Objective To evaluate the clinical application of Hb-A2 detection of thalassemia including-alpha-thalassemia and beta-thalassemia. Methods There were 70 Southeast Asia type alpha-thalassemia heterozygosity and 43 normal gene type resulted from Gap-PCR, and 33 beta-thalassemia heterozygosity and 36 normal gene type diagnosed by reverse dot blot (RDB). Cutoff value of Hb-A2 in finding of alpha-thalassemia and beta-thalassemia was present.The sensitivity, specificity, positive and negative likelihood ratio, and receiver operator characteristic curve (ROC) were used to evaluate the significance of Hb-A2 level in screening thalassemia in adults. Results The borderline values between normal and pathological range of Hb-A2 were ≤2.6% in alpha-thalassemia and ≥3.8% available in beta-thalassemia. Sensitivity and specificity were 59% and 54% in alpha-thalassemia, 76% and 83% in beta-thalassemia, respectively. ROC showed that the area covered beneath the curve of beta-thalassemia was more than that of alpha-thalassemia. Conclusions The cutoff between normal and pathological range of Hb-A2 is ≤2.3% in alpha-thalassemia and ≥3.8% in beta-thalassemia. Hb-A2 detection has higher sensitive and specific in beta-thalassemia diagnosis, but lower in alpha-thalassemia diagnosis.
Hemoglobin-based oxygen carriers (HBOCs) is a kind of blood substitutes. It is a separated, ultra-purified, modified human or bovine hemoglobin in a balanced saline solution. After modification, it has longer half-time, less renal toxicity, and better delivery of O2 even at low temperature and pH. Its shelf life is long and it dose not require cross-matching. In the field of cardiac surgery, the use of HBOCs can reduce the amount of transfusion postoperatively, and can be used in cardiopulmonary bypass priming and myocardial protection.
Objective To study relationship between hemoglobin-AGE (Hb-AGE) levels and diabetic retinopathy (DR) in diabetics. Methods Hb-AGE content of 125 type 2 diabetic patients with or without DR was measured by competitive ELISA technique and compared with that of 50 normal controls. Results Hb-AGE level in type 2 diabetic patients was 65% higher than that in normal individuals (Plt;0.01), and Hb-AGE level in the patients with DR was significantly higher than patients with DR was significantly higher than that in those without DR (Plt;0.05). It was found that fasting plasma glucose (FPG) level was not directly correlated with Bb-AGE levels and development of DR ,but HbAc,plasma lipid and blood pressure were related to the both (Plt;0.05 or Plt;0.01). Multivariate analysis showed that there was closer relationship between seriousness degree of DR and Hb-AGE (partial correlation coefficient was 0.604,Plt;0.001). Conclusion Diabetic control is related to alterations in vivo Hb-AGE,which may contribute to occurrence and developement of DR in type 2 diabetes mellitus. (Chin J Ocul Fundus Dis,2000,16:147-149)
Objective To determine the best threshold value of hemoglobin A2 (HbA2) for diagnosis of β-thalassemia (β-thal) carriers by using high performance liquid chromatography (HPLC), and to improve the application value of HbA2 as a diagnostic index for β-thal carriers to reduce the rates of missed diagnosis and misdiagnosis. Methods Using reverse dot blot (RDB) as a gold standard method, HbA2 results of 1 007 β-thal carriers and 606 normal controls in the past two years determined by HPLC were divided into true positive, false positive, true negative, and false negative based on the different threshold values of HbA2 results. Then, the evaluation indexes such as sensitivity, specificity, positive and negative likelihood ratio, and Youden’s index were evaluated. Next, the receiver operator characteristic (ROC) curve was drawn to determine the best threshold value of HbA2 for diagnosis of β-thal carriers by HPLC. Results If ≥4.0% was taken as the threshold value of HbA2 for diagnosis of β-thal carriers by HPLC, the evaluation indexes values were shown as follows: sensitivity 99.21%, specificity 99.34%, positive likelihood ratio 150.30, negative likelihood ratio 0.008, and Youden’s index 0.99. The Youden’s index was better than the other threshold values, and the corresponding tangent point was the peak point of the ROC curve. Conclusion When ≥4.0% serves as the best threshold value of HbA2 for diagnosis of β-thal carriers using HPLC, integrated evaluation performance of the corresponding sensitivity and specificity is the most ideal, and the authenticity of the diagnostic test is the best.
ObjectiveTo investigate the effect of using hemoglobin-revised trauma score (HB-RTS) on predicting mortality risk in trunk injury patients. MethodsAccording to case control study rules, medical records of patients with trunk injury who were treated between July 2011 and October 2013, were collected. Patients were divided into two groups according to their survival prognosis within 28 days. The HB-RTS, revised trauma score (RTS), and injury severity score (ISS) of the two groups were calculated. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) and Youden's index were calculated. And then, we selected the optimal cutoff value using HB-RTS and RTS to predict the trunk injury patients' mortality and calculated their sensitivity, specificity, and accuracy. In the end, the correlation of ISS with HB-RTS and RTS using linear correlation analysis method was analyzed. ResultsBesides RTS, HB-RTS and ISS in the death group were statistically significant higher than that in the survival group. The AUC of HB-RTS and RTS of the two groups were 0.922 and 0.888, respectively. The sensitivity of HB-RTS and RTS were 91.5% and 83%; and the specificity of HB-RTS and RTS were 95.7% and 76.6%, respectively. The correlation of HB-RTS and ISS was -0.592, while the correlation of RTS and ISS was 0.585. ConclusionCompared to RTS, ROC of HB-RTS is enlarged, the specificity is increased, and the sensitivity is decreased. HB-RTS has stronger correlation with ISS than with RTS. The predictive effect of HB-RTS is higher than RTS in predicting mortality of trunk injury patients.
ObjectiveTo observe and analyze the effect of HbA1c level on macular microcirculation in patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study. One hundred and twenty-four T2DM patients (124 eyes) without diabetic retinopathy who diagnosed by the examination of fundus color photography in Lixiang Eye Hospital Of Soochow University during September to December 2017 were enrolled in this study. There were 59 males (59 eyes) and 65 females (65 eyes), with the mean age of 65.06±7.99 years old. All patients underwent BCVA, fundus color photography, and OCT angiography (OCTA). The history of diabetes, hypertension and dyslipidemia were recorded in detail. According to the HbA1c level, patients were divided into three groups, HbA1c ideal control group (group A, HbA1c ＜7%, 67 eyes), HbA1c control group (group B, 7%≤HbA1c≤9%, 44 eyes), and HbA1c poor control group (group C, HbA1c＞9%, 13 eyes), respectively. The 3 mm×3 mm range of the macular area was scanned by OCTA instrument. The vascular density (VD) and skeleton density (SD) of nonsegmented retinal layer (NRL), superficial retinal layer (SRL) and deep retinal layer (DRL) in the macular area and foveal avascular zone (FAZ) area, non-circularity index, axial rate (AR) of SRL were measured. The correlation between HbA1c, BCVA and VD, SD of NRL, SRL, DRL was analyzed statistically with Spearman correlation test. The correlation between systemic factors and the above indicators was analyzed statistically with linear regression analysis.ResultsThe results of linear regression analysis showed that HbA1c was significantly correlated with VD (t=−3.237, −3.156, −2.050) and SD (t=−0.3.45, −3.034, −2.248) of NRL, SRL and DRL (P＜0.05); but no correlation with FAZ, non-circularity index and AR (t=1.739, 0.429, 1.155; P＞0.05). The differences of VD (F=6.349, 5.981, 3.709), SD (F=7.275, 6.085, 1.904) and AR (F=0.027) of NRL, SRL and DRL in group A, B and C were statistically significant (P＜0.05); but the differences of FAZ (F=1.904), non-circularity index (F=0.280) was not statistically significant (P＞0.05). Significant differences (P＜0.05) of VD and SD of NRL were found between group A and B (t=1.987, 2.201), group A and C (t=3.365, 3.572), group B and C (t=2.010, 2.076). Significant differences (P＜0.05) of VD and SD of SRL were found between group A and B (t=2.087, 2.168), group A and C (t=3.197, 3.194). There were significant differences (P＜0.05) in SD of DRL between group A and B (t=2.239), group A and C (t=−2.519). There was significant difference in VD of DRL between group A and C (t=2.363). The results of Spearman correlation analysis showed that HbA1c was negatively correlated with VD (r=−0.273, −0.255, −0.222; P=0.002, 0.004, 0.013) and SD (r=−0.275, −0.236, −0.254; P＜0.05) of NRL, SRL, DRL; positively correlated with FAZ and BCVA (r=0.221, 0.183; P＜0.05). BCVA was negatively correlated with VD (r=−0.210, −0.190, −0.245) and SD (r=−0.239, −0.207, −0.296) of NRL, SRL, and DRL (P＜0.05), but not correlated with FAZ (r=0.099, P＞0.05).ConclusionThe decrease of macular perfusion and the morphological change of FAZ accompanied by HbA1c increased.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.
ObjectiveTo investigate the effect of 24-week intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis (MHD) patients.MethodsFrom April to May 2019, 62 MHD patients were enrolled and randomly assigned into exercise group (n=31) and control group (n=31). Both groups of patients received regular routine hemodialysis, on that basis, patients in the exercise group completed intradialytic resistance exercise three times per week for 24 weeks. Each exercise included 8-10 muscle groups (grasping the grip ring with both hands, flexion and extension of the elbows and shoulders on the non-vascular side and lower limbs with sandbag), 3 sets of 15 repetitions with a rest of 1-2 min between 2 sets. Exercise began with a low load, the sandbag weight was gradually increased, and the Borg score was aimed to be 11-13 points after exercise. Hemoglobin, serum ferritin, transferrin saturation, serum creatinine, high-sensitivity C-reactive protein, urea clearance index, recombinant human erythropoietin (rHuEPO) dosage at baseline and after 24 weeks, as well as the cumulative iron supplement dose and hemoglobin variation of the two groups during the study period were evaluated.ResultsThere were 20 patients in the exercise group and 30 ones in the control group who completed the study. After 24 weeks of progressive resistance exercise, the medium (lower quartile, upper quartile) of the amount of rHuEPO in the exercise group decreased from 6 000 (6 000, 9 000) U/week to 6 000 (4 500, 7 125) U/week (Z=−2.599, P=0.009), while that in the control group had no statistically significant difference (Z=−1.340, P=0.180); there was no statistically difference in hemoglobin, hemoglobin coefficient of variation, serum ferritin, transferrin saturation, or 24-week cumulative iron supplementation between the two groups.ConclusionIntradialytic progressive resistance exercise can reduce the amount of rHuEPO in MHD patients, which is benefitial to optimizing the management of hemoglobin.
ObjectiveTo investigate the influence of hemoglobin level on in-hospital outcome of elderly patients with acute coronary syndrome (ACS).MethodsThis study retrospectively collected 262 elderly patients with ACS in the First Hospital of Tsinghua University from January 2015 to August 2019. Patients were divided into 4 groups according to the hemoglobin level. Patients with hemoglobin level≤121.75 g/L were classified into group A (n=65), patients with hemoglobin level between 121.76 and 132.50 g/L were classified into group B (n=66), patients with hemoglobin level between 132.51 and 144.00 g/L were classified into group C (n=69), and patients with hemoglobin level≥144.01 g/L were classified into group D (n=62). The primary endpoints of this study were in-hospital major adverse cardiovascular events, including all-cause death, reinfarction, acute or subacute stent thrombosis and cardiac arrest. Logistic regression analysis was used to explore the effect of hemoglobin on the in-hospital prognosis of elderly patients with ACS.ResultsLogistic regression analysis showed that the odds ratio of hemoglobin level in the major adverse cardiovascular events assessment was 0.971, the 95% confidence interval was (0.946, 0.996) and the P value was 0.024, while the odds ratio of hemoglobin level in the all-cause death assessment was 0.957, the 95% confidence interval was (0.929, 0.987) and the P value was 0.005.ConclusionLow hemoglobin level is a risk factor for in-hospital adverse events in the elderly patients with ACS.
ObjectiveTo assess the association of hemoglobin (Hb) levels with the prevalence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional study. From January 2017 to December 2018, 707 patients with T2DM who were hospitalized in the Department of Internal Medicine of Chu Hsien-I Memorial Hospital & Tianjin Medical University, were included in the study. All patients underwent color photography of the fundus of both eyes with dilated pupils. According to DR diagnostic criteria, patients were divided into DR group and non-DR (NDR) group, with 210 and 497 cases, respectively; DR group was further divided into non-proliferative DR group (NPDR) group and proliferative DR (PDR) group, about 186, 24 cases, respectively. Hb level was detected, single factor analysis of its correlation with DR; logistic regression analysis was used to evaluate the relationship between Hb level and DR risk.ResultsThe Hb levels of the patients in the NDR group and the DR group were 140.58±17.26 and 132.35±23.48 g/dl; compared with the NDR group, the Hb level of the DR group was significantly lower, and the difference was statistically significant (t=5.107, P=0.000). In the NDR group, NPDR group, and PDR group, Hb levels of male patients were 149.3±1.01, 142.6±2.35, 132.9±8.44 g/dl, respectively; Hb levels of female patients were 131.7±0.90, 124.0±2.09, 116.8±5.23 g/dl. With the progress of DR, Hb levels of different sexes decreased significantly, and the difference was statistically significant (P＜0.000 1). The results of correlation analysis showed that Hb reduction was an independent risk factor for DR (odds ratio=4.437, 95% confidence interval 2.590-7.603, P＜0.000 1).ConclusionThe reduction of Hb in T2DM patients is positively correlated with the severity of DR.