肝素锂、EDTA-K_2抗凝剂对生化检测影响的调查与分析

目的探讨肝素锂与EDTA-K2抗凝血浆对生化检测指标的影响,以期在临床上采用血浆代替血清进行生化检测。方法将同一血液样品放置于无抗凝剂的采血管、肝素锂抗凝管和EDTA-K2抗凝管,在同一时间内用全自动生化分析仪进行检测,并对检测结果进比较分析。结果 16项肝素锂、EDTA-K2抗凝血浆与血清样品比较差异无统计学意义（r2〉0.800、P〉0.05）;11项肝素锂抗凝血浆与血清比较差异无统计学意义（r2〉0.800、P〉0.05）;4项肝素锂抗凝血浆与血清比较差异有统计学意义（r2〉0.800、P〈0.05）,检测以上指标时可用肝素锂抗凝血浆代替血清。3项肝素锂与EDTA-K2抗凝血浆与血清相关性差（r2〈0.800）。结论大多数指标可以用肝素锂抗凝血浆代替血清,部分亦可用EDTA-K2抗凝血浆代替血清,但是需要建立相应的回归关系或者血浆参考体系,少数样品不宜用血浆代替血清或者只能采用血浆进行检测。临床检测用血浆代替血清,在提高检测效率以及避免患者多次多量采血等方面具有重要意义。     

标本类型和离心时间对临床常用心肌损伤标志物检测结果的影响

目的探讨肝素锂抗凝血浆、乙二胺四乙酸二钾(EDTA-K2)抗凝血浆、血清等3类标本和缩短离心时间对肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和肌红蛋白(Myo)等心肌损伤标志物检测结果的影响。方法使用VITROS 5600生化免疫分析仪检测28例3类标本的心肌损伤标志物,并进一步行cTnI的EDTA-K2干扰试验;将21例肝素锂抗凝标本在4 000r/min分别离心2和10min后检测心肌损伤标志物。采用SigmaPlot 11.0统计软件进行分析。结果 EDTA-K2抗凝组cTnI比肝素锂抗凝组低约15%,血清组CK-MB比肝素锂抗凝组高出大概7%,差异均有统计学意义(P0.05)。干扰试验证实EDTA-K2对检测cTnI存在负干扰。将肝素锂抗凝标本离心2min与10min的心肌损伤标志物比较,差异无统计学意义(P0.05)。结论肝素锂抗凝血浆、EDTA-K2抗凝血浆和血清的心肌损伤标志物检测结果间存在不一致性;缩短离心时间既不影响检测结果,又能缩短标本周转时间,使临床和患者获益。     

不同真空采血管对生化项目检测结果的影响

目的 分析不同真空采血管对生化项目检测结果的影响.方法 采用6种不同真空采血管采集受检者静脉血,比较血浆或血清标本在同等条件下生化项目检测结果.结果 与干燥管相比,分离胶管测定结果差异无统计意义(P>0.05),肝素钠管、肝素锂管多数检测结果差异无统计意义(P>0.05),EDTA-K2管和枸橼酸钠管多数或全部结果存在统计学差异(P＜0.05).结论 分离胶管和干燥管适用于生化项目检测,肝素管适合多数项目,EDTA-K2管和枸橼酸钠管不适用于生化项目检测;不同抗凝剂对检验结果的影响是不同的,不能简单地用抗凝血浆代替血清进行生化项目检测.     

肝素锂抗凝血浆代替血清用于临床生化检验的可行性研究

目的探讨肝素锂抗凝血浆代替血清用于临床生化检验的可行性。方法随机抽取40例患者和健康体检者静脉血标本,将每例标本3ml分别注入普通试管及肝素锂抗凝管中,于同一生化仪中对常规生化项目进行检测,并对结果进行统计学分析。结果Na、Cl、CK-MB、LDH、ASO、AMY、RF、C3、IgG、TP、Crea、DBil、Mg、CRP、P等项目肝素锂抗凝血浆与血清比较差异无统计学意义(P>0.05),TCO2、K、TCa、CHE、CK、HBD、AKP、Urea、Glu、C4、Ig M、IgA、Alb、TC、TG、ALT、AST、UA、GGT、Tbil、LDL-C、HDL-C、AFU、TBA等项目两组间比较差异有统计学意义(P<0.05),TCO2、K、Na、Cl、TCa、CHE、CK、ASO、AMY、AKP、RF、Urea、Glu、C3、C4、Ig M、IgG、IgA、TP、Alb、TC、TG、Crea、ALT、AST、UA、GGT、Tbil、DBil、LDL-C、HDL-C、Mg、CRP、P等项目肝素锂抗凝血浆与血清相关性良好(r>0.800),而CK-MB、LDH、HBD、AFU、TBA等项目肝素锂抗凝血浆与血清相关性较差(r<0.700)。结论大部分常规临床生化检验项目可用肝素锂抗凝血浆代替血清作为标本,但需建立回归方程或血浆参考体系,少数项目如CK-MB、LDH、HBD、AFU、TBA等不宜用肝素锂抗凝血浆。     

肝素锂抗凝血浆分离管用于血氨检测的可行性研究及评价

目的探讨肝素锂抗凝血浆分离管用于血氨检测的可行性及应用价值。方法首先选择20例健康成年人静脉血,分别将1.5 mL血液注入到肝素锂抗凝血浆分离管、EDTA-K2抗凝管、惰性分离胶管以及肝素抗凝管四种不同的真空采血管中,离心分离后将所得的血清或血浆用干化学法进行血氨即刻测定,然后研究它们在25 oC(室温)的保存条件下,随着时间的延长血氨检测结果的变化情况。另外,再选20例健康成人静脉血标本,用同样的方法探究相同血液标本即刻检测及标本常温放置1 h后再进行离心检测,分析四种不同真空采血管的血氨检测结果的差异。结果①肝素抗凝管与肝素锂抗凝血浆分离管的血氨检测即刻结果较为接近(P>0.05),且略低于EDTA-K2抗凝管及惰性分离胶管内的血氨检测结果,但四种采血管即刻检测结果间两两比较差异并不显著,无统计学意义(P>0.05)。②离心分离后常温保存时,EDTA-K2抗凝管的血氨检测结果不断升高,放置1 h即有显著变化。而肝素抗凝管、分离胶管组以及肝素锂抗凝血浆分离管组的检测结果较为接近,常温放置1 h开始升高,2 h有显著变化(P<0.05)。③肝素管与肝素锂抗凝血浆分离管的标本未离心分离常温放置1 h后的血氨检测结果略微升高,但差异无统计学意义。而EDTA-K2抗凝管和惰性分离胶管的1 h检测结果则与即刻检测结果有显著差异。结论肝素锂抗凝血浆分离管在血氨检测的实际应用中兼具肝素抗凝管与惰性分离胶管的优点,是临床血氨标本采集的优良选择。     

血清与肝素锂抗凝血浆急诊生化项目的结果比较

目的探讨肝素锂抗凝血浆用于急诊生化检验的可行性,弄清血清与血浆结果之间的差异。方法在相同条件下采用美国雅培公司生产的Aeroset全自动生化分析仪对血清与肝素锂抗凝血浆14项常规急诊项目的检测结果进行对比分析。结果血清与肝素锂抗凝血浆中谷草转氨酶、尿素、淀粉酶、葡萄糖、二氧化碳总量差异无统计学意义(P>0.05),胆碱酯酶、肌酸激酶、乳酸脱氢酶、钾、钠、氯、钙、肌酐、尿酸差异有统计学意义(P<0.01~0.05),血清钾(Y)和血浆钾(X)的回归方程为Y=0.972X 0.16,r=0.924。结论肝素锂抗凝血浆适合于检验结果无显著差异的急诊项目,钾可通过回归方程校正后报告结果,对于差异显著的项目不能用血浆代替血清,报告时应注明并建立本实验室的参考值范围。     

不同血液样本在常规生化项目检测中的结果比较

目的比较不同血液样本在常规生化项目检测中的结果差异,寻求最佳检测血液样本。方法对93例体检标本的5种不同血液样本即无抗凝普通试管血清、分离胶管血清、肝素锂血浆、枸橼酸钠血浆、乙二胺四乙酸二钾（EDTA-K2）血浆在相同测量条件下测定13项生化指标,统计分析比较。结果无抗凝普通试管血清组、分离胶管血清组各项指标比较差异无统计学意义,与无抗凝普通试管血清组比较：肝素锂血浆组血清总蛋白（TP）、清蛋白（ALB）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆固醇（TCH）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL）检测结果差异有统计学意义（P〈0.05）;枸橼酸钠组除肌酐（Cr）外,EDTA-K2血浆组除HDL、Cr外,其余各项的检测结果均与血清组差异有统计学意义（P〈0.05）。结论血清分离胶可用于对非抗凝标本的血清分离,可以保持被分离血清各成分的性状和稳定性很适合于临床生化检验。     

肝素锂抗凝血用于门急诊临床化学检验的可行性评价

目的探讨肝素锂抗凝血用于门急诊临床生化检验的可行性。方法采集40例门急诊患者静脉血液标本,每一患者标本分别置普通干燥真空管、肝素锂真空管和肝素钠真空管3种不同的标本收集管内,用Roche Modu larPE全自动生化分析仪,测定26项常规生化项目。结果26项项目中除钾(K )、钠(Na )、乳酸脱氢酶(LDH)血清、肝素锂、肝素钠抗凝血浆测定值差异有统计学意义(P<0.05~0.001)外,其余指标差异均无统计学意义。结论除K 、Na 、LDH外,肝素锂抗凝血浆可用于其他门急诊临床生化项目的检测。     

抗凝剂血浆和血清对血无机磷测定的相关性探讨

目的了解4种抗凝剂血浆和对应血清测定血无机磷的相关性。方法以血浆为候选法及对应血清为标准方法 ,采用全自动生化分析仪直接测定。结果 4种抗凝剂抗凝血浆及对应血清平行测定结果为:肝素、草酸钾、EDTA-K2抗凝血浆及对应血清均有较好的相关性(r=0.890、0.818、0.848);回归系数假设检验,肝素、草酸钾、EDTA-K2抗凝血浆和对应血清回归方程比较差异有统计学意义(P0.05),呈直线回归关系。枸橼酸钠抗凝血浆及对应血清呈中度相关(r=0.762);回归系数假设检验,血浆和血清回归方程比较差异有统计学意义(P0.05),呈直线回归关系。结论肝素、草酸钾、EDTA-K2抗凝血浆能快速、准确地提供检测结果 ,与参考方法结果有可比性,而枸橼酸钠抗凝血浆检测结果与参考方法结果的可比性不如前者。     

不同抗凝剂对5种特定蛋白检测结果的影响

目的观察常见的4种血样采集管对C3、C4、IgA、IgG、IgM这5项生化项目检测结果的影响,探讨能否用抗凝血浆替代血清用于生化检测。方法对43名体检人员的静脉血管,连续用乙二胺四乙酸二钾(EDTA-K_2)抗凝管、肝素锂抗凝管、普通血清管、枸橼酸钠抗凝管各抽取一管血液,经混匀、离心分离后提取血清或血浆在仪器上同时用C3、C4、IgA、IgG、IgM试剂盒进行测定。结果在相同条件下,5个项目中肝素锂抗凝管与普通血清管比较差异无统计学意义(P0.05),枸橼酸钠抗凝管与用普通血清管的结果比较差异有统计学意义(P0.05),EDTA-K_2抗凝管与用普通血清管的结果比较,IgA、IgM、IgG差异无统计学意义(P0.05),C3、C4差异有统计学意义(P0.05)。结论 IgA、IgM、IgG生化检验项目可用肝素锂抗凝血浆和EDTAK2血浆代替血清,C3和C4生化检验项目可用肝素锂抗凝血浆代替血清,但C4应建立血浆参考区间。     

Optimal conditions for collection of blood samples for assay of α2-macroglobulin trypsin complex-like substance (MTLS)

We have developed an enzyme-linked immunosorbent assay (ELISA) for the specific quantification of α2-macroglobulin-trypsin complex-like substance (MTLS). To exclude artifacts in measured values of MTLS, the conditions for collection of blood samples are critical. In the present study, we have determined the optimal conditions for blood collection and investigated the role of MTLS as a clinical tool for diagnosis in pancreatitis. Results obtained are as follows: (1) MTLS levels of all sera were more than 10-fold higher than the corresponding plasma; (2) MTLS levels of heparinized plasma were the lowest among plasma with three anticoagulants (sodium citrate, sodium EDTA and heparin); (3) some kinds of blood collection tubes containing heparin were not suitable for the sampling; (4) MTLS values of plasma obtained by blood collection tubes containing Trasylol® and sodium EDTA were demonstrated more stable and lower than those obtained by heparin tubes; and (5) under these conditions, we can exclude elevation of MTLS values caused by inappropriate blood sampling and find the time course of the elevation reflecting clinical course of a patient with acute pancreatitis and a patient after endoscopic retrograde cholangiopan-creatography (ERCP). The optimal conditions for collection of blood samples were as follows. Blood sampling should be performed by blood collection tubes containing Trasylol® (50 μl/ml blood) and sodium EDTA (1.5 mg/ml blood). The samples were immediately stored at 4°C and centrifuged at 3,000 rpm for 15 min. The plasma were stored in plastic tubes at 4°C until assayed. © 1996 Wiley-Liss, Inc.     

生化检验分析中肝素钠抗凝血浆应用的可行性分析

目的对生化检验分析中肝素钠抗凝血浆应用的可行性进行研究分析。方法对肝素钠抗凝血浆以及血清的10项生化项目的测定结果作相关比较,并提出对应的处理方法,选择20例本院门诊的患者,按照常规的方法抽取静脉血液4mL,各取一半分别注入2支不同的试管。其中一支试管不做抗凝处理,放置于37℃并水浴30min,然后通过离心分离出血清;另一试管含肝素钠抗凝剂,在加血之后立刻进行离心分离出血浆。钾(K+)、钙(Ca2+)、钠(Na+)、氯(Cl-)、镁(Mg2+)、葡萄糖(Glu)、血尿素氮(BUN)、肌酐(Cr)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST),以上10个项目指标均使用日立7080型的全自动分析仪来进行测定,并对结果进行记录。结果血清和血浆中Cl-、Ca2+、Mg2+、BUN、Cr、ALT、AST的检验结果基本一致;钠和葡萄糖差异有统计学意义(P<0.05);与钾差异也有统计学意义(P<0.01),血清钾浓度(Y)与血浆钾浓度(X)的回归方程为Y=0.715 X+0.499,r=0.749。结果清晰地表明了血清跟血浆中的K+、Glu、Na+测定值差异具有统计学意义(P<0.05),而其它的项目指标之间的差异无统计学意义(P>0.05)。结论采用肝素钠抗凝血浆进行生化检验分析,只要纠正了钾的差异或者可以考虑建立一个血浆钾参考值的范围即可迅速,准确地报告出结果,为协助临床医生的及时合理用药提供了技术保障。     

Blood specimen collection methods influence the concentration and the diagnostic validity of matrix metalloproteinase 9 in blood.

BACKGROUND: Matrix metalloproteinases (MMP) in blood are promising new diagnostic tools. It was shown that the blood sampling process resulted in different blood concentrations of MMPs. To clarify whether the sampling process also influences the diagnostic validity of MMPs, MMP-9 measurements were performed in plasma and serum samples of patients with prostate carcinoma and renal cell cancer. METHODS: MMP-9 ELISAs were performed in samples of heparin plasma and serum collected in blood tubes with and without clot accelerator. Measurements were undertaken in 78 healthy persons, 33 patients with prostate carcinoma and 33 patients with renal cell carcinoma. RESULTS: MMP-9 showed higher concentrations in serum samples than in heparin plasma and was about threefold higher in serum samples collected in tubes with clot activator than in native serum samples. Both patient groups had lower MMP-9 concentrations in serum, whereas in plasma, patients with renal cell carcinoma had higher, but patients with prostate cancer unchanged MMP-9 concentrations. 13 of 33 patients with renal cell carcinoma had increased MMP-9 plasma values but no patient had increased serum concentrations. CONCLUSIONS: To optimise the diagnostic validity of the MMP-9 in blood, measurements should be performed in heparin plasma but not in serum.     

Reverse pseudohyperkalemia in heparin plasma samples from a patient with chronic lymphocytic leukemia

ObjectivesTo investigate the spurious high potassium results in heparin plasma.Design and methodsPotassium values from heparin plasma, serum, and whole blood in a patient with chronic lymphocytic leukemia were determined and compared on chemistry and blood gas analyzers.ResultsPotassium levels were strikingly elevated in heparin plasma compared to serum or whole blood in which the potassium levels were surprisingly normal.ConclusionsThe phenomenon of reverse pseudohyperkalemia should be publicized.     

Rapid separation of serum does not avoid artificially higher matrix metalloproteinase (MMP)-9 levels in serum versus plasma

OBJECTIVES: To examine whether the time between blood drawing and centrifugation (TBDC) affects the levels of matrix metalloproteinase (MMP)-9 and MMP-2 levels in serum and in plasma samples, and to assess whether there is correlation between MMP-9 and MMP-2 levels in serum and plasma samples. DESIGN AND METHODS: Serum and plasma samples (N=8) were separated from venous blood collected into citrate, heparin, and EDTA tubes, which were either centrifuged immediately or after 5, 10, 20, or 30 min after blood drawing. We assessed the correlation between MMP-9/MMP-2 in serum and citrate, heparin, and plasma samples (N=20), which were assayed for gelatine zymography of MMP-2 and MMP-9. RESULTS: MMPs are released by platelets or leukocytes during platelet activation or sampling process, thus leading to artificially higher MMP-9 levels in serum compared with citrate, heparin, or EDTA plasma samples, independently of TBDC. Citrate and heparin plasma samples had the lowest Pro-MMP-9 and MMP-9 levels, which correlated with each other. Pro-MMP-9 levels in serum correlated with Pro-MMP-9 levels in EDTA or citrate plasma, but not with heparin plasma. While no significant correlations were found between MMP-9 levels in serum and those found in plasma samples, the total MMP-9 levels (Pro-MMP-9+MMP-9) in serum and in plasma samples correlated with each other. No significant differences were found in pro-MMP-2 levels. CONCLUSIONS: These results suggest that the circulating levels of MMP-9 should be assessed in citrate or heparin plasma samples, but not in serum samples because of artificially higher MMP-9 levels in serum, independently of TBDC, and because they do not correlate with the MMP-9 levels in plasma samples.     

Inhibitory Effect of Heparin on Gentamicin Concentrations in Blood

In monitoring gentamicin concentrations in the blood of patients with renal insufficiency, the assayed antibiotic concentration was found to be lower when the sample was drawn as heparinized plasma rather than as serum. This lowering of gentamicin concentrations by heparin was studied further by adding increasing doses of heparin and various amounts of gentamicin to human serum. With a range of 2 to 100 units of heparin per ml, gentamicin concentrations in the serum were lowered by 9 to 14%; with higher heparin concentrations, an even greater and increasing inhibition was noticed, reaching 56% for 1,000 units/ml. This inhibitory effect of heparin on gentamicin was reversible by dilution, indicating that it was not due to degradation or to formation of an inactive chemical complex. Underestimation by the laboratory of gentamicin concentrations in blood is likely to be greatest with capillary tubes, with which the concentration of heparin is especially high. With clinical heparinization, the amount of active heparin in the blood does not exceed 10 units/ml and is for the most part under 3 units/ml; thus, therapeutically significant inhibition of the antibiotic is unlikely in patients receiving anticoagulation.     

促红细胞生成素对血液透析患者血液流变学的影响

目的了解应用促红细胞生成素(EPO)治疗肾性贫血对尿毒症维持性透析患者血液流变学的影响.方法于EPO治疗前及治疗后4周、24周分别检查新进入维持性血透的27名患者的Hb、HCT及血液流变学指标,同时观察血压、肝素用量及内瘘等.结果患者EPO治疗前,全血高切、低切粘度均低于正常对照组,EPO治疗后,Hb及HCT逐渐升高,且随治疗时间延长升高,在治疗4周及24周时相差均显著(P<0.05).血浆粘度治疗前高于正常组,但相差不显著,且随EPO治疗无显著改变(P<0.05).红细胞聚集指数及纤维蛋白原明显高于正常组(P<0.05),随EPO治疗有升高趋势,但相差也不显著(均P>0.05).EPO治疗后患者高血压发生率及肝素用量均显著升高(P<0.05).结论EPO治疗可致全血粘度升高,主要与贫血改善有关,而血浆粘度未受显著影响.     

Free fatty acids exert a greater effect on ocular and skin blood flow than triglycerides in healthy subjects

BACKGROUND: Free fatty acids (FFAs) and triglycerides (TGs) can cause vascular dysfunction and arteriosclerosis. Acute elevation of plasma FFA and TG concentration strongly increase ocular and skin blood flow. This study was designed to discriminate whether FFA or TG independently induce hyperperfusion by measuring regional and systemic haemodynamics. METHODS: In a balanced, randomized, placebo-controlled, double-blind, three-way, crossover study nine healthy subjects received either Intralipid (Pharmacia and Upjohn, Vienna, Austria) with heparin, Intralipid alone or placebo control. Pulsatile choroidal blood flow was measured with laser interferometry, retinal blood flow and retinal red blood cell velocity with laser Doppler velocimetry, and skin blood flow with laser Doppler flowmetry during an euglycaemic insulin clamp. RESULTS: A sevenfold increase of FFA during Intralipid/heparin infusion was paralleled by enhanced choriodal, retinal, and skin blood flow by 17 +/- 4%, 26 +/- 5% (P < 0.001), and 47 +/- 19% (P = 0.03) from baseline, respectively. In contrast, a mere threefold increase of FFA by infusion of Intralipid alone did not affect outcome parameters, despite the presence of plasma TG levels of 250-700 mg dL(-1); similar to those obtained during combined Intralipid/heparin infusion. Systemic haemodynamics were not affected by drug infusion. CONCLUSIONS: Present findings demonstrate a concentration-dependent increase in ocular and skin blood flow by FFA independently of elevated TG plasma concentrations. As vasodilation of resistance vessels occur rapidly, FFA may play a role in the development of continued regional hyperperfusion and deteriorate microvascular function.     

血清肝素抗凝血浆对化学法检测微量元素的影响

目的探讨不同处理方式的血清及不同肝素浓度抗凝血浆对化学法检测微量元素的影响。方法以临床工作中可能出现的5种肝素浓度抗凝血浆与快速处理的血清标本在相同条件下配对检测微量元素,并与常规处理的血清标本进行比较。结果不同浓度肝素抗凝血浆与快速处理的血清比较,铜(Cu)、镁(Mg)、锌(Zn)、铁(Fe)和总钙(TCa)差异无统计学意义(P>0.05),磷(P)差异有统计学意义(P<0.01);快速与常规2种方式处理的血清比较:Mg、Zn和Fe差异有统计学意义(P<0.05,P<0.01);不同浓度肝素抗凝血浆与常规处理的血清比较除TCa外差异均有统计学意义(P<0.05,P<0.01);不同浓度肝素抗凝血浆之间比较差异无统计学意义(P>0.05)。结论如无条件快速处理血清,化学法检测微量元素应尽量使用肝素化抗凝血浆;肝素抗凝血浆的应用要充分考虑到个别项目如P的局限性;肝素抗凝浓度应按照《全国临床检验操作规程》执行,各实验室还应建立肝素抗凝血标本微量元素化学法检测指标的参考范围。