Glycated (glycosylated) hemoglobin yog ib feem ntawm tag nrho hemoglobin circulating hauv cov ntshav uas khi rau cov piam thaj. Qhov ntsuas no yog ntsuas hauv%. Cov ntshav qab zib ntau dua, ntau dua cov hemoglobin yuav raug glycated. Qhov no yog ib qho kev ntsuas ntshav tseem ceeb rau ntshav qab zib lossis xav tias ntshav qab zib. Nws tau qhia tseeb qib nruab nrab ntawm cov piam thaj hauv ntshav ntshav dhau 3 lub hlis dhau los. Tso cai rau koj los kuaj ntshav qab zib hauv lub sijhawm thiab pib kho. Lossis tso siab rau tus neeg yog tias nws tsis muaj ntshav qab zib.
Glycated hemoglobin (HbA1C) - txhua yam koj xav paub:
- Yuav npaj thiab ua li cas kuaj cov ntshav no;
- Feem ntau ntawm glycated hemoglobin - lub rooj yooj yim;
- Glycated hemoglobin hauv cov poj niam cev xeeb tub
- Yuav ua li cas yog tias qhov txiaj ntsig nce;
- Kev kuaj mob ntshav qab zib, hom 1 thiab ntshav qab zib hom 2;
- Saib xyuas qhov ua tau zoo ntawm kev kho ntshav qab zib.
Nyeem kab lus!
Peb tam sim ntawd yuav tsum qhia meej tias HbA1C cov qauv zoo ib yam rau cov menyuam yaus. Qhov kev soj ntsuam no tuaj yeem siv los kuaj ntshav qab zib hauv menyuam yaus, thiab tseem ceeb tshaj plaws, los saib xyuas qhov kev ua tau zoo ntawm kev kho. Tus neeg mob ntshav qab zib feem ntau kho lawv lub siab ua ntej soj ntsuam ib txwm muaj, txhim kho lawv cov ntshav qab zib, thiab yog li ua rau lawv muaj kev tswj ntshav qab zib tau. Nrog glycated hemoglobin, xws li tus lej tsis ua haujlwm rau lawv. Qhov kev tsom xam no qhia tau meej tias tus neeg mob ntshav qab zib "tau ua txhaum" 3 lub hlis dhau los lossis tau coj kev ua "kev ncaj ncees". Saib cov lus "Tshooj 1 ntshav qab zib rau cov me nyuam thiab cov neeg hluas."
Lwm lub npe rau qhov ntsuas no:
- glycosylated hemoglobin;
- hemoglobin A1C;
- HbA1C;
- lossis tsuas yog A1C.
Kev kuaj ntshav rau glycated hemoglobin yooj yim rau cov neeg mob thiab kws kho mob. Nws muaj cov txiaj ntsig zoo dua ntawm qhov ntsuas cov ntshav qab zib kom yoo thiab dhau 2-teev cov ntsuas cov piam thaj hauv qab. Dab tsi yog cov zoo:
- tsom xam rau glycated hemoglobin tuaj yeem coj thaum lub sijhawm twg los tau, tsis tas yuav ntawm lub plab khoob;
- nws yog qhov tseeb ntau dua li kev sim ntshav ntsuas cov ntshav qab zib, tso cai rau koj kuaj ntshav qab zib ua ntej;
- nws nrawm dua thiab yooj yim dua li 2-teev kev ntsuas lub suab qab zib;
- tso cai rau koj kom teb meej cov nqe lus nug seb tus neeg puas muaj ntshav qab zib lossis tsis yog;
- pab xyuas kom paub tias cov ntshav qab zib tswj tau nws cov ntshav qab zib li cas 3 lub hlis dhau los;
- glycated hemoglobin tsis cuam tshuam los ntawm lub sijhawm nuances zoo li mob khaub thuas lossis xwm txheej ntxhov siab.
Cov lus qhia zoo: thaum koj mus kuaj ntshav - tib lub sijhawm kuaj xyuas koj qib ntshav hemoglobin HbA1C.
Qhov kev tshuaj ntsuam no tau pom zoo los ntawm WHO txij li xyoo 2009 rau kev kuaj mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2, nrog rau kev soj ntsuam kom zoo rau kev kho mob.
Qhov txiaj ntsig ntawm qhov kev txheeb xyuas no TSIS YOG nyob ntawm:
- lub sij hawm ntawm ib hnub thaum lawv pub ntshav;
- yoo nws lossis tom qab noj mov;
- noj lwm yam tshuaj tsis yog tshuaj ntshav qab zib;
- kev siv lub cev;
- kev xav hauv lub xeev ntawm tus neeg mob;
- mob khaub thuas thiab lwm yam mob.
Vim li cas thiaj li kuaj ntshav rau glycated hemoglobin
Qhov ib, txhawm rau kuaj ntshav qab zib lossis ntsuas qhov pheej hmoo rau tus neeg kom muaj ntshav qab zib. Thib ob, txhawm rau kom ntsuas cov ntshav qab zib kom tus neeg mob tswj tau tus mob thiab tswj ntshav qab zib kom nyob li qub.
Txog kev kuaj mob ntshav qab zib, qhov ntsuas no tau siv tiav (raws li kev pom zoo los ntawm World Health Organization) txij li xyoo 2011, thiab nws tau yooj yim rau cov neeg mob thiab cov kws kho mob.
Feem ntau ntawm glycated hemoglobin
Qhov tshwm sim ntawm kev tsom xam,% | Nws txhais li cas |
|---|---|
< 5,7 | Nrog rau cov carbohydrate metabolism koj tsis tau zoo, kev muaj mob ntshav qab zib muaj tsawg heev |
5,7-6,0 | Tsis muaj mob ntshav qab zib, tab sis nws txoj kev pheej hmoo nce ntxiv. Nws yog lub sijhawm hloov mus rau kev noj zaub mov kom tsawg los ntawm kev tiv thaiv. Nws kuj yog tsim nyog nug tias dab tsi ua mob metabolic syndrome thiab insulin tsis kam. |
6,1-6,4 | Kev phom sij ntawm ntshav qab zib yog siab tshaj plaws. Hloov mus rau txoj kev ua neej noj qab nyob zoo thiab, tshwj xeeb, kom cov zaub mov tsis muaj roj ntau ntau. Tsis pom qhov twg yuav muab tso tawm. |
≥ 6,5 | Kev kuaj pom ua ntej yog ua mob ntshav qab zib mellitus. Nws yog ib qho tsim nyog yuav tsum tau ua cov kev ntsuam xyuas ntxiv kom paub meej lossis rov ua haujlwm rau nws. Nyeem kab lus “Kev kuaj mob ntawm hom 1 thiab hom 2 ntshav qab zib.” |
Qhov qis dua theem ntawm glycated hemoglobin hauv tus neeg mob, qhov zoo dua nws cov ntshav qab zib tau raug them rov qab hauv 3 lub hlis dhau los.
Kev sib raug zoo ntawm HbA1C rau cov ntshav qabzib feem ntau hauv cov ntshav ntshav tau li 3 lub hlis
| HbA1C,% | Cov piam thaj, mmol / L | HbA1C,% | Cov piam thaj, mmol / L |
|---|---|---|---|
| 4 | 3,8 | 8 | 10,2 |
| 4,5 | 4,6 | 8,5 | 11,0 |
| 5 | 5,4 | 9 | 11,8 |
| 5,5 | 6,5 | 9,5 | 12,6 |
| 6 | 7,0 | 10 | 13,4 |
| 6,5 | 7,8 | 10,5 | 14,2 |
| 7 | 8,6 | 11 | 14,9 |
| 7,5 | 9,4 | 11,5 | 15,7 |
Kev kuaj ntshav rau glycated hemoglobin: qhov zoo thiab tsis zoo
Kev kuaj ntshav rau HbA1C, piv nrog kev ntsuas cov ntshav qab zib, muaj ntau qhov zoo:
- ib tug neeg tsis tas yuav muaj lub plab khoob;
- cov ntshav tso tau yooj yim tso rau hauv lub raj ntsuas kom txog thaum muaj kev soj ntsuam tam sim ntawd (preanalytical stability);
- yoo plasma ntshav qab zib tuaj yeem sib txawv heev vim kev ntxhov siab thiab kev kis kab mob, thiab glycated hemoglobin yuav ruaj khov dua
Kev kuaj ntshav rau glycated hemoglobin tso cai rau koj los kuaj ntshav qab zib thaum ntxov, thaum kev txheeb xyuas cov ntshav qab zib tseem qhia tau tias txhua yam ua haujlwm.
Qhov tsis zoo ntawm kev kuaj ntshav glycated hemoglobin:
- tus nqi ntau dua piv rau kev kuaj ntshav hauv ntshav hauv ntshav (tab sis sai thiab yooj yim!);
- hauv qee tus neeg, qhov kev sib txheeb ze ntawm qib HbA1C thiab qhov piam thaj hauv nruab nrab yog txo qis;
- nyob rau hauv cov neeg mob uas mob ntshav tsis txaus thiab hemoglobinopathies, cov kev tshuaj ntsuam tau cuam tshuam;
- hauv qee thaj tsam ntawm lub tebchaws, cov neeg mob yuav tsis muaj chaw sim rau qhov ntsuas no;
- nws xav tias yog tias ib tus neeg noj tshuaj vitamin C thiab / lossis E ntau dua, ces nws tus nqi ntawm glycated hemoglobin yog dag ntxias qis (tsis muaj pov thawj!);
- cov theem ntawm cov thyroid hormones tsawg yuav ua rau HbA1C nce, tab sis cov ntshav qab zib tsis nce ntxiv.
Yog tias koj txo qis HbA1C tsawg kawg 1%, qhov pheej hmoo ntawm cov ntshav qab zib yuav txo qis npaum li cas:
| Yam 1 ntshav qab zib | Retinopathy (tsis pom kev) | 35% ↓ |
| Neuropathy (lub paj hlwb, ceg) | 30% ↓ | |
| Ntshav cov ntshav (raum) | 24-44% ↓ | |
| Mob ntshav qab zib Hom 2 | Tag nrho cov teeb meem micro-vascular | 35% ↓ |
| Mob ntshav qab zib-txog kev tuag | 25% ↓ | |
| Myocardial infarction | 18% ↓ | |
| Tag nrho cov neeg tuag | 7% ↓ |
Glycated hemoglobin thaum cev xeeb tub
Glycated hemoglobin thaum cev xeeb tub yog ib qho kev sim uas yuav ua tau los tswj ntshav qab zib. Txawm li cas los xij, qhov no yog qhov kev xaiv tsis zoo. Thaum cev xeeb tub, nws zoo dua tsis txhob pub ntshav glycated hemoglobin, tab sis kom kuaj xyuas tus poj niam cov ntshav qab zib hauv lwm txoj kev. Cia peb piav qhia vim li cas qhov no thiaj yog, thiab tham txog cov kev xaiv kom raug dua.
Dab tsi yog qhov phom sij ntawm cov piam thaj ntau ntxiv hauv cov poj niam cev xeeb tub? Ua ntej tshaj plaws, qhov tseeb tias tus me nyuam hauv plab loj dhau, thiab vim qhov no yuav muaj kev yug me nyuam nyuaj. Txoj kev pheej hmoo rau leej niam thiab tus me nyuam nce ntxiv. Tsis hais txog qhov yuav tshwm sim ntev ntev rau ib qho ntawm lawv. Muaj ntshav qab zib ntau ntxiv thaum cev xeeb tub ua rau cov hlab ntshav, raum, qhov muag pom, thiab lwm yam Cov txiaj ntsig ntawm qhov no yuav tshwm sim tom qab. Muaj menyuam yog ib nrab ntawm kev sib ntaus sib tua. Nws yog tsim nyog tias nws tseem muaj kev noj qab haus huv txaus nws loj ...
Cov piam thaj hauv ntshav thaum cev xeeb tub tuaj yeem nce ntxiv txawm tias cov poj niam uas tsis tau yws yws txog lawv txoj kev noj qab haus huv ua ntej. Muaj ob qho tseem ceeb nuances ntawm no:
- Cov piam thaj ntau tsis ua rau muaj mob dabtsi. Feem ntau tus poj niam tsis xav tias muaj dab tsi, txawm hais tias nws muaj txiv hmab txiv ntoo loj heev - loj heev uas hnyav 4-4,5 kg.
- Qab zib nce tsis nyob ntawm lub plab khoob, tab sis tom qab noj mov. Tom qab noj mov tas, nws cia kom tau nce li 1-4 teev. Lub sijhawm no, nws tabtom ua nws txoj haujlwm rhuav tshem. Fasting suab thaj yog feem ntau ib txwm. Yog tias cov piam thaj yog tsa rau ntawm lub plab khoob, ces qhov teeb meem no yuav phem heev.
Vim li cas thiaj li kuaj ntshav rau glycated hemoglobin kuj tsis haum? Vim tias nws hnov mob heev. Glycated hemoglobin hlob zoo tsuas yog tom qab cov ntshav qab zib tau cia kom nce hauv 2-3 lub hlis. Yog tias tus poj niam nce qab zib, ces qhov no feem ntau tsis tshwm sim ntxov dua li 6 lub hlis ntawm kev xeeb tub. Hauv qhov no, glycated hemoglobin yuav nce ntxiv tsuas yog 8-9 lub hlis, twb dhau los ua ntej khoom xa tuaj. Yog tias tus poj niam cev xeeb tub tsis tswj nws cov piam thaj ua ntej, tom qab ntawd yuav muaj qhov tsis zoo rau nws thiab nws tus menyuam.
Yog tias glycated hemoglobin thiab qhov kev kuaj ntshav ntawm cov ntshav qab zib tsis haum, tom qab ntawd yuav kuaj xyuas cov piam thaj hauv cov poj niam cev xeeb tub li cas? Teb: nws yuav tsum tau kuaj xyuas tom qab noj mov tas li txhua 1-2 asthiv. Txhawm rau ua qhov no, koj tuaj yeem coj mus kuaj ntshav ntev li 2-teev nyob hauv chav kuaj. Tab sis qhov no yog qhov xwm txheej ntev thiab laj siab. Nws yooj yim los yuav qhov ntsuas cov ntshav qab zib hauv tsev thiab ntsuas ntsuas qab zib 30, 60 thiab 120 feeb tom qab noj mov. Yog tias cov txiaj ntsig tsis siab tshaj 6.5 mmol / l - zoo heev. Hauv qhov ntau ntawm 6.5-7.9 mmol / l - siab ntev. Los ntawm 8.0 mmol / l thiab siab dua - tsis zoo, koj yuav tsum ntsuas kom txo cov suab thaj.
Khaws cov zaub mov uas tsis muaj carbohydrate tsawg, tab sis noj txiv hmab txiv ntoo, carrots, thiab beets txhua hnub los tiv thaiv ketosis. Nyob rau tib lub sijhawm, cev xeeb tub tsis yog lub laj thawj tso cai rau koj tus kheej kom noj ntau nrog cov khoom qab zib thiab hmoov. Xav paub ntaub ntawv ntau ntxiv, saib cov lus txog Kev Xeeb Mob Ntshav Qab Zib thiab Ntshav Qab Zib Gestational.
HbA1C cov hom phiaj mob ntshav qab zib
Cov lus pom zoo tshaj plaws rau cov neeg mob ntshav qab zib yog kom ua tiav thiab tau txais HbA1C qib <7%. Hauv qhov no, ntshav qab zib tau txiav txim siab hais tias them nyiaj tau zoo, thiab qhov ntxim nyiam ntawm qhov muaj teeb meem tsawg tsawg. Tau kawg, nws tseem zoo dua yog tias glycated hemoglobin Performance index yog nyob rau hauv ib txwm muaj rau cov neeg muaj kev noj qab haus huv, i.e., HbA1C <6.5%. Txawm li cas los xij, Dr. Bernstein ntseeg hais tias txawm tias muaj ntshav glycated hemoglobin ntawm 6.5%, ntshav qab zib tsis tau them tsawg, thiab nws cov kev mob tshwm sim sai heev. Hauv kev noj qab haus huv, cov neeg nyias nyias nrog rau kev noj cov zaub mov uas muaj carbohydrate metabolism, glycated hemoglobin feem ntau yog 4.2-4.6%. Qhov no sib raug rau ib qho ntshav qabzib feem ntau ntawm 4-4.8 mmol / L. Nov yog lub hom phiaj uas peb yuav tsum siv zog rau kev kho mob ntshav qab zib, thiab qhov no yeej tsis yooj yim rau qhov ua tiav yog tias koj hloov mus rau kev noj haus uas tsis muaj cov carbohydrate ntau rau cov ntshav qab zib hom 1 lossis hom 2.
Qhov teeb meem yog tias qhov ua kom zoo dua rau tus neeg mob ntshav qab zib tau them rov qab, ntau dua qhov muaj feem yuav ua rau muaj kev mob ntshav qab zib sai thiab ua rau nws lub siab tsis zoo. Sim tswj hwm nws cov ntshav qab zib, tus neeg mob yuav tsum tswj kom nws lub cev sib luag kom zoo li qhov xav tau kom muaj ntshav qab zib kom tsawg thiab muaj kev hem thawj rau lub qog ntshav qab zib. Nov yog yam txuj ci ua uas neeg mob ntshav qab zib kawm paub thiab coj ua thoob plaws nws lub neej. Tab sis yog tias koj ua raws li qab qab thiab muaj zaub mov tsis muaj roj ntau ntau, ces lub neej tam sim ntawd yooj yim dua. Vim tias cov khoom noj carbohydrates tsawg koj tau noj tsawg dua koj yuav xav tau cov tshuaj insulin lossis txo cov ntshav qab zib. Thiab cov tshuaj insulin tsawg dua, qhov tsawg dua yuav muaj kev puas ntshav siab. Yooj yim thiab siv tau.
Rau cov neeg laus nrog lub neej kev cia siab tsawg dua 5 xyoos, tus nqi ntawm glycated hemoglobin yog suav tias yog 7.5%, 8% lossis ntau dua. Hauv pab pawg ntawm cov neeg mob no, qhov kev pheej hmoo ntawm cov ntshav qog ntshav qab zib yog qhov muaj kev phom sij ntau dua li qhov yuav ua rau muaj mob ntshav qab zib sai. Tib lub sijhawm, cov menyuam yaus, cov hluas, cov poj niam cev xeeb tub, thiab cov tub ntxhais hluas tau hais qhia kom sim thiab ua kom lawv tus nqi HbA1C <6.5%, lossis zoo dua, qis dua 5%, raws li Dr. Bernstein qhia.
Algorithm rau cov kev xaiv cov hom phiaj kho mob ntshav qab zib hom HbA1C
| Kev ntsuas | Lub hnub nyoog | ||
|---|---|---|---|
| hluas | qhov nruab nrab | cov laus thiab / lossis cov muaj sia tag nrho * <5 xyoos | |
| Tsis muaj mob hnyav los yog pheej hmoo ntawm cov ntshav qog ntshav qab zib siab heev | < 6,5% | < 7,0% | < 7,5% |
| Kev mob nyhav lossis pheej hmoo ua rau ntshav nce siab qis | < 7,0% | < 7,5% | < 8,0% |
* Lub neej tos ntev - lub neej tos.
Cov ntshav qabzib ntshav hauv qab no thiab 2 teev tom qab noj mov (tom qab hloov) yuav sib haum rau cov ntshav glycated hemoglobin muaj nuj nqis:
| HbA1C,% | Yoo plasma cov piam thaj / ua ntej noj mov, mmol / l | Plasma cov piam thaj 2 teev tom qab noj mov, mmol / l |
|---|---|---|
| < 6,5 | < 6,5 | < 8,0 |
| < 7,0 | < 7,0 | < 9,0 |
| < 7,5 | < 7,5 | <10,0 |
| < 8,0 | < 8,0 | <11,0 |
Kev tshawb fawb mus ntev hauv lub sijhawm xyoo 1990 thiab 2000s tau ua pov thawj tias qhov kev kuaj ntshav rau cov ntshav glycated hemoglobin pub rau kwv yees tias qhov muaj feem ua rau muaj ntshav qab zib tsis muaj teeb meem tsis zoo zuj zus thiab tseem zoo dua li kev yoo ntshav ntshav qabzib.
Ntev npaum li cas los kuaj ntshav rau glycosylated hemoglobin:
- Yog tias koj lub hemoglobin HbA1C qis dua 5.7%, nws txhais tau hais tias koj tsis muaj ntshav qab zib thiab nws qhov kev pheej hmoo yog qhov tsis txaus ntseeg, yog li koj tsuas yog xav tswj cov ntsuas no txhua peb lub xyoos.
- Koj qib glycosylated hemoglobin yog nyob nruab nrab ntawm 5.7% - 6.4% - rov noj dua txhua xyoo vim tias muaj kev pheej hmoo mob ntshav qab zib. Nws txog sijhawm uas koj yuav pauv mus rau qhov kev noj haus cov zaub mov tsis muaj rog kom tiv thaiv tau ntshav qab zib.
- Koj muaj ntshav qab zib, tab sis koj tswj nws zoo, i.e. HbA1C tsis tshaj 7%, - hauv qhov xwm txheej no, cov kws kho mob qhia kom rov ua dua tshiab txhua rau lub hlis.
- Yog tias koj nyuam qhuav pib kho koj cov ntshav qab zib lossis hloov koj cov kev kho mob, lossis yog tias koj tseem tsis tuaj yeem tswj ntshav qab zib tau zoo, ces koj yuav tsum ua tib zoo kuaj HbA1C txhua peb lub hlis.
Peb pom zoo kom cov neeg mob mus kuaj ntshav rau glycosylated hemoglobin thiab lwm yam kev kuaj ntshav thiab zis - tsis yog nyob hauv cov tsev koom pej xeem, tab sis nyob hauv chaw soj ntsuam kuaj ntiag tug. Nws yog qhov tsim nyog nyob rau hauv "network" cov tuam txhab, uas yog, nyob rau hauv lub teb chaws loj lossis txawm tias chaw kuaj thoob ntiaj teb. Vim tias muaj kev cia siab ntau dua uas qhov kev txheeb xyuas qhov tseeb yuav ua tiav rau koj, ntau dua li sau qhov tshwm sim "los ntawm lub qab nthab".
