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題 名 | Falsely Low Hemoglobin A1c Values in Diabetic Patients Receiving Peginterferon-alpha and Ribavirin for Chronic Hepatitis C=以長效型干擾素(Peginterferon-alpha)及雷巴威林(Ribavirin)治療慢性C型肝炎造成糖尿病患假性偏低的糖化血色素值 |
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作 者 | 戴研光; 黃秋玲; 簡誌銘; 蔡青陽; 羅海韻; | 書刊名 | 內科學誌 |
卷 期 | 22:6 2011.12[民100.12] |
頁 次 | 頁431-437 |
分類號 | 418.285 |
關鍵詞 | 長效型干擾素; 雷巴威林; 慢性C型肝炎; 糖尿病; 糖化血色素; Hemoglobin A1c; Diabetes mellitus; Chronic hepatitis C; Ribavirin; Hemolytic anemia; |
語 文 | 英文(English) |
中文摘要 | 由於紅血球的生命周期變短,溶血性貧血會造成假性偏低的糖化血色素值。目前,長效型干擾素(peginterferon-alpha)加上抗病毒藥雷巴威林(Ribavirin)是慢性C型肝炎的標準治 療,其中的雷巴威林會引起可逆性的溶血性貧血。本研究目的在評估雷巴威林的治療對糖尿病患糖化血色素值的影響程度。我們採回溯性方法找出27 位接受過長效型干擾素及雷巴威林治療至少12 週以上的糖尿病患作為研究對象。每位病患必需於治療前,治療中及治療後各有至少一次的糖化血色素,空腹血糖,血色素,肝功能(GPT)及總膽紅素值。在接受C肝治療期間,平均血色素從治療前的14.0 g/dL下降至最低點的10.2 g/dL(p < 0.001)。平均糖化血色素值從治療前的7.1%降低至治療中的6.1%(p = 0.023);反之,對應的空腹血糖值則無顯著的改變 (p = 0.89)。此外,肝功能(GPT)從治療前的129 U/L改善至64 U/L(p < 0.001);同時間的總膽紅素則從0.82 mg/dL上升至1.08 mg/dL(p = 0.016),這個結果支持溶血性貧血的診斷。 本研究顯示以長效型干擾素及雷巴威林治療慢性C型肝炎並未影響糖尿病患的空腹血糖值,卻造成糖化血色素值顯著的下降了1.0%,這可能與雷巴威林治療引起的溶血性貧血有關。假性偏低的糖化血色素值可能導致臨床醫師鬆懈了對血糖的控制,因此建議,在糖尿病患接受雷巴威林治療慢性C型肝炎期間,不應以糖化血色素值來指引糖尿病的治療。 |
英文摘要 | Hemoglobin A1c (A1C) values are usually lower during hemolysis because of the shortened red cell survival. Ribavirin (RBV) used in combination with peginterferon-alpha (peg-IFN) for chronic hepatitis C virus (HCV) infection causes reversible hemolytic anemia. This study was aimed to examine the effect of RBV treatment on A1C values in diabetic patients. A retrospective analysis identified 27 type 2 diabetic patients receiving peg-IFN and RBV for HCV. Each subject had at least three measures of hemoglobin (Hb), A1C, fasting plasma glucose, GPT and total bilirubin: before, during and after HCV therapy. During therapy, Hb levels decreased from 14.0 g/dL at baseline to a nadir of 10.2 g/dL (p < 0.001). A1C values decreased from a pre-treatment level of 7.1% to the lowest on-treatment level of 6.1% [mean paired difference: -1.0%; 95% confidence interval (CI) -1.93 to -0.11; p = 0.023]. In contrast, matched fasting plasma glucose levels did not change significantly (mean paired difference: -4.4 mg/dL; 95% CI -26.9 to 18.2; p = 0.89). In addition, GPT decreased from a pre-treatment level of 129 U/L to an on-treatment level of 64 U/L (p < 0.001); simultaneously measured total bilirubin increased from 0.82 mg/dL to 1.08 mg/dL (p = 0.016) supporting the occurrence of hemolysis. In conclusion, HCV therapy with peg-IFN plus RBV caused a significant fall in A1C values without a change to fasting plasma glucose levels in diabetic patients. The mean reductions of A1C values by 1.0% might be mostly caused by RBV-induced hemolysis. Falsely low A1C values may lead the clinicians to relax glycemic control inappropriately. Therefore, A1C should not be used to guide diabetes therapy during HCV treatment with RBV. |
本系統中英文摘要資訊取自各篇刊載內容。