Sedass-20型自动血沉仪临床应用及质量控制

目的通过魏氏法与血沉仪的比较以及对仪器各孔不同时间检测的一致性来了解自动血沉仪分析结果的可靠性.方法采用低、中、高三种不同标本分别用魏氏法和自动血沉分析仪同时测定红细胞沉降率（ESR）;采用三种不同值的标本各分两份,任意放置于两孔中测定,进行分析;用同一标本放置不同时间测定对结果准确性的判断进行统计学处理;用质量控制图监控血沉的室内质量控制.结果仪器法和魏氏法测定的血沉比较,差异无显著性意义（t=1.9665,0.20＜P＜0.40）;仪器各孔除两孔外测定结果比较,差异无显著性意义（t=0～1.6942,＞0.4～0.5）;同一标本放置不同时间结果比较,差异无显著性意义（F0.05（4,16）=2.45,P＞0.05）;室内质量控制结果良好.结论 Sedass-20型自动血沉仪能适合临床大批量的血沉检测.     

Monitor-20全自动红细胞沉降率检测仪应用评价

目的：评价Monitor‐20全自动红细胞沉降率检测仪（简称Monitor‐20全自动血沉仪）与传统魏氏法测定红细胞沉降率（ESR）结果的可比性。方法分别用Monitor‐20全自动血沉仪和传统魏氏法同时测定50例临床标本的ESR ,并对数据进行比较分析。结果 Monitor‐20全自动血沉仪与魏氏法所测ESR比较差异无统计学意义（t＝0．4673,P＞0．05）,两者有较好的相关性（r＝0．9890,P＜0．01）。结论 Monitor‐20全自动血沉仪检测ESR与传统魏氏法比较具有良好的相关性,是一种检测ESR的快速、准确、可靠的方法,值得临床推广应用。     

Comparative study between the Ves-matic and microerythrocyte sedimentation rate method

In this study, Ves-matic erythrocyte sedimentation rate and micro-erythrocyte sedimentation rate methods were compared on 96 subjects mean age 4.9+/-4.3 years. Ves-matic erythrocyte sedimentation rate an automated method, and micro-erythrocyte sedimentation rate method required minimal bloods are various approaches on the erythrocyte sedimentation rate. An important relationship between that the Ves-matic and micro-erythrocyte sedimentation rate was revealed. Although there was significantly correlation between these two methods, they are different to use interchangeably. Our study implies that "Micro-Automated Erythrocyte Sedimentation Rate Systems" could be developed which require a few amounts of blood and study automatically.     

ESR—K与血浆纤维蛋白原水平的临床相关性探讨

目的探讨ESR-K与血浆纤维蛋白原水平的临床相关性及其意义。方法对445例无活动性炎症的男女性中老年成人检测ESR-K、血浆纤维蛋白原及红细胞压积，并作动态ESR分析。结果ESR-K值与血浆纤维蛋白原水平呈显著直线正相关(r=0.603,P<0.01)；按ESR-K水平分组显示ESR-K水平依次上升其血浆纤维蛋白原值及其阳性率呈阶梯增高，有非常显著意义(P<0.01)；动态ESR-K呈持续缓降、前/后期速降、持续速降型表现时，各组血浆纤维蛋白原水平及其阳性率依次增高，有非常显著意义(P<0.01)。     

45例恶性肿瘤患者血液流变学指标检测与分析

目的探讨恶性肿瘤患者血液流变学指标的变化。方法对45例恶性肿瘤患者与35例健康人血液流变学指标进行检测并比较。结果男、女恶性肿瘤患者全血黏度、血浆黏度、纤维蛋白原、红细胞沉降率（下称血沉）和血沉K值结果均较健康对照组明显增高,差异有统计学意义（P〈0．01）;红细胞压积较健康对照组降低,差异有统计学意义（P〈0．05）。结论恶性肿瘤患者血液流变学存在明显异常,呈高黏滞血症改变,通过血液流变学各指标的动态观察,对恶性肿瘤患者诊断、治疗及预后判断有一定的临床价值。     

红细胞沉降率在评估系统性红斑狼疮活动性中的应用价值

目的评价红细胞沉降率是否可用于评估系统性红斑狼疮患者的疾病活动性。方法选择2012年6~12月共77例系统性红斑狼疮患者纳入本研究,诊断符合美国风湿病协会要求,男14例,女63例,红细胞沉降率、补体3(C3)、补体4(C4)、抗dsDNA抗体等检测项目于就诊当天完成检测,按系统性红斑狼疮疾病活动度评分表(SLEDAI)评分标准将上述患者分为活动期组(n=44,SLEDAI4分)和缓解期组(n=33,SLEDAI=0~4分),比较两组上述指标差异有无统计学意义,计算各指标与SLEDAI评分的相关性。双侧以P0.05为差异有统计学意义。结果活动期红细胞沉降率[21(10,37)]mm/h,明显高于缓解期的[11(5,21)]mm/h,差异有统计学意义(Z=-2.787,P=0.005),在区分系统性红斑狼疮活动与否能力方面,红细胞沉降率与C3、C4及抗dsDNA抗体相比,差异并无统计学意义(P0.05)),Pearson相关性分析显示,红细胞沉降率与SLEDAI评分呈正相关(r=0.293,P=0.010)。结论红细胞沉降率可用于对系统性红斑狼疮患者进行疾病活动性评估。     

Correlation of disease activity in systemic vasculitis with serum C-reactive protein measurement. A prospective study of thirty-eight patients

In a prospective study over 2 years, serum C-reactive protein (CRP) concentration and erythrocyte sedimentation rate were measured serially in thirty-eight patients with various types of necrotizing systemic vasculitis. The CRP concentration was always elevated in patients with active vasculitis and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. In contrast the sedimentation rate responded more slowly to changes in disease activity and did not necessarily reflect the level of inflammation at a particular time. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial measurement of the serum CRP fills the urgent need for an objective index of the activity of the systemic vasculitides and their response to therapy.     

ESR、血沉方程K值、Fbg、hs-CRP及GLB水平变化用于筛查鼻咽癌的价值初探

目的观察鼻咽癌(nasopharyngeal carcinoma,NPC)和鼻咽炎(nasopharyngitis,Npi)患者红细胞沉降率(e-rythrocyte sedimentation rate,ESR)、血沉方程K值(equation K value of erythrocyte sedimentation rate,ESRK)、纤维蛋白原(fibrinogen,Fbg)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)及球蛋白(globulin,GLB)水平及其相互之间关系,探讨其用于鉴别二者的潜在价值。方法收集经病理组织学确诊的下列患者血液标本:Npi 30例,NPC 61例,检测其ESR、Hct、Fbg、hs-CRP及GLB水平,并计算得到ESRK,分析各变量在两种疾病之间的变化。结果 (1)除GLB外,NPC组各指标总体水平均高于Npi组,其中Fbg和hs-CRP差异显著(P<0.05),但此二指标中位水平仍未超过参考值上限。(2)将NPC各期分别与Npi比较,发现Fbg和hs-CRP在NPC早期即明显升高(P<0.05),二者呈正相关(P<0.05),而ESR和ESRK在肿瘤晚期显著升高(P<0.05),二者也呈正相关(P<0.05)。结论 Fbg和hs-CRP对NPC的预警价值高于ESR和ESRK,但目前的参考值体系限制了二者在预测NPC上的应用。     

红细胞沉降率标准物质均匀性和稳定性评价

目的：对红细胞沉降率（ESR）标准物质的均匀性和稳定性进行评价。方法根据国际化标准组织 GUIDE 35《标准物质定值的通用原则及统计学原理》对制备完成的标准物质随机抽取足够的样品,采用方差分析法进行均匀性评价,用线性趋势模型评价标准物质的稳定性。结果均匀性评价结果表明样品组内和组间方差差异无统计学意义（P ＞0．05）;稳定性数据分析结果显示,标准物质 ESR 随存储时间的线性变化趋势稳定,差异无统计学意义（P＞0．05）。结论制备的 ESR 标准物质均匀性、稳定性符合国家二级标准物质的要求。     

Efficacy of pentastarch in granulocyte collection by centrifugal leukapheresis

The efficacy of 6% hydroxyethyl starch (hetastarch, HS) in enhancing granulocyte harvest by centrifugal leukapheresis has been described by a simple equation which predicts the granulocyte collection efficiency (GCE) based on an intrinsic donor variable, the erythrocyte sedimentation rate (ESR): GCE (%) = 1.3 ESR (mm/hr) + 45. Ten percent low molecular weight hydroxyethyl starch (pentastarch, PS) has been reported to be as effective as HS with potentially fewer adverse donor reactions (ADR). The derivation of an analogous equation for PS under conditions previously reported for HS may quantify PS efficacy and allow comparison to HS. We prospectively measured the in vitro and the in vivo effects of PS on the donor ESR in 53 granulocyte collections from 44 donors using the model CS-3000 Plus blood cell separator (CS). We then correlated the findings with the GCE of each procedure and derived an equation which expresses GCE in terms of baseline donor ESR. The in vitro addition of PS increased the donor ESR 2.4-fold, but its administration to a donor during a collection procedure did not appreciably change the ESR. Higher baseline donor ESR was more likely to result in more efficient cell collections: GCE (%) = 0.8 ESR (mm/hr) + 20; (r = 0.37). For granulocyte harvests using the CS and PS as the sedimenting agent 1) baseline donor ESR affects granulocyte harvests, but the poor correlation does not allow an accurate prediction of GCE and cell yield from the baseline donor ESR; 2) in comparison with HS (results from a previous study), PS may be less effective in vitro and not effective in vivo in elevating ESR, and may be less effective in enhancing granulocyte harvest; and 3) the parameters (slope, y-intercept, correlation coefficient) which define the linear relationship between baseline donor ESR and GCE may serve collectively as a quantitative measure of the effectiveness of different hydroxyethyl starch agents in enhancing granulocyte harvests. These parameters may be helpful in rapidly assessing the clinical efficacy of new, potentially useful hydroxyethyl starch agents prior to initiating a randomized, controlled clinical trial.     

235家临床实验室红细胞沉降率参考区间和医学决定水平的现况调查

目的调查全国235家实验室红细胞沉降率(ESR)参考区间和医学决定水平的现状。方法利用基于Web方式的室间质量评价软件系统,收集参加2014年ESR参考区间调查室间质量评价计划的实验室与参考区间和医学决定水平有关的结果。使用SPSS 13.0软件对所有参加的实验室结果进行分析,按照仪器对各实验室进行分组进行参考区间和医学决定水平的统计描述。结果参加调查ESR参考区间的实验室数量为235家,其中96家上报了医学决定水平。参考区间来源中,比例最高的为《全国临床检验操作规程》(80.85%),接下来依次为教科书(8.51%)、仪器试剂厂家说明书(6.38%)、实验室自己确定(2.98%)和其他。医学决定水平的来源中,最多的也是《全国临床检验操作规程》(75.00%),其次为仪器试剂厂家说明书(15.63%)。仅有45.11%和46.88%的参与实验室在使用参考区间和医学决定水平前对其进行了验证。分别有168家和72家实验室按照性别对ESR参考区间和医学决定水平进行了区分。男、女和未分组的参考区间上限和医学决定水平在不同仪器组无明显差异(P0.05)。结论我国ESR参考区间和医学决定水平的现况不尽如人意,目前急需一致的国家标准来指导实验室制订适当的ESR参考区间和医学决定水平。     

两种方法检测红细胞沉降率的性能比较

目的探讨采用不同方法检测红细胞沉降率的性能。方法采用魏氏法和自动血沉仪检测126例患者红细胞沉降率,并对两种方法的性能进行比较。结果两种方法检测红细胞沉降率的相关系数（r）=0.996,但MicroSed自动血沉仪测定结果均值低于魏氏法,而且两种结果的差值随着红细胞沉降率值的升高而增大。结论两种方法测定红细胞沉降率的结果具有良好的相关性,但MicroSed自动血沉仪测定结果偏低,当其测定结果在临界值或高值时,则最好用魏氏法进行复检。     

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins in clinical materials and models

The relationship between the erythrocyte sedimentation rate (ESR) and plasma proteins was studied within homogenous clinical material and in in vitro models. In acute phase reactions, fibrinogen was the likely cause of the ESR-elevation, but there were significant associations between the ESR and the concentrations of α₁-antitrypsin, C₃, haptoglobin and albumin. In chronic diseases, the ESR-elevation was probably caused by fibrinogen, mono- or polyclonal increase of IgG, IgA, IgM alone or in combinations. In multiple myeloma of the IgG and IgA subtypes, significant correlations were found between the ESR and the monoclonal proteins or between the ESR and the percentage of plasma cells in bone marrow. Model studies showed that the ESR increased linearly with the concentrations of fibrinogen or gammaglobulin (IgG) when these exceeded normal thresholds. The ESR was slightly decreased by increasing concentrations of albumin. Albumin had a synergistic effect on the ESR together with gammaglobulin, but not together with fibrinogen.     

Diagnostic value of C-reactive protein measurement does not justify replacement of the erythrocyte sedimentation rate in daily general practice

Abstract. The purpose of this paper was to establish the diagnostic value of the C-reactive protein measurement (CRP) in patients attending their general practitioner (GP) with a new complaint for which the GP considers determination of the erythrocyte sedimentation rate (ESR) to be indicated. During 4 successive months in 1992, 11GPs in four general practice centres in the Netherlands identified patients indicated for the erythrocyte sedimentation rate. ESR and CRP were determined at the local hospital laboratory. One year later, an independent GP established the follow-up diagnoses. By comparing the test results with the follow-up diagnoses, using logistic regression analysis and Receiver Operating Characteristic curves, sensitivities, specificities, predictive values and odds ratios were established. In 396 patients the prevalence of inflammatory diseases and malignancies ('pathology') was found to be 26% in males and 15% in females. Both ESR and CRP were valuable in discriminating pathology from harmless, often self-limiting diseases. The optimal upper limits of reference values ('cut-off points') for ESR were found to be 31 mm in both males and females. At these cut-off points, the diagnostic gains from positive and negative test results (positive predictive value minus prevalence, and negative predictive value minus 100% minus prevalence) were 45% and 4% for males and 30% and 2% for females. The optimal cut-off point for CRP was found at 15mgL^-1in males and 34mgL^-1in females. The diagnostic gain from positive and negative test results were 18% and 9% in males and 25% and 4% in females. In daily general practice there is no reason to abandon ESR in favour of CRP. Only if a GP wants to be informed of the test result as quickly as possible, and the costs of ordering tests are Jess important, might CRP be reconsidered as a test.     

Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein for the Exclusion of Septic Arthritis in Emergency Department Patients

BackgroundPrevious studies in post-operative orthopedic and pediatric patients suggest that erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing may be helpful in ruling out septic arthritis. However, these tests have not been evaluated in a population of adult Emergency Department (ED) patients.Study ObjectiveDetermine the sensitivity of ESR and CRP in patients with septic arthritis.MethodsRetrospective analysis of ED patients with septic arthritis from 2003 to 2008. Eligible patients had an International Classification of Diseases - Ninth Revision diagnosis of pyogenic arthritis (711.0x) plus: positive synovial fluid culture, positive synovial Gram stain, or operative irrigation. Patients were excluded if no ESR or CRP was performed within 24 h. Sensitivity of ESR and CRP at various cutoffs was calculated with 95% confidence intervals (CI).ResultsWe identified 167 patients with septic arthritis. We included 143 (86%) who had ESR (n = 140, 84%) or CRP (n = 96, 57%) performed. Mean age was 49 (± 22) years, and 85 (59%) were male. Race was: 125 (87%) white, 4 (3%) black, and 12 (8%) Hispanic. Thirty-five (24%) had infection of prosthetic joints. Synovial cultures were positive in 102 (71%). Sensitivity of ESR was: 98% (95% CI 94–100%) using a cutoff of ≥ 10 mm/h (n = 134) and 94% (95% CI 88–97%) using a cutoff of ≥ 15 mm/h (n = 131). The sensitivity of CRP was 92% (95% CI 84–96%) using a cutoff of ≥ 20 mg/L (n = 88).ConclusionESR and CRP have sensitivities of > 90% for septic arthritis, but only when low thresholds are used. Further study is required to determine the clinical usefulness of ESR and CRP testing.     

Precil XC-40型全自动动态血沉测试仪的应用评价

目的比较Precil XC-40型全自动动态血沉测试仪测定结果与传统魏氏法测定结果的相关性和线性。方法分别用自动血沉仪法和传统魏氏法测定238例临床患者1h红细胞沉降率(ESR)。结果经统计学处理,238例ESR在两种方法的测定结果经检验,差异无统计学意义(P>0.05)。在正常参考值范围内,二者测定结果一致。但当ESR>15mm/h后,Precil XC-40型全自动动态血沉测试仪测定中位数高于魏氏法,而且随着测定值增加,二者之间差异越明显。结论全自动动态血沉测试仪对正常标本测定结果与魏氏法接近,而在贫血、脂血标本以及ESR明显升高的标本则应以魏氏法为金标准。     

人工髋关节置换术前后红细胞沉降率、C反应蛋白及血清淀粉样蛋白变化的检验分析

目的分析人工髋关节置换术前后红细胞沉降率(ESR)、C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)的变化。方法选取该院2012年4月至2015年4月收治的单侧人工髋关节置换术共124例作为受试对象,患者接受人工髋关节置换术,检测患者术前和术后1、3、5、7、14d和1、3个月的CRP、ESR和SAA水平。并回溯性分析术后出现下肢深静脉血栓阻塞的患者与术后恢复正常的患者在上述指标的区别。结果 CRP术后急剧上升,并于第3天到达峰值后迅速消退,术后1个月即恢复至术前水平;ESR术后持续上升直至到达峰值后缓慢下降,术后3个月可恢复至正常水平;SAA术后急剧上升,于3d内到达峰值并缓慢下降,术后3个月可恢复至术前水平。出现术后并发症的患者,其CRP、ESR和SAA水平在同一时间显著高于术后正常恢复的患者,且术后3个月不能恢复至术前水平。结论行人工髋关节置换术后动态监测患者CRP、ESR和SAA水平可能有助于提早发现术后下肢深静脉血栓堵塞并发症。     

全自动红细胞沉降率分析仪Monitor-100测定结果的评价

目的评价全自动血沉仪Monitor-100测定红细胞沉降率(ESR)结果的可靠性和准确性。方法随机选取住院和门诊患者146例,采用自动ESR分析仪Monitor-100的30min和1h及魏氏法测定ESR,并对3种方法进行比较并进行重复性检测。结果 (1)仪器法30min、仪器法1h、魏氏法检测ESR值分别为37.8±34.1、38.1±33.7和36.4±32.9,两两比较其差异均无统计学意义(P0.05)。(2)仪器法30min、仪器法1h、魏氏法的阳性结果检出率依次为43.2%、44.5%和45.2%,未发现有统计学差异(P0.05)。(3)仪器法30min、仪器法1h、仪器法30min与魏氏法、仪器法1h与魏氏法之间比较,Kapper值依次为0.944、0.875、0.903。(4)重复性检测CV值均较小,均在可接受范围内。结论全自动ESR分析仪Monitor-100与魏氏法相比,假阳性率和假阴性率均较低,且一致性、重复性极好,方便快速且安全,应在临床上大量推广。     

Test‐1 analyzer and conventional Westergren method for erythrocyte sedimentation rate: A comparative study between two laboratories

Background

Measurement of the length of sedimentation reaction in blood (LSRB), also called erythrocyte sedimentation rate (ESR), is a widely used hematology test. This study intends to compare ESR levels measured by Test‐1 method and International Council for Standardization in Hematology's (ICSH) reference method, and analyzes the effect of hematocrit (Hct) on ESR results.

Material and Methods

A total of 755 patients from 2 hospitals were included in the study, and samples with EDTA were studied by Test‐1 method for ESR measurement and total blood count, whereas citrated samples were studied with reference Westergren method. Then, 2 methods were compared. Distribution of ESR results according to the ESR(≤20, >20 mm/h) and Hct(≥35%, <35%) levels and hospital type was analyzed. ESR levels with Hct levels<35% were corrected with Fabry's formula.

Results

The mean and SD values for the Test‐1 method, reference Westergren method, and corrected ESR measurement were 21.30 ± 18.39, 28.59 ± 25.82, and 24.92 ± 20.58 mm/h, respectively. Within the whole group, the correlation coefficient (r) was .77 (.7‐.80) with a significance level P < .001. Passing‐Bablok regression analysis of the methods resulted in a regression equation y = 1.00 (95% Cl: 0.43‐1.88) + 0.75 (95% Cl: 0.70‐0.78)x while the significance of linearity was acceptable (P < .01). All subgroup linear regression analyses revealed that the correlation was acceptable, except ESR > 20 mm/h group, Hct < 35% group, and corrected ESR group (significance level were P > .10).

Conclusion

The study showed that the role of the hospital and the capacity of testing are important in choosing the instrument for measuring ESR. Furthermore, the patient profile, especially malignancy possibility and Hct level, may be important for instrument selection.

     

血小板计数对判断肺结核病情的价值探讨

目的了解外周血小板计数增高对结核病患者病情的诊治价值。方法选择2012年1—6月住院初治肺结核进展期80例（进展期组）、治疗后好转期43例（好转期组）及同期健康体检者89名（对照组）。采用血常规细胞计数仪检测外周血白细胞、血小板计数，中性粒细胞比值；同日送检血红细胞沉降率（ESR）及C反应蛋白（CRP）。SPSS13．0统计软件处理数据。结果进展期组ESR及CRP分别明显高于好转期组（P=0．0065，P=0．0073）；进展期组血小板计数高于正常参考值上限者占41．94％，均值亦明显高于好转组及对照者（分别为P=0．0014，P=0．0000）；且血小板计数分别与ESR及CRP呈正相关。而白细胞计数及中性粒细胞比值与对照组比较差异无统计学意义（P〉0．05）。结论结核病患者外周血血小板计数升高，对判断病情的活动性及治疗效果具有一定参考价值。