High performance liquid chromatography (HPLC) is currently the mainstream technology for detecting hemoglobin. Glycated hemoglobin (HbA1c) is a gold indicator for diagnosing diabetes, however, the accuracy of HbA1c test is affected by thalassemia factor hemoglobin F (HbF)/hemoglobin A2 (HbA2) and variant hemoglobin during HPLC analysis. In this study, a new anti-interference hemoglobin analysis system of HPLC is proposed. In this system, the high-pressure three-gradient elution method was improved, and the particle size and sieve plate aperture in the high-pressure chromatography column and the structure of the double-plunger reciprocating series high-pressure pump were optimized. The system could diagnose both HbA1c and thalassemia factor HbF/HbA2 and variant hemoglobin, and the performance of the system was anti-interference and stable. It is expected to achieve industrialization. In this study, the HbA1c and thalassemia factor HbF/HbA2 detection performance was compared between this system and the world’s first-line brand products such as Tosoh G8, Bio-Rad Ⅶ and D10 glycosylated hemoglobin analysis system. The results showed that the linear correlation between this system and the world-class system was good. The system is the first domestic hemoglobin analysis system by HPLC for screening of HbA1c and thalassemia factor HbF/HbA2 rapidly and accurately.
ObjectiveTo study the correlation of postoperative cognitive dysfunction (POCD) with type-2 diabetes and glycosylated hemoglobin (HbA1c) levels in elderly patients. MethodsA total of 140 elderly patients who were going to undergo non-cardiothoracic surgery in our hospital between January 2011 and February 2013 were included in this study.ASA classification was between I and Ⅲ.There were 78 males and 62 females,aged between 65 and 86 years old.Group A had 70 patients with diabetes,while group B had another 70 corresponding patients without diabetes.One day before surgery and a week after surgery,Mini-mental State Examination (MMSE) and Montreal Cognitive Functioning Scale (MoCA) were used to test patients'cognitive function,and the incidence of POCD was compared between the two groups.Group A patients,according to HbA1c levels,were divided into group AH (HbA1c>7.5%) and group AL (HbA1c<7.5%).And we compared the relationship between group AL and group B,and the relationship between group AH and group B. ResultsThe incidence of POCD in group A was significantly higher than that in group B (P<0.05).Group AH had a significantly higher incidence of POCD than group AL (P<0.05).No significant difference was found in fasting plasma glucose among the groups. ConclusionElderly diabetic patients with poor glycemic control is a risk factor for POCD occurrence,but fasting glucose as a predictor of POCD is not as good as HbA1C.
ObjectiveTo explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery.MethodsA total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used.Results Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events.ConclusionHbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.
Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (Emean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve Emean and VEGF-B/HbA1c. Results The Emean values of the left and right median nerves, Emean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The Emean values of the left and right median and tibial nerves, Emean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve Emean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve Emean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.
ObjectiveTo study the relationship between preoperative pan-immune-inflammation value (PIV), preoperative hemoglobin, albumin, lymphocyte and platelet score (HALP) and tumor pathological features and microsatellite status of colorectal cancer, and to analyze the predictive value of HALP and PIV for microsatellite status. MethodsThe clinicopathological data of 156 patients who underwent radical colorectal cancer resection admitted to the Second Hospital of Shanxi Medical University from May 2021 to February 2024 were retrospectively analyzed. HALP and PIV were calculated by preoperative related laboratory indicators, and then the patients were divided into high HALP/low HALP (HHALP/LHALP) group (n=78) and high PIV/low PIV (HPIV/LPIV) group (n=78) according to the median of their calculated values. The correlation between preoperative HALP and PIV and clinicopathologic features of colorectal cancer was analyzed. According to the results of microsatellite stability detection, the patients were divided into microsatellite standard/microsatellite instability-high（MSS/MSI-H）group. The correlation between preoperative HALP and PIV and microsatellite stability was analyzed. The predictive value of HALP and PIV for microsatellite status was analyzed by using receiver operating characteristic (ROC) curve. ResultsThere were statistically significant differences in tumor diameter, tumor location, HALP, T stage and microsatellite status between the HPIV group and the LPIV group (P<0.05), and high PIV was more common in patients with right-sided colon cancer and MSI-H, and the tumors were larger and had higher T stage. The differences in gender, body mass index（BMI）, tumor diameter, tumor location, PIV, T stage and microsatellite status between the HHALP group and the LHALP group were statistically significant (P<0.05), and low HALP was more common in women, patients with right-sided colon cancer, and MSI-H, and had a low BMI, large tumors, and high T stage. There were statistically significant differences in HALP and PIV between MSS group and MSI-H group (P<0.05), and patients with MSI-H tended to have low HALP and high PIV, and the area under curve of HALP and PIV in predicting MSI-H for colorectal cancer was 0.848 9 and 0.851 6, respectively, and the optimal cut-off value was 26.84 scores and 507.04, respectively, and the sensitivity was 1.000, 0.923, specificity 0.643, 0.817, respectively. ConclusionLow HALP and high PIV are more common in patients with right-sided colon cancer and MSI-H, who have poor nutritional and immune status, severe inflammation, larger tumors, deeper invasion, and predictive value for MSI-H, which can assist in the formulation of clinical treatment plans to a certain extent.
Objective To investigate different gases and hematocrits on cerebral injury during deep hypothermic circulatory arrest (DHCA) in a piglet model including monitoring by near-infrared spectroscopy (NIRS). Methods Twenty-four piglets were assigned to 4 groups with respect to different blood gas and hematocrit during DHCA. Group A: hematocrit was maintained between 0.25 to 0.30, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group B: hematocrit was maintained between 0.25 to 0.30 and alpha stat strategy; group C: hematocrit was maintained between 0.20 to 0.25, pH-stat strategy during cooling phases and alpha stat strategy in other phases; group D: hematocrit was maintained between 0.20 to 0.25 and alpha stat strategy. Cerebral oxygenations of piglets were monitored continuously by NIRS. The brain was fixed in situ at 6 hours after operation and a histological score for neurological injury was assessed. Results Oxygenated hemoglobin (HbO2) and total hemoglobin (HbT) signals detected by NIRS were significantly lower in group D than those in group A and group B during cooling (Plt;0.05). Oxygenated hemoglobin nadir time was significantly shorter in group A(Plt;0.05). All piglets with oxygenated hemoglobin signal nadir time less than 25 minutes were free from histological evidence of brain injury. Conclusion Combination of pH-stat strategy and higher hematocrit reduces neurological injury after DHCA.
Objective Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (tHb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of tHb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery. Methods A retrospective study was conducted on patients who underwent coronary artery bypass graft (CABG) and/or valve replacement (VR) procedures from January 2014 to June 2016, using MedAssets discharge data. The patient population was sub-divided by the measurement modality (tHb and Hct), using detailed billing records and Current Procedural Terminology coding. Cost was calculated using hospital-specific cost-to-charge ratios. Multivariable logistic regression was performed to identify significant drivers of RBC transfusion and resource utilization. Results The study population included 18 169 cardiovascular surgery patients. Hct-monitored patients accounted for 66% of the population and were more likely to have dual CABG and VR procedures (10.4% vs. 8.9%, P=0.006 9). After controlling for patient and hospital characteristics, as well as patient comorbidities, Hct-monitored patients had significantly higher RBC transfusion risk (OR=1.26, 95%CI 1.15-1.38,P<0.000 1), longer LOS (IRR=1.08, P<0.000 1) and higher costs (IRR=1.15, P<0.000 1) than tHb-monitored patients. RBC transfusions were a significant driver of LOS (IRR=1.25, P<0.000 1) and cost (IRR=1.22, P<0.000 1). Conclusion tHb monitoring during cardiovascular surgery could offer a significant reduction in RBC transfusion, length of stay and hospital cost compared to Hct monitoring.
Objective To analyze the influencing factors of prognosis of patients with traumatic brain injury (TBI), and explore the influence of hemoglobin (Hb) level combined with blood pressure variability (BPV) on the quality of prognosis of patients with TBI. Methods The data of 186 TBI patients who received systemic treatment in the Affiliated Zhangjiagang Hospital of Soochow University between January 2020 and December 2021 were retrospectively analyzed. According to the Glasgow Outcome Scale (GOS) 3 months after treatment, they were divided into group A (GOS 4-5, 159 cases) and group B (GOS 1-3, 27 cases). The general clinical data, BPV indexes and Hb levels of the two groups were analyzed by single factor analysis and multiple logistic regression analysis, and the predictive value of the logistic regression model was evaluated by receiver operating characteristic (ROC) curve, sensitivity, specificity and area under the curve (AUC). Results There was no statistical significance in gender, age, body mass index, blood urea nitrogen, prothrombin time, fasting blood glucose level, or smoking history (P>0.05); the patients’ Glasgow Coma Scale at admission in group A was higher than that in group B (P<0.05), and the constituent ratio with a history of hypertension of group A was significantly lower than that of group B (P<0.05). The between-group differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and Hb at admission, and SBP, DBP, and MAP 72 h after treatment were not statistically significant (P>0.05); the SBP-standard deviation (SD), DBP-SD, SPB-coefficient of variation (CV) and DBP-CV of group B 72 h after treatment were significantly higher than those of group A (P<0.05), and the level of Hb was significantly lower than that of group A (P<0.05). Hb [odds ratio (OR)=0.787, 95% confidence interval (CI) (0.633, 0.978), P=0.031], SBP-CV [OR=1.756, 95%CI (1.073, 2.880), P=0.023] and DBP-CV [OR=1.717, 95%CI (1.107, 2.665), P=0.016] were all independent prognostic factors of TBI patients. The ROC showed that the combined index of BPV and Hb was more valuable than that of single prediction, with an AUC of 0.896 [95%CI (0.825, 0.935), P<0.05]. Conclusions Both BPV and Hb are independent factors affecting the prognosis of TBI patients, and their combined application can more effectively predict the prognosis of TBI patients. Therefore, when treating and evaluating the prognosis of TBI patients, closely monitoring the changes in blood pressure and Hb levels can timely and effectively control the development of the disease, and provide scientific reference for subsequent treatment.
ObjectiveTo explore the association between glycosylated hemoglobin level and poor prognosis in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis.MethodsThe AIS patients treated with recombinant tissue-type plasminogen activator who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Henan University of Science and Technology from September to December 2020 were retrospectively included. According to different levels of glycosylated hemoglobin, they were divided into pre-diabetic group (5.7%≤glycated hemoglobin≤6.4%), diabetic group (previously diabetic or glycosylated hemoglobin≥6.5%), and non-diabetic group (glycated hemoglobin <5.7%). The relevant information of the patients was collected, and a telephone follow-up was conducted 90 days after discharge. According to the modified Rankin Scale (mRS) score, the patients were divided into the good prognosis group (mRS score≤2) and the poor prognosis group (mRS score>2). Logistic regression analysis was used to determine the risk factors for the poor prognosis of intravenous thrombolysis in patients with AIS.ResultEventually 101 patients were included, including 44 in the non-diabetic group, 24 in the pre-diabetic group, and 33 in the diabetic group. And 64 patients were in the good prognosis group and 37 patients were in the poor prognosis group. Regression analysis results showed that diabetes was associated with poor prognosis 3 months after intravenous thrombolysis in patients with AIS [odds ratio=6.518, 95% confidence interval (1.568, 27.096), P=0.010]; and the higher the National Institutesof Health Stroke Scale score at admission was, the higher the risk of poor prognosis would be [odds ratio=1.421, 95% confidence interval (1.231, 1.640), P<0.001].ConclusionIn AIS patients who received intravenous thrombolysis, diabetes is associated with poor prognosis after 3 months.
Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.