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作者：武汉市第四医院检验科 汪晓玲
糖化血红蛋白（GHb）是在红细胞生存期间，血红蛋白A（HbA）与己糖（即六碳糖）缓慢、连续的非酶促反应的产物，其检测结果可反应近2-3个月的平均血糖水平，在糖尿病的诊断和治疗中起着非常重要的作用。根据与HbA结合的己糖的不同，GHb又可分为HbA1a（与磷酰葡萄糖结合）、HbA1b（与果糖结合）、HbA1c（与葡萄糖结合），其中HbA1c含量最高，占60%-80%，是目前临床最常用的测量指标。
HbA1c是一种具有特定六肽结构的血红蛋白分子，拥有血液浓度相对稳定的优点，临床常用其代表总的糖化血红蛋白水平。在实际的检测中，除血糖浓度外，还有一些因素也可以影响糖化血红蛋白的值，如果出现糖化结果与临床不符，不妨考虑是否为以下因素引起的。
红细胞的寿命是影响GHb的一个重要因素。GHb在红细胞内的合成是缓慢、连续进行的，一些慢性肝病、肾病会使红细胞寿命的缩短，减少GHb形成的时间，使结果偏低；反之，脾切除术后、再生障碍性贫血等导致红细胞寿命延长的疾病会使检测结果偏高。
Hb出现变异体可使相应的分子空间构象和等电点等发生改变，影响HbA1c的测量。美国(NGSP)网站公布了一些检测系统受Hb变异体或衍生物干扰与否的数据（见表1）。
@在缺乏具体方法数据的情况下，通常可以假定免疫分析方法在临床检测中不会受到HbE和HbD的显著干扰，因为E和D替换距离血红蛋白β链的n端较远(16)。 $ 在缺乏特定方法数据的情况下，一般可以认为当HbF水平大于10-15%，免疫分析法和硼酸亲和法会受到干扰 (20,43)。 # 当区分出HbE变异体时，结果不受明显的干扰。在未区分出HbE变异体的情况下，HbA1c结果偏低。 ↑ 表示干扰导致结果偏高 ↓ 表示干扰导致结果偏低 表1 NGSP总结的各种Hb变异体或衍生物对糖化血红蛋白检测的影响，另外，由平均血红蛋白量减低造成的低色素贫血，如缺铁性贫血，也可影响HbA1c的测定，使其结果偏高。
尿毒症患者常伴高尿素血症，尿素在体内可自发地分离形成氨和氰酸盐，氰酸盐经质子化作用后形成异氰酸，异氰酸与蛋白质的α和ε氨基基团反应即形成氨基甲酰。Hbβ链N端的缬氨酸可与异氰酸发生特异性的结合反应，形成稳定的氨基甲酰Hb。对于离子交换法测定的GHb，氨基甲酰化的Hb浓度超过5.4%时就会使其结果出现极大的假性偏高。不过，对于免疫法和亲和色谱法，其结果不受氨基甲酰Hb的影响。
大量服用含有维生素C和维生素E的食物或药物可抑制Hb糖基化，使测定结果假性降低。一些抗感染的药物，如，可通过降低血浆中肿瘤转移因子-α水平，增强胰岛素抵抗，从而降低HbA1c水平。
妊娠是育龄期妇女经历的一个特殊时期。妊娠期的血容量较妊娠前会有明显增加，Hb出现生理性降低，导致HbA1c的测定结果要低于非妊娠期妇女。部分妊娠中晚期的妇女会有贫血的困扰，在检测时也要考虑贫血对检测的影响。
样本的储存时间及温度都对GHb的结果有一定的影响。用于测量GHb的血在长时间存放后，其测定结果会随着存放时间的延长而逐渐升高。与免疫法相比，离子交换色谱法和硼酸盐亲和色谱法测量受到温度的影响较小。大多数检测方法的样本都可在-70℃低温冻干条件下保存1年，检测结果不受影响。全血样本可在4℃保存1周。在37℃条件下，未经任何处理的全血样本保存时间应小于1天。在室温条件下，全血样本可保存数天。 【参考文献】 1. Bry L, Chen PC, Sacks DB. Effects of hemoglobin variants and chemically modified derivatives on assays for glycated hemoglobin. Clin. Chem. 2001;47:153-63. REVIEW 2. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM: American Diabetes Association Technical Review on Tests of Glycemia. Diabetes Care 1995;18:896-909. 3. Sundaram RC, Selvaraj N, Vijayan G et al.: Increased plasma malondialdehyde and fructosamine in iron deficiency anemia: effect of treatment. Biomed Pharmacother 2007; 61:682-5. 4. Tarim O, Kucukerdogan A, Gunay U, Eralp O, Ercan I. Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus. Pediatr Int 1999;41:357-62. 5. 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