Objective: To compare the effects of different hemolytic diseases on the level of glycosylated hemoglobin (HbA(1c)) to further explore the relationship between HbA(1c) and laboratory indexes to disclose implications of HbA(1c) in hemolytic diseases. Methods: The distribution of 192 decreased HbA(1c) cases in 4 categories of hemolytic diseases was analyzed. Laboratory indexes related to hemolysis were tested and analyzed in each kind of disease, and relationship between laboratory indexes and HbA(1)c was statistically explored. Results: Diagnoses of decreased HbA(1c) cases mainly included erythrocyte membranopathies (88 cases), immunohemolytic anemia (72 cases), hemoglobinopathy (4 cases) and erythrocyte enzymopathy (5 cases). The distribution of HbA(2) and normal HbF subjects in immunohemolytic anemia and hemoglobinopathy was significantly different from those of HbA(2) and / or abnormal HbF subjects (41.7% vs 22.0%, χ(2)=5.574, P=0.018; 0.7% vs 7.3%, P=0.031). Compared with non-hemolytic disease patients, those who suffered from 4 categories of hemolytic diseases showed lower HbA(1c) level and higher reticulocyte percentage (Ret), indirect bilirubin (IBIL) and free hemoglobin (F-Hb). Different levels of Ret, reticulocyte hemoglobin content (Ret-He), mean corpuscular volume (MCV), IBIL and F-Hb among the 4 kinds of diseases were observed, but the causes of the differences were not the same. HbA(1c) was negatively correlated with other laboratory indexes in erythrocyte membranopathies and immunohemolytic anemia. Conclusions: Hemolytic disease resulted in false lower HbA(1c), but impact of difference on HbA1c between different diseases was not significant. HbA(1c) was closely connected to laboratory indexes related to hemolysis, which might have potential implications for hemolytic diseases such as erythrocyte membranopathies and immunohemolytic anemia.
目的： 观察溶血性疾病相关糖化血红蛋白（HbA(1c)）降低患者的临床及实验室特征，探讨HbA(1c)与溶血相关实验室指标的关系，发掘其对溶血性疾病的提示意义。 方法： 回顾性分析2016年10月至2017年11月192例HbA(1c)降低血液病患者临床资料，比较各类疾病溶血相关实验室指标的检测数据，分析HbA(1c)和溶血相关实验室指标的关系。 结果： HbA(1c)降低病例的诊断主要包括红细胞膜病（88例）、免疫性溶血性贫血（72例）、血红蛋白病（4例）和红细胞酶病（5例），其中HbA(2)和HbF正常者与HbA(2)和（或）HbF异常升高者在免疫性溶血性贫血（41.7%对22.0%，χ(2)=5.574，P=0.018）和血红蛋白病（0.7%对7.3%，P=0.031）中的分布差异有统计学意义。相对于非溶血性疾病患者，溶血性疾病患者显示出HbA(1c)降低和网织红细胞比值（Ret）、间接胆红素（IBIL）、游离血红蛋白（F-Hb）升高的趋势，Ret、网织红细胞血红蛋白含量（Ret-He）、平均红细胞体积（MCV）、IBIL、F-Hb在不同溶血性疾病之间表现出了水平的差异，但造成差异的原因并不一致。在红细胞膜病和免疫性溶血性贫血中，HbA(1c)与其他各项实验室指标均呈现负相关趋势。 结论： 溶血性疾病可导致HbA(1c)假性降低，但不同病种对其影响程度的差异不显著。HbA(1c)与溶血相关实验室指标具有密切关系，对红细胞膜病和免疫性溶血性贫血等疾病具有潜在的提示意义。.
Keywords: Clinical feature; Glycosylated hemoglobin; Hemolytic disease; Laboratory feature.