| Summary: | 碩士 === 國立中興大學 === 生命科學院碩士在職專班 === 91 === Abstract
The traditional way by employing the ion-change method to measure glycosylated hemoglobin (HbA1c) can be influenced by carbamylated Hb, which limits the application of HbA1c in diabetic dialysis patients. The HbA1C level usually represents the glucose level within recent 2~3 months.The breakdown of large amount of erythrocytes and decrease of EPO make the glycosylated Hb higher in dialysis patients than normal adults. Therefore, the HbA1c in patients with renal disease represents the glucose levels less than 2-3 months. In this study we have tried to employ the affinity HPLC method to overcome the interference of carbamylated Hb and to clarify whether the HbA1c can repressent the glucose level accurately. In addition, the effect of a new hypoglycemic agent, rosiglitazone, was measured in patients with impaired renal function and end stage renal disease.
Three hundred and three patients (69 normal healthy adults, 43 diabetic patients without dialysis, 137 diabetic dialysis and 54 non-diabetic dialysis patients) were included in the study to examine the relationship between serum glucose and HbA1c. No significant difference in serum glucose levels was found between normal adults and non-diabetic dialysis patients, however, significant difference（p<0.05）was existed in HbA1C levels. Significant difference was also found in serum glucose and HbA1c levels between diabetic patients with and without dialysis. The correlation of glucose and HbA1c levels in non-diabetic dialysis patients was not significant（r=0.151, p=ns）, however, the correlation was significant in diabetic patient groups (with and without dialysis)（r=0.617, p<0.05）. Only in the diabetic patients can the HbA1c level be used to represent the glucose level. The formula is Glucose = 25.1(HbA1C) + 3.5.
Besides, we treated 58 diabetic patients (28 with normal renal function, 30 with impaired renal function) by 4 mg rosiglitazone daily for 6 months. Serum glucose (fasting and postprandial) and HbA1c levels were measured in the second, fourth and sixth months after the treatment. Fasting serum glucose, postprandial serum glucose and HbA1c levels all showed significantly progressive decrease within 6-month treatment period, except that, in diabetic patients, the HbA1C levels in the beginning and the second month showed no significant difference. We conclude that rosiglitazone, which increases cellular insulin sensitivity, can be used effectively in diabetic patients with or without renal impairment.
|
|---|
