAlc 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 IE- HPLC 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 HbA1c. 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-Bangkok and βN/β^J-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. （ Chin J Lab Meal,2014,37：123-126）

关 键 词：血红蛋白A 糖基化 血红蛋白类 变异(遗传学) 色谱法 高压液相 

分 类 号：R446.1[医药卫生—诊断学]