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目的:探讨糖化白蛋白在CKD 3~5期非透析和血液透析合并糖尿病患者中的血糖评估价值。方法:入选187例糖尿病患者,其中CKD 1~2期68例,CKD 3~5期ND患者89例,CKD 5期HD患者30例,比较各组患者空腹血糖与糖化白蛋白、糖化血红蛋白的相关性,应用多因素回归分析方法分析影响终末期肾脏病合并糖尿病患者糖化白蛋白、糖化血红蛋白的因素。结果:HbAlc与GA在每组均显著相关(CKD 1~2期:r=0.632,P<0.001、CKD 3~5 ND期:r=0.647,P<0.05、CKD 5 HD期:r=0.585,P<0.001),但血液透析患者直线回归方程的斜率显著高于CKD 1~2期及CKD 3~5期非透析患者(4.14 vs 1.84、2.12,P<0.05)。CKD 5 HD组GA/HbAlc的值显著低于非透析组(3.01±0.75 vs 2.48±0.58、2.48±0.59)。多因素回归分析提示在透析组仅空腹血糖是影响GA的因素。结论:GA与HbAlc在CKD 3~5期非透析合并糖尿病患者的血糖评估价值差异无统计学意义,而在血液透析合并糖尿病患者,HbAlc明显低估了血糖的真实水平,GA较HbAlc更能反映真实的血糖水平。
Objective: To investigate the value of glycosylated albumin in CKD stage 3 ~ 5 non-dialysis and hemodialysis patients with diabetes mellitus. Methods: A total of 187 patients with diabetes mellitus were enrolled. Among them, 68 were CKD stage 1 to 2, 89 CKD stage 3 to 5 ND patients and 30 CKD stage 5 HD patients. The fasting plasma glucose, glycated albumin and glycosylated hemoglobin were compared The factors influencing glycated albumin and glycosylated hemoglobin in patients with end stage renal disease complicated with diabetes mellitus were analyzed by multivariate regression analysis. Results: HbAlc was significantly associated with GA in each group (CKD stage 1 to stage 2: r = 0.632, P <0.001, CKD stage 3 to 5 ND stage: r = 0.647, P < P <0.001). However, the slope of the linear regression equation in hemodialysis patients was significantly higher than those in CKD stage 1 and 2 and CKD stage 3 to 5 (4.14 vs 1.84 and 2.12, P <0.05). The values of GA / HbAlc in CKD 5 HD group were significantly lower than those in non-dialysis group (3.01 ± 0.75 vs 2.48 ± 0.58, 2.48 ± 0.59). Multivariate regression analysis showed that only fasting blood glucose in the dialysis group was a factor that affected GA. Conclusion: There was no significant difference in the blood glucose level between GA and HbAlc in CKD stage 3-5 non-dialysis patients with diabetes, whereas in hemodialysis patients with diabetes, HbA1c significantly underestimated the actual level of blood glucose, and GA was more reliable than HbAlc Blood sugar level.