摘要目的 观察溶血性疾病相关糖化血红蛋白(HbA1c)降低患者的临床及实验室特征,探讨HbA1c与溶血相关实验室指标的关系,发掘其对溶血性疾病的提示意义.方法 回顾性分析2016年10月至2017年11月192例HbA1c降低血液病患者临床资料,比较各类疾病溶血相关实验室指标的检测数据,分析HbA1c和溶血相关实验室指标的关系.结果 HbA1c降低病例的诊断主要包括红细胞膜病(88例)、免疫性溶血性贫血(72例)、血红蛋白病(4例)和红细胞酶病(5例),其中HbA2和HbF正常者与HbA2和(或)HbF异常升高者在免疫性溶血性贫血(41.7％对22.0％,x2=5.574,P=0.018)和血红蛋白病(0.7％对7.3％,P=0.031)中的分布差异有统计学意义.相对于非溶血性疾病患者,溶血性疾病患者显示出HbA1c降低和网织红细胞比值(Ret)、间接胆红素(IBIL)、游离血红蛋白(F-Hb)升高的趋势,Ret、网织红细胞血红蛋白含量(Ret-He)、平均红细胞体积(MCV)、IBIL、F-Hb在不同溶血性疾病之间表现出了水平的差异,但造成差异的原因并不一致.在红细胞膜病和免疫性溶血性贫血中,HbA1c与其他各项实验室指标均呈现负相关趋势.结论 溶血性疾病可导致HbA1c假性降低,但不同病种对其影响程度的差异不显著.HbA1c与溶血相关实验室指标具有密切关系,对红细胞膜病和免疫性溶血性贫血等疾病具有潜在的提示意义.

abstractsObjective To compare the effects of different hemolytic diseases on the level of glycosylated hemoglobin (HbA1c) to further explore the relationship between HbA1c and laboratory ihdexes to disclose implications of HbA1c in hemolytic diseases.Methods The distribution of 192 decreased HbA1c cases in 4 categories of hemolytic diseases was analyzed.Laboratory indexes related to hemolysis were tested and analyzed in each kind of disease,and relationship between laboratory indexes and HbA1c was statistically explored.Results Diagnoses of decreased HbA1c cases mainly included erythrocyte membranopathies (88 cases),immunohemolytic anemia (72 cases),hemoglobinopathy (4 cases) and erythrocyte enzymopathy (5 cases).The distribution of HbA2 and normal HbF subjects in immunohemolytic anemia and hemoglobinopathy was significantly different from those of HbA2 and/or abnormal HbF subjects (41.7％ vs 22.0％,x2 =5.574,P =0.018;0.7％ vs 7.3％,P =0.031).Compared with non-hemolytic disease patients,those who suffered from 4 categories of hemolytic diseases showed lower HbA1c level and higher reticulocyte percentage (Ret),indirect bilirubin (IBIL) and free hemoglobin (F-Hb).Different levels of Ret,reticulocyte hemoglobin content (Ret-He),mean corpuscular volume (MCV),IBIL and F-Hb among the 4 kinds of diseases were observed,but the causes of the differences were not the sa me.HbA1c was negatively correlated with other laboratory indexes in erythrocyte membranopathies and immunohemolytic anemia.Conclusions Hemolytic disease resulted in false lower HbA1c,but impact of difference on HbAlc between different diseases was not significant.HbA1c was closely connected to laboratory indexes related to hemolysis,which might have potential implications for hemolytic diseases such as erythrocyte membranopathies and immunohemolytic anemia.