呵呵，论述观点要看原文啊

这一段阐释了为什么a1c值低死亡率反而高，总结一下就是有一些基础血红蛋白病，慢性贫血性疾病，炎症，肝病，会引起血红蛋白异常，因而引起糖化血红蛋白A1c异常降低。这类人的死亡率高，不是因为他们血糖太低，而是因为本身的基础疾病。正常人很少看到a1c会低于四。文章里说调整了这些marker，还是死亡率升高，但是不是很确定为什么。所以也没有完全定论。其实大部分人都不用去担心自己a1c太低

临床上怀疑病人有血红蛋白疾病，贫血性疾病时候，是不测a1c的，用其他方法监测血糖

It is not clear what biological processes may be underlying the association between low HbA1c and all-cause mortality. In the present study, participants with low HbA1c values had unfavorable profiles of red blood cell related factors, iron storage, and liver function. Red blood cell distribution width has been associated with an increased risk of morbidity and mortality19–22 and with inflammation.21 Younger red blood cells are typically larger and have more size variability compared with older red blood cells,20 which could affect red blood cell distribution width and HbA1c values.6,23 Also, iron stores were elevated among those with low HbA1c in the present study. Iron-deficiency anemia has been associated with increased HbA1c values among individuals without diabetes; however, patients with iron-deficiency anemia who were treated with iron therapy had decreases in HbA1c values.24,25 Also, ferritin was elevated among those with low HbA1c in the present study. Elevated ferritin has been associated with an increased risk of myocardial infarction26 and atherosclerosis,27 but it is also an acute-phase reactant and could be reflecting an inflammatory response. Finally, liver function enzymes were elevated and hepatitis C was more prevalent among those with an HbA1c <4.0% in the present study. Elevated ALT is frequently associated with fatty liver and an adverse cardiometabolic risk factor profile. ALT was positively associated with HbA1c levels among participants with and without diabetes in the British Women’s Heart and Health Study, with a stronger association noted among women without diabetes.28 Certain combination therapies for hepatitis C have been reported to temporarily lower HbA1c levels29; however, the low HbA1c-mortality association observed in the present study was still evident after excluding participants with hepatitis C. The overall biomarker profile of the participants without diabetes and an HbA1c < 4.0% is suggestive of red blood cell markers, inflammation, and liver function as part of the biological underpinning for the association noted in this study. However, the low HbA1c and all-cause mortality association observed in this study persisted after adjustment for lifestyle, cardiovascular, metabolic, red blood cell, iron storage, and liver function indices. The association also persisted after excluding participants with cancer, CVD, anemia, or hepatitis C in sensitivity analyses. Additional research is needed to explore the potential health effects of aberrations in red blood cell markers, inflammation, and liver function indices and associations with all-cause mortality among individuals with a low HbA1c.

所有跟帖： 

• 但这个值的确不是越低越好。我总是看最佳值。 -kathyzh- ♀ (1417 bytes) () 07/05/2022 postreply 11:31:13

• 花医生已经给你说的很明白了，你的论点不是越低越好是不成立的。正常人基本不会小于4，低于4死的早是因为其他基础病。你在正常 -让理想飞- ♀ (558 bytes) () 07/05/2022 postreply 11:55:44

• 我是想说在正常range里，这个值不是越低越好。你说我的值接近上限，但最佳值就是5.2. -kathyzh- ♀ (311 bytes) () 07/05/2022 postreply 12:08:08

• 既然你认为自己是最佳值，为什么还要犹豫不决来问呢？ -GoGym- ♀ (0 bytes) () 07/05/2022 postreply 12:18:11

• 我今天才发现的！以前我也一直以为这个值在正常范围内是越低越好。多看多读多学。 -kathyzh- ♀ (347 bytes) () 07/05/2022 postreply 12:25:53

• 你这个就是抬杠。你的原帖用Hemoglobin A1c指标讨论你糖尿病的风险，但是你却引用针对于没有糖尿病的人群的论文。 -让理想飞- ♀ (959 bytes) () 07/05/2022 postreply 12:57:34

• 大家讨论学习。如有冒犯实在抱歉。 -kathyzh- ♀ (0 bytes) () 07/05/2022 postreply 13:16:24

• Nothing personal, 我以前说过这个坛子估计绝大多数都是全奖博士，可能当年都考过GRE.我就是受不了逻辑混 -让理想飞- ♀ (128 bytes) () 07/05/2022 postreply 13:26:05

• 花布不错，花布头哈哈 -喵儿爸- ♂ (0 bytes) () 07/05/2022 postreply 14:14:16

• 赞学霸精神。 -落花飘零- ♀ (0 bytes) () 07/05/2022 postreply 15:05:34

• 我上面说了一堆，意思这个study里讨论的情况并不能apply到你的问题。 -落花飘零- ♀ (408 bytes) () 07/05/2022 postreply 15:04:08