目的：探讨不同糖化血红蛋白（ HbA1c）水平对2型糖尿病（ T2DM）患者红细胞及胞内血红蛋白（Hb）的影响。方法：选取健康人30名为对照组（H组），T2DM患者102例，按HbA1c水平分为3组：血糖控制良好组（A组）30例（HbA1c ＜7.0％）；血糖控制较差组（B组）36例（7.0％≤HbA1c＜9.0％）；持续高血糖组（C组）36例（ HbA1 c≥9.0％）。利用新型静态显微图像分析技术和紫外-可见光谱技术，对各组红细胞及胞内Hb进行检测。结果：与H组比较，A、B、C组红细胞的圆度因子明显增大（ P＜0.05）且与HbA1 c水平呈正相关；B组红细胞的截面积和C组红细胞的全部形态参数均较H组明显增大（ P＜0.05）；A、B、C组，除A、B组间红细胞长短轴参数无显著差异，其它组间参数比较差异有统计学显著性。与H组比较，A、B、C组Hb的紫外-可见光谱的谱型和谱峰未出现明显差异，但B、C组Hb的吸光度较H组明显下降（P＜0.01），且C组Hb的吸光度也明显低于A组（P＜0.05），随HbA1c水平的升高呈逐渐下降趋势。结论：随HbA1c水平的升高，T2DM患者红细胞的形态发生改变，变形功能逐渐减弱，胞内Hb的结构可能发生改变。%AIM:To explore the effect of HbA1c level in the patients with type 2 diabetes mellitus (T2DM) on the rheological properties of erythrocytes and the structure of hemoglobin (Hb).METHODS:The patients with T2DM were classified into 3 groups:the patients with good glycaemic control (group A, HbA1c<7.0%), the patients with poor glycaemic control (group B, 7.0%≤HbA1c<9.0%) and the patients with persistent hyperglycemia (group C, HbA1c≥9.0%) .The rheological properties of a single living erythrocyte were analyzed by the techniques of static imaging and anal -ysis.Ultraviolet-visible spectroscopy was used to study the structure of Hb .RESULTS: Compared with group H , the roundness effect factor (REF) of erythrocytes, which was positively related with HbA1c level, was significantly increased in groups A, B and C (P<0.05).The contact area of erythrocytes in group B and all the morphological parameters of erythrocytes in group C were significantly higher than those in group H ( P <0.05 ) .There were significant differences among groups A , B and C in deformation capacity and elastic parameters of the cell membrane ( P<0.05 ) , but with no difference in the long axis and short axis between group A and group B .Compared with group H , no obvious change in the spectral pattern and spectrum peak of Hb in groups A , B and C was observed.However, the absorbance of Hb, which showed a trend of gradual decline with the increase in HbA 1c level, in group B and group C was significantly decreased as compared with group H (P<0.01), and the Hb absorbance in group C were also lower than that in group A (P<0.05). CONCLUSION:With the increase in HbA1c level, the morphology along with the deformation function of erythrocytes in T2DM changes and declines gradually , and the structure of Hb may also change .
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