酶法与苦味酸速率法测定肌酐的技术性能比较

目的了解酶法与苦味酸速率法测定血清肌酐的优缺点,为实验室选用检测方法提供依据。方法对酶法与苦味酸速率法测定血清肌酐分别进行线性、精密度、准确度(回收率和方法比较)和干扰五项试验,并对上述各项技术性能指标作出评价和比较。结果两种方法测定肌酐的精密度均达到美国CLIA′88的规定,准确性均符合要求,而且两种方法测定结果有良好的相关性(r=0.9985),但是酶法与苦味酸速率法比较,线性范围宽9倍,精密度和准确度均较高,抗胆红素和血红蛋白干扰能力均较强。结论用酶法试剂盒测定血清肌酐是继苦味酸速率法后方法学上的又一大进步,而且不存在比色杯污染问题,但相对价格较高,建议各实验室根据自身实际情况选用检测方法。     

酶法与苦味酸法检测血清肌酐的差异

测定血清肌酐有两种方法,一种为苦味酸法特异性差,易受多种干扰物的干扰。另一种为酶法特异性高,结果稳定,为了进一步了解两种方法,在不同肌酐浓度和不同干扰物存在时差异,对其进行对比。     

苦味酸法和酶法测定肌酐结果的比较

目的 分析苦味酸法和酶法测定血清肌酐的结果是否一致,为实验室评估提供依据.方法 按美国临床实验室标准化委员会(NCCLS)EP9-A文件进行评估,将测定结果进行相关同归分析,计算两种方法间的偏倚.结果 酶法和苦味酸法相关系数r=0.999,回归方程为Y=0.916 x+7.978.酶法和苦味酸法有明显恒定偏倚.结论 必须对方法原理不同的肌酐测定方法建立不同参考范围,同一实验室采用不同方法,建议以酶法为基准.     

尿肌酐的酶法测定及在临床中的应用

在临床中肌酐的测定对于因肾小球的高度病变而引起的肾功能不全、肾炎等肾脏疾病、尿毒症等的诊断 ,和在治疗过程中的观察都是一种必须的临床生化检查措施。近年来 ,随着诊断技术的进步、新技术的应用和在控制外部肌酐摄入的条件下 ,尿中肌酐的排除量是比较恒定的 ,而且与尿中其它物质的排除量呈相关关系 ,这样就可以用尿肌酐的排除量作为参照 ,衡量其它物质的排除量 ,就可以避免留 2 4h尿存在的弊端。目前用尿肌酐来换算其它物质排出量的项目在不断增加以期提高诊断的可靠性和敏感性 〔1 ,2〕,因此尿肌酐浓度的准确测定在临床应用中越来越…     

胆红素对苦味酸法测定血清肌酐的影响

目的探讨总胆红素干扰苦味酸法测定血清肌酐的剂量响应曲线。方法根据美国临床实验室标准化委员会（CLSI）制定的评价方案EP7-A2文件,应用冻干粉型总胆红素标准品作为干扰物添加于混合血清,配制成不同浓度总胆红素混合血清,用苦味酸法测定血清肌酐。结果随着混合血清中总胆红素浓度的增加,血清肌酐测定值随之降低,其剂量响应曲线呈线性关系,回归方程为y（Scr）=-0.088x（TBil）＋74.224,r=0.994,P〈0.001,具有统计学意义。结论总胆红素对苦味酸法测定血清肌酐有负干扰。     

胆红素对苦味酸法测定血清肌酐的影响

目的探讨总胆红素干扰苦味酸法测定血清肌酐的剂量响应曲线。方法根据美国临床实验室标准化委员会(CLSI)制定的评价方案EP7-A2文件,应用冻干粉型总胆红素标准品作为干扰物添加于混合血清,配制成不同浓度总胆红素混合血清,用苦味酸法测定血清肌酐。结果随着混合血清中总胆红素浓度的增加,血清肌酐测定值随之降低,其剂量响应曲线呈线性关系,回归方程为y(Scr)=-0.088x(TBil)+74.224,r=0.994,P<0.001,具有统计学意义。结论总胆红素对苦味酸法测定血清肌酐有负干扰。     

尿液稀释对尿肌酐结果测定的影响

目的探讨尿液稀释20倍后与原倍尿液在全自动生化分析仪上测定尿肌酐结果的差异分析。方法随机抽取150份7月份在我院住院病人测定ACR(尿微量白蛋白/尿肌酐的比值)的尿液标本,在全自动生化分析仪上用苦味酸法试剂盒分别测定原倍与稀释20倍后的尿肌酐结果,并用SPSS 19.0对两组数据结果进行配对t检验及线性回归分析,采用MedCalc对两组数据做bland-altman分析图进行分析。结果稀释20倍后与原倍的尿肌酐结果配对t检验差异显著,有统计学意义(P<0.05)。由bland-altman分析图结果发现当尿肌酐结果小于10000μmol/L时,其值散在分布于均值两侧,与稀释20倍后的尿肌酐结果进行配对t检验,无显著差异(P=0.096),当尿肌酐结果大于10000μmol/L时,在图中偏于一侧,与稀释20倍后的尿肌酐结果进行配对t检验两者差异显著(P<0.05),有统计学意义。对两组数据拟合线性回归分析,得到线性回归方程y=1.2743x-1321.3,随机抽取50份新尿液标本,由此方程计算出理论尿肌酐值,与稀释20倍后上机实测结果进行配对t检验,两者无显著差异(P=0.129)。结论尿液稀释20倍后与原倍尿液在全自动生化分析仪上测得尿肌酐的结果有显著差异,两者有统计学意义。尤其当尿肌酐结果大于10000μmol/L时,应对尿液标本进行稀释后上机检测,才能得到更准确的结果。     

胆红素对酶法和碱性苦味酸法测定肌酐的影响

目的：应用酶法和碱性苦味酸法测定消除胆红素前后的血清肌酐,探讨胆红素对这碱性苦味酸肌酐测定方法的影响程度。方法：收集临床黄疸血清标本30份,用碱性苦味酸法和酶法的方法测定肌酐水平,经铁氰化钾消除胆红素后再用碱性苦味酸方法再行测定。将处理前后的肌酐测定结果进行t检验,观察处理前后肌酐测定值有无差异。结果：30份临床黄疸标本分别用碱性苦味酸法（方法Ⅰ）酶法（方法Ⅱ）以及用铁氰化钾消除胆红素影响后的碱性苦味酸法（方法Ⅲ）测定肌酐值,结果发现方法Ⅱ和方法Ⅰ及方法Ⅲ之间差别有显著意义（p〈0.01）,胆红素对肌酐的碱性苦味酸法的测定有显著干扰,而对酶法测得的肌酐测定干扰不明显。结论：发现胆红素影响碱性苦味酸法测定肌酐,而不影响酶法对测定肌酐。     

酶法和Jaffe速率法测定血清肌酐结果比较

血中肌酐的产生和排泄较为恒定,其不受食物中蛋白质等物质的影响,测定血清肌酐的含量能更准确反映肾脏的排泄功能^[1]。目前,我国临床实验室测定血清肌酐的方法主要有两类,一类是属化学测定法的碱性苦味酸速率法（Jaffe速率法）,另一类是酶学测定法。由于这两类测定方法的原理不同,受非特异“假肌酐”物质的干扰不同^[2],其测定结果也产生差异,为了研究Jaffe速率法和酶法测定的血清肌酐结果是否有一致性,     

肌酐检测方法解析及尿汞报告的转换

结合工作实际,对常用尿液肌酐及汞的报告进行解析,以期为临床医师实际工作中的应用及查阅文献资料提供方便。     

Dental amalgam exposure and urinary mercury levels in children: the New England Children's Amalgam Trial

BACKGROUND: Urinary mercury (U-Hg) excretion is a commonly used biomarker for mercury exposure from dental amalgam restorations. OBJECTIVES: Our goal was to determine the most efficient measure of dental amalgam exposure for use in analyses concerning U-Hg in children. METHODS: We analyzed time-sensitive longitudinal amalgam exposure data in children randomized to amalgam restorations (n = 267) during the 5-year New England Children's Amalgam Trial. We calculated 8 measures of amalgam, evaluating current versus cumulative exposure, teeth versus surfaces, and total versus posterior occlusal amalgams. Urine samples collected during follow-up years 3-5 were analyzed for mercury excretion. Multivariate models for current and cumulative U-Hg excretion estimated associations between exposures and U-Hg. RESULTS: At the end of follow-up, the average (+/- SD) cumulative exposure was 10.3 +/- 6.1 surfaces and 5.7 +/- 2.9 teeth ever filled with amalgam, corresponding to 30 +/- 21 surface-years. Amalgam measures and U-Hg were moderately correlated. Of amalgam exposure measures, the current total of amalgam surfaces was the most robust predictor of current U-Hg, whereas posterior occlusal surface-years was best for cumulative U-Hg. In multivariate models, each additional amalgam surface present was associated with a 9% increase in current U-Hg, and each additional posterior occlusal surface-year was associated with a 3% increase in cumulative U-Hg excretion (p < 0.001). CONCLUSIONS: One single measure of amalgam exposure is insufficient. Studies of cumulative effects of mercury from amalgam exposure in children are likely to have improved validity and precision if time-sensitive amalgam exposure measures are used. In contrast, simple counts of current amalgam fillings are adequate to capture amalgam-related current U-Hg.     

两种尿汞表达方式在汞中毒实际的应用比较

目的比较尿汞mg/L、μg/g Cr两种表达方式应用于汞中毒诊断及预防实际中的效果。方法收集188名正常人(对照组)、1046名职业接触汞人员(试验组)随机尿样于聚乙烯塑料瓶中,用校正后的F732-Ⅴ型测汞仪、酸性氯化亚锡还原-冷原子荧光法测定尿总汞含量,用手工碱性苦味酸法检测尿液肌酐含量,尿汞结果分别以mg/L、μg/g Cr两种方式报告。结果对照组及试验组尿总汞含量两种表达结果均成正偏态分布,对照组尿汞mg/L的几何均数为0.00123、尿汞μg/g Cr的几何均数为0.96,两种报告方式的结果之间存在正相关关系(r=0.9967,P0.001);试验组尿汞mg/L的几何均数为0.00287、尿汞μg/g Cr的几何均数为2.42,两种报告方式的结果之间存在正相关关系(r=0.9935,P0.001)。以0.01 mg/L与4μg/g Cr为正常人参考值标准判断试验组检测结果时,差异有统计学意义(P0.01)。结论以0.01 mg/L为正常人参考值做标准判断结果的漏诊率较高;判断个体样本的测定值是否超过正常参考值或生物限值,以μg/g Cr方式报告尿汞含量更符合临床实际;但大样本调查研究,以mg/L、μg/g Cr两种方式报告得出的结论差异无统计学意义。     

婴幼儿尿锌/尿肌肝比值与锌营养状况关系的临床研究

[目的]探讨一种准确、灵敏、简便、适应于婴幼儿的锌营养评价指标.[方法]用吡啶偶氮酚比色法与干化学酶法,结合全自动生产化分析仪,对昆明某地区506例散居婴幼儿进行尿锌/尿肌肝比值检测,其中并对同一地区某幼儿园的51例婴幼儿作了血锌与尿锌/尿肌肝比值的原子吸收法和比色法的配对研究.从506例健康儿童中获得了该年龄段尿锌/尿肌肝比值参考值,并在82例缺锌儿童中进行临床验证.[结果]采用原子吸收法和比色法测定的血锌与尿锌/尿肌肝比值有较高的相关性（P＜0.001或P＜0.05）.尿锌/尿肌肝比值在健康儿童中无性别差异（P＞0.05）,随月龄增加有所降低（P＜0.05或P＜0.01）,高身长、高体重儿童尿锌/尿肌肝比值高于低身长、低体重儿童（P＜0.05）.缺锌儿童尿锌/尿肌肝比值低于参考值,差异有显著性（P＜0.05）,补锌治疗后尿锌/尿肌肝比值90.2%有不同程度的升高,与补锌前比较差异有显著性（P＜0.05）.[结论]采用本方法检测的尿锌/尿肌肝比值可以作为临床评价儿童锌营养状况的一项较可靠指标,尤其适合于婴幼儿的缺锌筛查和疗效复查.     

Adjustment to concentration-dilution of spot urine samples: correlation between specific gravity and creatinine

Objective: Spot urine samples were investigated to determine correlations between urinary creatinine and specific gravity, and intra- and inter-day variations other than gender- and age-dependence of urinary concentrations. Methods: Urinary creatinine concentrations and specific gravity were determined in 534 spot samples (385 from men and 149 from women). Subjects' ages ranged between 18 and 68 years. Spot urine samples were also collected from 14 male subjects before and after a 1-week work-shift for the evaluation of intra- and inter-day variations of creatinine and specific gravity. Results: In spot samples, creatinine concentrations ranged between 0.16 and 4.36 g/l and specific gravity between 1.002 and 1.037. A high correlation (r=0.82, P < 0.001) was observed between creatinine and specific gravity; male subjects showed significantly higher values of creatinine (P < 0.001) than did female subjects (1.90 ± 0.74 and 1.41 ± 0.72 g/l, respectively) and specific gravity (1.023 ± 0.006 and 1.020 ± 0.007, respectively). In addition, creatinine but not specific gravity significantly decreased (P < 0.02) in subjects older than 50 years, compared with those under 40. Conclusions: Results confirm the gender-dependence of creatinine concentrations in spot specimens and also show age-dependence, indicating the need for these aspects to be considered when the range of acceptable samples is to be set. No significant intra- or inter-day variations were observed for the two parameters. Lastly, the possibility of a comparison of differently adjusted values was indicated by a conversion formula derived from adjustments to creatinine and the corresponding specific gravity of a hypothetical urinary value, as follows: specific gravity adjusted values= 1.48 × creatinine adjusted values. Received: 14 February 2000 / Accepted: 26 July 2000     

直接测汞仪法测定尿中汞国标方法的研制

目的 建立一种快速简便、能满足生物监测国家标准要求的尿中汞的测定方法。 方法 采用直接测汞仪对尿中汞的测定情况进行考察和试验。 结果 尿中汞含量在1.6~100 μg/L时测得的峰面积和汞浓度之间呈良好的线性关系,相关系数>0.999。方法检出限为0.5 μg/L,方法定量下限为1.6 μg/L。批间、批内测定的相对标准偏差均小于5%。对10、30、60 μg/L三个浓度水平的尿样,加入与原浓度相近的汞浓度的加标回收率为91.6%~99.9%,对有证参考物质的测定及与冷原子吸收法的比对结果满意。 结论 直接测汞仪法作为一种简单、快速的测定方法能满足生物材料中化学物质测定方法的要求,可以用于职业接触者尿中汞的测定。     

尿液的采集时间对尿汞测定结果的影响

目的更准确地掌握人体不同尿液采集时间尿汞含量的大小,以便为临床治疗汞中毒提供更可靠的数据。方法采集不同时间点的尿液,用WS/T97的方法测定尿肌酐,用原子荧光光谱法测定尿汞。结果同一患者3 d晨尿、随机尿液(每天3次)以及24 h尿液的尿汞肌酐校正平均值与T值(所有尿汞肌酐校正值的平均值)的差异分别为0.5%、0.8%、22.4%、22.4%、0.1%;不同患者晨尿与T24(24小时尿液的尿汞肌酐校正值)差异值在10%以内,而随机尿液与T24的差异值波动较大,从2.2%～196%,且无特定规律。结论 24 h尿液和晨尿的尿汞肌酐校正值最为稳定,住院患者最好留取24h尿液,而门诊患者应留取晨尿,随机尿液的尿汞肌酐校正值差异较大,不具有临床意义。     

Statistical study of the correlation between mercury exposure (TWA) and urinary mercury concentrations in chloralkali workers

The present report completes a previous study made on three chloralkali plants that was presented at the 8th International Conference on Occupational Health in the Chemical Industry, Tokyo, 1980, with the final results from five plants located in various regions of Italy. A total of 14,339 measurements of mercury in air and 8,042 determinations of mercury in urine were considered. The total number of workers involved was 275. On the basis of these data, we believe it can be concluded that, as previously reported, a correlation exists between mercury concentrations in the air and in the urine of exposed workers. This correlation is such that for exposures in the order of the present TLV (0.05 mg/m³), the value of the Z ratio (ratio between mean urinary mercury values expressed in mg/l and mean airborne mercury concentrations expressed in mg/m³) is 1.3, while the urinary mercury values vary from 0.051 mg/l to 0.078 mg/l with a mean value of 0.065 mg/l.     

三种方法检测尿中肌酐的结果比对

目的:验证反相高效液相色谱法(WS/T 98-1996)、分光光度法(WS/T 97-1996)和肌酐测定试剂盒(苦味酸法)三种方法检测尿中肌酐的结果可比性。方法:以同一尿样,在采集后第1天、第3天、第5天以上述三种检测方法进行尿中肌酐的检测,卫生部行标方法按标准检验进行操作,临床生化非标方法按说明书要求进行操作。结果:同一尿样在采集后第1天、第3天、第5天按同一方法检测,尿中肌酐检测值无显著性差异(P>0.05);同一尿样按不同的方法进行检测,尿中肌酐的结果有显著性差异(P<0.01)。结论:三种方法检测尿中肌酐的结果有显著性差异,结果无可比性。     

糖尿病肾病中血清胱抑素C、肾小球滤过率(e-GFR)、尿微量白蛋白与肌酐比值的相关研究

目的:探讨糖尿病肾病中血清胱抑素C(Cys-C)、肾小球滤过率(e-GFR)、尿微量白蛋白与肌酐比值(m-Alb/Cr)的相关关系。方法:对121例糖尿病肾病患者及60例正常对照组人群进行血清Cys-C、e-GFR、尿m-Alb/Cr检测,并按不同血清Cys-C水平分组,比较血清Cys-C、e-GFR、尿m-Alb/Cr的敏感性与相关性。结果:糖尿病肾病组与正常对照组之间血清Cys-C水平差别存在统计学意义(P<0.05);在不同的血清Cys-C分组中,糖尿病肾病A组尿m-Alb/Cr与正常对照组存在显著性差异(P<0.05),而糖尿病肾病B组与糖尿病肾病A组及正常对照组间比较Cys-C、e-GFR、m-Alb/Cr三指标间差别均存在统计学意义(P<0.01)血清Cys-C在e-GFR异常时,两者具有很好的相关性。结论:糖尿病肾病中尿m-Alb/Cr敏感性明显高于血清Cys-C及e-GFR;血清Cys-C在e-GFR异常时存在明显相关性,血清Cys-C在糖尿病肾病的病程监控中具有很好的应用价值。