{"id":9252,"date":"2020-04-23T04:32:41","date_gmt":"2020-04-23T01:32:41","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/hemoglobina-glicata-hb-a1c\/"},"modified":"2026-02-19T01:11:53","modified_gmt":"2026-02-18T23:11:53","slug":"hemoglobina-glicata-hb-a1c","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/hemoglobina-glicata-hb-a1c\/","title":{"rendered":"\u0413\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d HbA1c"},"content":{"rendered":"

Informatii generale si recomandari <\/em><\/strong>pentru determinarea HbA1c<\/em><\/strong>\u00a0<\/em><\/span><\/p>\n

Efectuarea glicemiei permite evaluarea statusului curent al metabolismului carbohidratilor la pacientii diabetici in momentul recoltarii probei de sange. Spre deosebire de aceasta, determinarea hemoglobinei glicate ofera o estimare retrospectiva a statusului glicemic, independenta de ritmul circadian, dieta si alte fluctuatii tranzitorii ale concentratiei glucozei in sange2;4;5<\/sup>.<\/span><\/p>\n

Importanta hemoglobinei glicate sau HbA1c ca marker al controlului glicemic la pacientii diabetici a fost evidentiata de rezultatele celor doua mari studii \u2013 DCCT (Diabetes Control and Complications Trial) si UKPDS (United Kingdom Prospective Diabetes Study). Acestea au demonstrat intr-un mod convingator efectul benefic al controlului glicemic intensiv atat asupra parametrilor metabolici (glicemia si HbA1c), cat si asupra complicatiilor pe termen lung (micro- si macrovasculare) ale diabetului zaharat de tip I sau II si au permis stabilirea unor tinte terapeutice specifice bazate pe HbA1c8<\/sup>.<\/span><\/p>\n

Termenul de \u201ehemoglobina glicata\u201d (GHb) descrie o varietate de compusi ce au in comun glicarea hemoglobinei \u2013 reactia de atasare non-enzimatica a glucozei sau a altor hexoze la molecula de hemoglobina. Glicarea se poate produce la mai multe reziduuri de aminoacizi din structura hemoglobinei si are loc in doua etape (vezi fig.1<\/em>):<\/span><\/p>\n

-condensarea glucozei cu gruparea amino libera a hemoglobinei genereaza o baza Schiff (aldimina instabila);<\/span><\/p>\n

-in urma fenomenului de rearanjare Amadori rezulta o ketoamina stabila (in cazul glucozei, fructozamina).<\/span><\/p>\n

\"hemoglobina\"hemoglobina<\/span><\/p>\n

Fig. 1 Glicarea hemoglobinei<\/span><\/p>\n

(Adaptare dupa Helmut R. Henrichs, HbA1c \u2013 Glycated Hemoglobin and Diabetes Mellitus<\/em>)<\/span><\/p>\n

Initial a fost larg utilizat termenul de \u201ehemoglobina glicozilata\u201d, insa tinandu-se cont de faptul ca reactiile de glicare se deosebesc din punct de vedere chimic de cele de glicozilare, IUPAC-IUB Joint Commission on Biochemical Nomenclature (JBCN) a recomandat termenul \u201ehemoglobina glicata\u201d pentru a descrie compusii mentionati mai sus5<\/sup>.<\/span><\/p>\n

HbA1 desemneaza cantitatea totala de hemoglobina glicata si o diferentieaza de hemoglobina A normala, non-glicata. Exista mai multe tipuri de HbA1; HbA1c, denumita astfel deoarece a constituit cel de-al treilea peak individual A1 la separarea cromatografica,\u00a0 s-a dovedit a fi fractiunea cea mai importanta a hemoglobinei glicate (75-80%). Conform definitiei IFCC (International Federation of Clinical Chemistry), HbA1c reprezinta hemoglobina glicata ireversibil la una sau ambele valine amino-terminale ale lanturilor \u03b2<\/span> (vezi fig.2<\/em>)4;5<\/sup>.<\/span><\/p>\n

\u00a0\"-\"<\/a><\/span><\/p>\n

\u00a0\"-\"<\/a><\/span><\/p>\n

\u00a0<\/span>Fig. 2 HbA1c<\/span><\/p>\n

(Adaptare dupa Garry John, IFCC, Achieving a Global Standardization of HbA1c: Not there yet<\/em>)<\/span>\u00a0<\/span><\/p>\n

Nivelul HbA1c din sange se coreleaza atat cu timpul de injumatatire a hemoglobinei cat si cu nivelul mediu al glucozei sangvine pe perioada duratei de viata a acesteia. Astfel, cresterea HbA1c este proportionala cu nivelul mediu al glucozei sangvine (glicemia medie) in cursul ultimelor 2-3 luni anterioare testarii (corespunzatoare duratei medii de viata a eritrocitelor)2;5;6<\/sup>.<\/span><\/p>\n

Un studiu recent (2006-2008), sponsorizat de principalele organizatii internationale de diabet, a definit mai exact relatia matematica intre HbA1c si glicemia medie estimata \u00a0(eAG=estimated average glucose). Pe baza unei analize de regresie lineara, aceasta relatie este definita prin ecuatia:<\/span><\/p>\n

\u00a0<\/span><\/p>\n

eAG (mg\/dL) = 28.7 x HbA1c-46.7<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Este astfel posibil ca pentru fiecare valoare a HbA1c sa fie stabilita glicemia medie (eAG) corespunzatoare5<\/sup>:<\/span><\/p>\n

\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
A1c<\/strong><\/span><\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 eAG\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/span><\/td>\n<\/tr>\n
%<\/span><\/td>\nmg\/dL<\/span><\/td>\nmmol\/L<\/span><\/td>\n<\/tr>\n
6<\/span><\/td>\n126<\/span><\/td>\n7<\/span><\/td>\n<\/tr>\n
6.5<\/span><\/td>\n140<\/span><\/td>\n7.8<\/span><\/td>\n<\/tr>\n
7<\/span><\/td>\n154<\/span><\/td>\n8.6<\/span><\/td>\n<\/tr>\n
7.5<\/span><\/td>\n169<\/span><\/td>\n9.4<\/span><\/td>\n<\/tr>\n
8<\/span><\/td>\n183<\/span><\/td>\n10.1<\/span><\/td>\n<\/tr>\n
8.5<\/span><\/td>\n197<\/span><\/td>\n10.9<\/span><\/td>\n<\/tr>\n
9<\/span><\/td>\n212<\/span><\/td>\n11.8<\/span><\/td>\n<\/tr>\n
9.5<\/span><\/td>\n226<\/span><\/td>\n12.6<\/span><\/td>\n<\/tr>\n
10<\/span><\/td>\n240<\/span><\/td>\n13.4<\/span><\/td>\n<\/tr>\n
11<\/span><\/td>\n269<\/span><\/td>\n14.9<\/span><\/td>\n<\/tr>\n
12<\/span><\/td>\n298<\/span><\/td>\n16.5<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/span><\/p>\n

Determinarea HbA1c constituie un test de evaluare si monitorizare pe termen lung a controlului glicemic la pacientii cu diabet zaharat. De asemenea are un rol predictiv in ceea ce priveste riscul complicatiilor diabetului: cetoacidoza, nefropatia, retinopatia. Poate evalua abordarea terapeutica cea mai eficienta: antidiabetice orale, insulina, transplant de celule \u03b2. Din aceste motive, HbA1c ar trebui efectuata de rutina la toti pacientii cu diabet, atat in momentul diagnosticului cat si ca parte a monitorizarii continue1;2;5;6<\/sup>.<\/span><\/p>\n

Majoritatea asociatiilor recomanda 6.5%<\/strong> \u0438\u043b\u0438 7% HbA1c<\/strong> ca tinta terapeutica pentru pacientii diabetici. Frecventa testarii HbA1c depinde de tipul de diabet si de stabilitatea controlului glicemic: <\/span><\/p>\n

    \n
  • \u00a0 la 3-4 luni, pentru pacientii cu diabet zaharat tip I sub tratament conventional;<\/span><\/li>\n
  • \u00a0 la 1-2 luni, pentru pacientii cu diabet zaharat tip I sub tratment intensiv;<\/span><\/li>\n
  • \u00a0 la 6 luni, pentru pacientii cu diabet zaharat de tip II cu un control glicemic stabil;<\/span><\/li>\n
  • \u00a0 la fiecare 1-2 luni pentru gravidele cu diabet zaharat;<\/span><\/li>\n
  • \u00a0 la fiecare 1-2 luni pentru pacientele cu diabet gestational1;2<\/sup>.<\/span><\/li>\n<\/ul>\n

    Desi inca din 1994 ADA (American Diabetes Association) a stabilit tinte terapeutice specifice pentru HbA1c, variabilitatea mare intre rezultatele obtinute prin metode diferite a limitat initial utilizarea adecvata a acestora de catre medicii clinicieni. \u00a0Pentru ca rezultatele HbA1c sa fie comparabile cu cele din studiile DCCT\/UKPDS si sa se realizeze astfel o standardizare a acestora, a fost implementat in 1996 programul NGSP (National Glycohemoglobin Standardization Program). Prin intermediul unei retele de laboratoare de referinta NGSP certifica\u00a0 metodele HbA1c ale diversilor producatori ca fiind trasabile la DCCT. Pentru asigurarea stabilitatii rezultatelor, NGSP recomanda ca producatorii sa isi certifice metodele anual8<\/sup>.<\/span><\/p>\n

    Pana recent nu s-a recomandat folosirea testului HbA1c in diagnosticul diabetului zaharat in principal datorita lipsei de standardizare a rezultatelor. \u00a0In 2010 insa, ADA a recomandat includerea HbA1c in criteriile de diagnostic ale diabetului la o valoare cut-off de 6.5%<\/strong> (testul trebuie sa fie efectuat printr-o metoda standardizata DCCT si certificata NGSP). In stabilirea acestei decizii au fost luate in considerare avantajele pe care le prezinta HbA1c fata de glicemie: <\/span><\/p>\n

      \n
    • Nu sunt necesare conditiile \u201ca jeun\u201d;<\/span><\/li>\n
    • Stabilitate preanalitica mai mare;<\/span><\/li>\n
    • Variatie biologica intraindividuala \u2193 in comparatie cu glicemia;<\/span><\/li>\n
    • Variatii \u2193 in conditii de stres si afectiuni intercurente.<\/span><\/li>\n<\/ul>\n

      Pe de alta parte, exista si unele dezavantaje ale HbA1c:<\/span><\/p>\n

        \n
      • Cost mai ridicat;<\/span><\/li>\n
      • Lipsa de disponibilitate a testului in unele tari\/regiuni;<\/span><\/li>\n
      • Lipsa de corelatie a HbA1c cu glicemia medie la unele persoane;<\/span><\/li>\n
      • HbA1c nu este relevanta la pacientii cu turn-over eritrocitar anormal<\/em> (anemii hemolitice, anemii feriprive); in aceste situatii diagnosticul diabetului trebuie sa se bazeze exclusiv pe valorile glicemiei.<\/span><\/li>\n<\/ul>\n

        De asemenea ADA a recomandat ca pacientii cu valori ale HbA1c\u00a0 cuprinse in intervalul 5.7-6.4%<\/strong> sa fie inclusi in categoria celor cu risc crescut pentru diabet, impreuna cu cei care prezinta glicemie bazala modificata (impaired fasting glucose=IFG) sau intoleranta la glucoza (impaired glucose tolerance=IGT)1<\/sup>.<\/span><\/p>\n

        Pregatire pacient <\/em><\/strong>-<\/em> Nu sunt necesare conditiile \u201ca jeun\u201d (pe nemancate)7<\/sup>.<\/span><\/p>\n

        Specimen recoltat <\/em><\/strong>-<\/em> sange venos7<\/sup>.<\/span><\/p>\n

        Recipient de recoltare <\/em><\/strong>-<\/em> vacutainer cu EDTA K37<\/sup>.<\/span><\/p>\n

        Cantitate recoltata <\/em><\/strong>-<\/em> cat permite vacuumul7<\/sup>.<\/span><\/p>\n

        Stabilitate proba <\/em><\/strong>-<\/em> 7 zile<\/em> la 2-8\u00b0C7<\/sup>.<\/span><\/p>\n

        Metoda <\/em><\/strong>- <\/em>i<\/span>munoturbidimetrica<\/span> (standardizata DCCT: Diabetes Control and Complications Trial si certificata NGSP: National Glycohemoglobin Standardization Program). Datorita specificitatii inalte a anticorpilor anti-HbA1c pentru o secventa de 4 aminoacizi de la capatul N-terminal al lantului \u03b2 in stare glicata, testul nu<\/span><\/strong> prezinta interferenta cu majoritatea hemoglobinelor patologice, cu hemoglobina carbamilata intalnita la pacientii uremici si nici cu hemoglobina acetilata generata de terapia cu aspirina. Testul masoara astfel HbA1c \u201cadevarata\u201d, conform definitiei IFCC. Determinarea HbA1c in sangele total hemolizat se bazeaza pe o reactie de inhibitie turbidimetrica: <\/span><\/p>\n

          \n
        • in prima etapa HbA1c din proba reactioneaza cu anticorpii anti-HbA1c si rezulta compexe antigen-anticorp solubile;<\/span><\/li>\n
        • in a doua etapa se adauga polihaptene ce reactioneaza cu anti-HbA1c in exces formand complexe anticorpi-polihaptene ce vor fi determinate imunoturbidimetric. <\/span><\/li>\n<\/ul>\n

          Concentratia de hemoglobina totala este determinata intr-un canal separat. In proba de sange hemolizata hemoglobina eliberata este convertita intr-un derivat cu un spectru de absorbtie caracteristic ce va fi masurat bicromatic;\u00a0 calculul HbA1c in procente este efectuat conform protocolului DCCT\/NGSP cu ajutorul unei formule de corectie:<\/span><\/p>\n

          \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 %HbA1c = (HbA1c\/Hb) x 91.5 + 2.157<\/sup>.<\/span><\/p>\n

          \u00cen laboratorul central Synevo, detec\u021bia hemoglobinei glicate (Hb A1c ) se efectueaz\u0103 prin metoda HPLC (High \u2013 Performance Liquid Chromatography assay).<\/strong><\/p>\n

          Valori de referinta si <\/i><\/b>interpretarea rezultatelor<\/i><\/b><\/p>\n

          Interpretarea rezultatelor conform ADA:<\/span><\/p>\n

          \u2013 normal: 4.8-5.6%<\/p>\n

          \u2013 risc crescut de a dezvolta diabet: 5.7-6.4%<\/p>\n

          \u2013 diabet zaharat: >=6.5%<\/p>\n

          Tinta terapeutica la pacientii diabetici: <=7%1<\/sup>.<\/p>\n

          Observatii:<\/span><\/p>\n

          \u2022\u00a0 Cresterea Hb A1c\u00a0indica prezenta unei hiperglicemii \u00een ultimele 2-3 luni;<\/p>\n

          \u2022\u00a0 Valorile sunt crescute la persoanele cu diabet zaharat controlat deficitar sau nou diagnosticat;<\/p>\n

          \u2022\u00a0 Nivelul Hb A1c\u00a0poate creste p\u00e2n\u0103 la 20% in cazul unui control glicemic deficitar;<\/p>\n

          \u2022 \u00a0Scaderea HbA1c are loc treptat, pe durata mai multor luni, pe masura ce hematiile cu hemoglobina glicata normal le \u00eenlocuiesc pe cele cu niveluri crescute2;6<\/sup>.<\/p>\n

          \u2022\u00a0 Un rezultat crescut obtinut la un pacient asimptomatic trebuie repetat pentru confirmarea diagnosticului de diabet zaharat1<\/sup>.<\/p>\n

          Limita de detectie<\/i><\/b> \u2013 HbA1c: 0.2 g\/dL (0.124 mmol\/L)<\/p>\n

          \u2013 Hb 0.3 g\/dL (0.186 mmol\/L)7<\/sup>.<\/p>\n

          Interpretarea rezultatelor<\/em><\/strong><\/span><\/p>\n

          \u2022\u00a0 cresterea Hb A1c\u00a0indica prezenta unei hiperglicemii in ultimele 2-3 luni;<\/span><\/p>\n

          \u2022\u00a0 valorile sunt crescute la persoanele cu diabet zaharat controlat deficitar sau nou diagnosticat; <\/span><\/p>\n

          \u2022\u00a0 diabetul zaharat este controlat adecvat cand se obtin valori sub 7%6<\/sup>;<\/span><\/p>\n

          \u2022\u00a0 nivelul Hb A1c\u00a0poate creste pana la 20% in cazul unui control glicemic deficitar;<\/span><\/p>\n

          \u2022 \u00a0scaderea HbA1c are loc treptat, pe durata mai multor luni, pe masura ce hematiile cu hemoglobina glicata normal le inlocuiesc pe cele cu niveluri crescute2<\/sup>.<\/span><\/p>\n

          Un rezultat crescut obtinut la un pacient asimptomatic trebuie repetat pentru confirmarea diagnosticului de diabet zaharat1<\/sup>.<\/span><\/p>\n

          Limite si interferente\u00a0<\/em><\/strong><\/span><\/p>\n

          In afara diabetului zaharat, cresteri<\/em> ale HbA1c pot sa mai apara si in urmatoarele situatii: anemie feripriva, post-splenectomie, policitemie (datorita unei oarecare prelungiri a duratei de viata a eritrocitelor). <\/span><\/p>\n

          Scaderi<\/em> pot fi intalnite in sarcina, pierderi cronice de sange, posttransfuzional si in anemiile hemolitice (datorita scaderii duratei de viata a hematiilor si reducerii consecutive a expunerii la glucoza)2;6<\/sup>. <\/span><\/p>\n

          \u2022 Medicamente<\/span><\/p>\n

          Cresteri<\/span><\/strong>: aspirina, atenolol, betablocante, gemfibrozil, hidroclorotiazida, indapamid, lovastatin, nicardipin, propranolol3<\/sup>.<\/span><\/p>\n

          Scaderi<\/span><\/strong>: deferoxamil, diltizem, enalapril, glipizid, insulina, lisinopril, metformin, pravastatin, ramipril, verapamil3<\/sup>.<\/span><\/p>\n

          \u2022 Interferente analitice: in cazuri foarte rare, la pacientii cu gamapatii monoclonale, in special de tip IgM (boala Waldenstr\u00f6m) rezultatele obtinute pot fi neconcludente7<\/sup>.<\/span><\/p>\n

          \u00a0<\/span><\/p>\n

          \u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n

          1. American Diabetes Association. Standards of Medical Care in Diabetes. In Diabetes Care, vol.34, supplement 1, January 2011.<\/span><\/p>\n

          2. Frances Fischbach. Chemistry studies. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams & Wilkins, USA, 8 Ed., 2009, 355-359.<\/span><\/p>\n

          3. Frances Fischbach. Effects of Drugs on Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams & Wilkins, USA, 8 Ed., 2009, 1242.<\/span><\/p>\n

          4. Garry John, IFCC. Achieving a Global Standardization of HbA1c: Not there yet.<\/span><\/p>\n

          5. Helmut R. Henrichs. HbA1c -Glycated Hemoglobin and Diabetes Mellitus, 1st edition, Bremen: UNI-MED, 2009.<\/span><\/p>\n

          6. Jacques Wallach. Afectiuni endocrine. In Interpretarea testelor de diagnostic. Editura Stiintelor Medicale, Bucuresti, 7 Ed., 2006; 804 806.<\/span><\/p>\n

          7. Laborator Synevo. Referinte specifice tehnologiei de lucru utilizate 2011. Ref Type: Catalog.<\/span><\/p>\n

          8. Randie R. Little, Curt L. Rohlfing, David B. Sacks, National Glycohemoglobin Standardization Program (NGSP) Steering Committee. Status of Hemoglobin A1c Measurement and Goals for Improvement:From Chaos to Order for Improving Diabetes Care. In Clinical Chemistry, 57:2, 205-214, 2011.<\/span><\/p>","protected":false},"excerpt":{"rendered":"

          \u0413\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d \u043e\u0431\u0440\u0430\u0437\u0443\u0435\u0442\u0441\u044f \u0432 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 \u043c\u0435\u0434\u043b\u0435\u043d\u043d\u043e\u0433\u043e \u043d\u0435\u0444\u0435\u0440\u043c\u0435\u043d\u0442\u0430\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u043f\u0440\u0438\u0441\u043e\u0435\u0434\u0438\u043d\u0435\u043d\u0438\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u043a \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0443 \u0410, \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u0449\u0435\u043c\u0443\u0441\u044f \u0432 \u044d\u0440\u0438\u0442\u0440\u043e\u0446\u0438\u0442\u0430\u0445. \u0413\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 (\u0443\u043f\u043e\u0442\u0440\u0435\u0431\u043b\u044f\u0435\u0442\u0441\u044f \u0442\u0430\u043a\u0436\u0435 \u0442\u0435\u0440\u043c\u0438\u043d \u00ab\u0433\u043b\u0438\u043a\u043e\u0437\u0438\u043b\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439\u00bb) \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u0443\u0435\u0442 \u0432 \u043a\u0440\u043e\u0432\u0438 \u0438 \u0443 \u0437\u0434\u043e\u0440\u043e\u0432\u044b\u0445 \u043b\u044e\u0434\u0435\u0439. \u0421\u043a\u043e\u0440\u043e\u0441\u0442\u044c \u044d\u0442\u043e\u0433\u043e \u043d\u0435\u0444\u0435\u0440\u043c\u0435\u043d\u0442\u0430\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u043f\u0440\u0438\u0441\u043e\u0435\u0434\u0438\u043d\u0435\u043d\u0438\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0438 \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u043e \u043e\u0431\u0440\u0430\u0437\u0443\u044e\u0449\u0435\u0433\u043e\u0441\u044f \u0433\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0433\u043e \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 \u0437\u0430\u0432\u0438\u0441\u044f\u0442 \u043e\u0442 \u0441\u0440\u0435\u0434\u043d\u0435\u0433\u043e \u0443\u0440\u043e\u0432\u043d\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0432 \u043a\u0440\u043e\u0432\u0438 \u043d\u0430 \u043f\u0440\u043e\u0442\u044f\u0436\u0435\u043d\u0438\u0438 \u0441\u0440\u043e\u043a\u0430 \u0436\u0438\u0437\u043d\u0438 \u044d\u0440\u0438\u0442\u0440\u043e\u0446\u0438\u0442\u043e\u0432. \u0412 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 \u0440\u0435\u0430\u043a\u0446\u0438\u0438 \u043e\u0431\u0440\u0430\u0437\u0443\u0435\u0442\u0441\u044f \u043d\u0435\u0441\u043a\u043e\u043b\u044c\u043a\u043e \u0444\u043e\u0440\u043c \u0433\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0445 \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u043e\u0432: \u041dbA1a, HbA1b, HbA1c. \u041f\u043e\u0441\u043b\u0435\u0434\u043d\u044f\u044f \u0444\u043e\u0440\u043c\u0430 \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u043e \u043f\u0440\u0435\u043e\u0431\u043b\u0430\u0434\u0430\u0435\u0442 \u0438 \u0431\u043e\u043b\u0435\u0435 \u0442\u0435\u0441\u043d\u043e \u043a\u043e\u0440\u0440\u0435\u043b\u0438\u0440\u0443\u0435\u0442 \u0441\u043e \u0441\u0442\u0435\u043f\u0435\u043d\u044c\u044e \u0432\u044b\u0440\u0430\u0436\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430.<\/p>\n

          \u0413\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d \u043e\u0442\u0440\u0430\u0436\u0430\u0435\u0442 \u0433\u0438\u043f\u0435\u0440\u0433\u043b\u0438\u043a\u0435\u043c\u0438\u044e, \u0438\u043c\u0435\u0432\u0448\u0443\u044e \u043c\u0435\u0441\u0442\u043e \u043d\u0430 \u043f\u0440\u043e\u0442\u044f\u0436\u0435\u043d\u0438\u0438 \u0432\u0441\u0435\u0433\u043e \u043f\u0435\u0440\u0438\u043e\u0434\u0430 \u0436\u0438\u0437\u043d\u0438 \u044d\u0440\u0438\u0442\u0440\u043e\u0446\u0438\u0442\u043e\u0432 (\u0434\u043e 120 \u0441\u0443\u0442\u043e\u043a). \u042d\u0440\u0438\u0442\u0440\u043e\u0446\u0438\u0442\u044b, \u0446\u0438\u0440\u043a\u0443\u043b\u0438\u0440\u0443\u044e\u0449\u0438\u0435 \u0432 \u043a\u0440\u043e\u0432\u0438, \u0438\u043c\u0435\u044e\u0442 \u0440\u0430\u0437\u043d\u044b\u0439 \u0432\u043e\u0437\u0440\u0430\u0441\u0442. \u041e\u0431\u044b\u0447\u043d\u043e \u043e\u0440\u0438\u0435\u043d\u0442\u0438\u0440\u0443\u044e\u0442\u0441\u044f \u043d\u0430 \u0443\u0441\u0440\u0435\u0434\u043d\u0435\u043d\u043d\u044b\u0439 \u0441\u0440\u043e\u043a \u2013 60 \u0441\u0443\u0442\u043e\u043a. \u0423\u0440\u043e\u0432\u0435\u043d\u044c \u0433\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0433\u043e \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0435\u043c \u043a\u043e\u043c\u043f\u0435\u043d\u0441\u0430\u0446\u0438\u0438 \u0443\u0433\u043b\u0435\u0432\u043e\u0434\u043d\u043e\u0433\u043e \u043e\u0431\u043c\u0435\u043d\u0430 \u043d\u0430 \u043f\u0440\u043e\u0442\u044f\u0436\u0435\u043d\u0438\u0438 \u044d\u0442\u043e\u0433\u043e \u043f\u0435\u0440\u0438\u043e\u0434\u0430 \u0432\u0440\u0435\u043c\u0435\u043d\u0438, \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0434\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u0434\u0438\u0435\u0442\u044b \u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f. \u041d\u043e\u0440\u043c\u0430\u043b\u0438\u0437\u0430\u0446\u0438\u044f \u0443\u0440\u043e\u0432\u043d\u044f \u0433\u043b\u0438\u043a\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u043e\u0433\u043e \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 \u0432 \u043a\u0440\u043e\u0432\u0438 \u043f\u0440\u043e\u0438\u0441\u0445\u043e\u0434\u0438\u0442 \u043d\u0430 4-6 \u043d\u0435\u0434\u0435\u043b\u0435 \u043f\u043e\u0441\u043b\u0435 \u0434\u043e\u0441\u0442\u0438\u0436\u0435\u043d\u0438\u044f \u043d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0443\u0440\u043e\u0432\u043d\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b.<\/p>\n

          \u0423 \u0431\u043e\u043b\u044c\u043d\u044b\u0445 \u0441\u0430\u0445\u0430\u0440\u043d\u044b\u043c \u0434\u0438\u0430\u0431\u0435\u0442\u043e\u043c \u0443\u0440\u043e\u0432\u0435\u043d\u044c HbA1c\u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u043f\u043e\u0432\u044b\u0448\u0435\u043d \u0432 2-3 \u0440\u0430\u0437\u0430. \u0412 \u0441\u043e\u043e\u0442\u0432\u0435\u0442\u0441\u0442\u0432\u0438\u0438 \u0441 \u0440\u0435\u043a\u043e\u043c\u0435\u043d\u0434\u0430\u0446\u0438\u044f\u043c\u0438 \u0412\u0441\u0435\u043c\u0438\u0440\u043d\u043e\u0439 \u043e\u0440\u0433\u0430\u043d\u0438\u0437\u0430\u0446\u0438\u0438 \u0437\u0434\u0440\u0430\u0432\u043e\u043e\u0445\u0440\u0430\u043d\u0435\u043d\u0438\u044f (\u0412\u041e\u0417), \u044d\u0442\u043e\u0442 \u0442\u0435\u0441\u0442 \u043f\u0440\u0438\u0437\u043d\u0430\u043d \u043e\u043f\u0442\u0438\u043c\u0430\u043b\u044c\u043d\u044b\u043c \u0438 \u043d\u0435\u043e\u0431\u0445\u043e\u0434\u0438\u043c\u044b\u043c \u0434\u043b\u044f \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u044f \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430.<\/p>\n

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          \u041f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0430 \u043a \u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0435<\/strong><\/p>\n

          \u0421\u043f\u0435\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u043f\u043e\u0434\u0433\u043e\u0442\u043e\u0432\u043a\u0438 \u043a \u043f\u0440\u043e\u0446\u0435\u0434\u0443\u0440\u0435 \u043d\u0435 \u0442\u0440\u0435\u0431\u0443\u0435\u0442\u0441\u044f. \u0418\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0435 \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u0441\u044f \u0443 \u0434\u0435\u0442\u0435\u0439 \u0434\u043e 6 \u043c\u0435\u0441\u044f\u0446\u0435\u0432. \u0418\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043d\u0435\u0446\u0435\u043b\u0435\u0441\u043e\u043e\u0431\u0440\u0430\u0437\u043d\u043e \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u0442\u044c \u043f\u043e\u0441\u043b\u0435 \u043a\u0440\u043e\u0432\u043e\u0442\u0435\u0447\u0435\u043d\u0438\u0439, \u0433\u0435\u043c\u043e\u0442\u0440\u0430\u043d\u0441\u0444\u0443\u0437\u0438\u0439 (\u043f\u0435\u0440\u0435\u043b\u0438\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438).<\/p>\n

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          \u0414\u043b\u044f \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0438 \u0434\u0438\u0430\u0431\u0435\u0442\u0430 \u0432 \u044d\u0442\u0438\u0445 \u0441\u0438\u0442\u0443\u0430\u0446\u0438\u044f\u0445 \u0441\u043b\u0435\u0434\u0443\u0435\u0442 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u0442\u044c \u0442\u043e\u043b\u044c\u043a\u043e \u043a\u0440\u0438\u0442\u0435\u0440\u0438\u0438 \u0443\u0440\u043e\u0432\u043d\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0432 \u043f\u043b\u0430\u0437\u043c\u0435 \u043a\u0440\u043e\u0432\u0438.<\/p>\n

          \u0418\u043d\u0442\u0435\u0440\u043f\u0440\u0435\u0442\u0430\u0446\u0438\u044f \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0430 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0437\u0430\u0442\u0440\u0443\u0434\u043d\u0435\u043d\u0430 \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435\u043c \u0432\u0430\u0440\u0438\u0430\u043d\u0442\u043d\u044b\u0445 \u0444\u043e\u0440\u043c \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430: \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 \u04102, \u043f\u043e\u0432\u044b\u0448\u0430\u044e\u0449\u0435\u0433\u043e\u0441\u044f \u043f\u0440\u0438 \u0431\u0435\u0442\u0430-\u0442\u0430\u043b\u0430\u0441\u0441\u0435\u043c\u0438\u0438 (\u0433\u0435\u043d\u0435\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u043c \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0438), \u0438 \u0444\u0435\u0442\u0430\u043b\u044c\u043d\u043e\u0433\u043e \u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 (\u0433\u0435\u043c\u043e\u0433\u043b\u043e\u0431\u0438\u043d\u0430 \u043f\u043b\u043e\u0434\u0430), \u0432\u044b\u0441\u043e\u043a\u043e\u0435 \u0441\u043e\u0434\u0435\u0440\u0436\u0430\u043d\u0438\u0435 \u043a\u043e\u0442\u043e\u0440\u043e\u0433\u043e \u0441\u043e\u0445\u0440\u0430\u043d\u044f\u0435\u0442\u0441\u044f \u0434\u043e 6 \u043c\u0435\u0441\u044f\u0446\u0435\u0432 \u043f\u043e\u0441\u043b\u0435 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u044f.<\/p>\n

          \u0414\u043b\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f \u0431\u0435\u0440\u0435\u0442\u0441\u044f \u043a\u0440\u043e\u0432\u044c \u0438\u0437 \u0432\u0435\u043d\u044b.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[953],"product_tag":[],"class_list":{"0":"post-9252","1":"product","2":"type-product","3":"status-publish","5":"product_cat-teste-de-biochimie","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/9252","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=9252"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=9252"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=9252"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=9252"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=9252"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}