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分析糖化血色素測定之血量和檢體保存溫度對糖化血色素測定的影響

The Factors That Influence the Measurement of Glycohemoglobin

摘要


糖化血色素(HbA1c)是評估長期血糖控制的重要指標,其值高低和糖尿病併發症的發生具有顯著的關聯性,所以HbA1c對於糖尿病控制佔有非常重要的角色。因而各種影響HbA1c因子都應謹慎評估,以減少誤差的產生。由於採檢單位(如病房護士)對檢驗部門訂定HbA1c測定之所需最低血量常抱著懷疑態度,由於目前無文獻報導關於糖化血色素檢測所需之最低血量,且保存檢體的溫度及保存期限,早年之建議亦因近年來使用方法之不同或檢測標的不同或保存狀況有異,而可能不再適用。此外,如檢體運送過程有所延誤,檢體因置放於室溫過久,可能會影響HbA1c之值。近年來因醫療儀器及檢驗方法之日新月異,本研究希望能提出精確的實驗數據來探討目前檢測HbA1c所需之最低血量。另外,希望能從HbA1c之數值及其圖形變化探討檢體處於不同溫度下對HbA1c之影響,希望能提高檢測HbA1c更準確的結果。 本研究所使用之HbA1c檢測儀器為Tosoh HLC723 G5機型,醫療院所使用繁多,因此很須要更準確的結果。研究結果發現(1)檢測HbA1c之最低血量為0.1ml;(2)以HbA1c數值變化而言:檢體保存於4℃最多可保存60日、室溫(23℃)可保存10日、32℃可保存3日、40℃則不能保存檢體;(3)以HbA1c圖形變化而言,圖形變化比數值變化更早顯現:在4℃的溫度下約1.5月圖形開始變化,室溫(23℃)則約於8日圖形即開始變化,室溫(32℃)下其圖形約2日即產生變化。

並列摘要


Hemoglobin A1c (HbA1c) is an invaluable tool for monitoring long-term glycemic control. Their value is associated with the risk of chronic complications, and as such it is a key issue in diabetes care. The literatures reporting about the minimal blood amount needed for HbA1c measurement is still lacking. The temperature for storage of blood specimens and the period of storage vary depending on the measuring methods, the detecting targets, or the storage conditions. Because of the improvement of new equipments and methods, the aim of the present study is to determine the minimal required blood amount for the measurement of HbA1c. In order to increase the accuracy of HbA1c measurement, the influence of the storage temperature of blood specimens will also be investigated. The equipment for HbA1c measurement is Tosoh HLC 723 G5, by which the method of cation exchange high performance liquid chromatography was employed. The minimal amount of blood required for the measurement of HbA1c and the influence of various temperatures for specimens storage will be evaluated from the HbA1c values and the HbA1c figures. The results show that the minimal required blood amount is 0.1 mL. It is noted that specimens can be used for the measurement of HbA1c value with significant changes when they are stored in 4℃ for up to 60 days, when in room temperature (23℃) for up to 10 days, in 32℃ for up to 3 days, specimens can not be used when they are stored in 40℃. However, the distortion of HbA1c figures occurred earlier than the changes of the values. The HbA1c figure begin to change (left-shifted) after 1.5 months when the specimens are stored in 4℃, 8 days when stored in room temperature (23℃), 2 days when stored in room temperature (32℃). In conclusion, any factor that could influence HbA1c measurement should be evaluated in preventing the occurrence of error.

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