深圳正常人糖化血红蛋白测定参考范围的建立

目的探讨深圳正常人群糖化血红蛋白（HbAlc）的参考范围。方法使用日本TOSOH公司HLC-723G7全自动糖化血红蛋白分析仪检测202名健康体检者的糖化血红蛋白，并同时进行肝功能、血糖、血脂、血常规测定。HbAlc正常参考值按至士1．96s计算。结果HbAlc呈正态分布，不同性别HbAlc的分布未发现明显差异（t=1.443，P=0.152）；不同年龄分组HbAlc的均值存在显著性差异（P=0．043，〈0．05），以60Y为分界年龄；HbAlc的参考值为：〈60Y参考值为4．35％-5．58％，〉60Y参考值为4．92％-5．73％；HbAlc与空腹血糖水平（r=0.294，P=0.003）和年龄（r=0．382，P〈0．001）均相关。结论HbAlc的水平存在年龄差异，不同实验室需要建立各自的参考值。     

POCT血糖仪的性能分析

目的比对5个品牌9款床边检测（POCT）血糖仪的主要分析性能。方法用高、中、低3个浓度的质控品在9款POCT血糖仪上进行检测,连续测试30d,计算变异系数（CV）。取高、中、低3种不同葡萄糖浓度的患者样本,同一样本取2份。一份为新鲜全血[乙二胺四乙酸（EDTA）抗凝],在9款POCT血糖仪上进行检测,计算同一样本在9款POCT血糖仪上检测所得结果的均值（x）、标准差（s）、CV;另一份为新鲜血清样本,用日立7060全自动生化分析仪进行检测,评价日立7060全自动生化仪与POCT血糖仪测定结果的相关性。结果质控品在9款POCT血糖仪上所测结果的CV在2．62％～5．86％之间,符合国家对血糖检测系统的测量重复性要求（CV不超过7．5％）。高浓度血糖用POCT血糖仪所测结果的CV在10％左右,中、低浓度血糖用POCT血糖仪所测结果的CV均〉10％,与美国临床实验室标准化委员会（NCCLS）对葡萄糖POCT的管理要求（总误差≤10％）不符。Johnson Ultra和ArkRay GT-1810 2款POCT血糖仪与日立7060全自动生化仪所测结果的相关系数（r）〈0．95,相关性略差;其他几款POCT血糖仪与日立7060全自动生化仪所测结果的r均t〉0．95,相关性较好。KBCT-X10、Roche Integra、Advantage和Johnson Ultra POCT血糖仪的斜率（b）超出1．0±0．05。结论POCT血糖仪仅可用于患者空腹血糖的监测或血糖过筛试验,不能代替实验室血糖的检测结果作为确诊试验。同时在选择POCT血糖仪时,不能仅一味追求其检测的快速,应该对血糖仪的分析性能进行综合评价。     

河南省义马矿区糖尿病高危人群糖代谢特征及影响因素调查

目的：调查分析河南省义马矿区糖尿病高危人群的血糖异常状况及其相关危险因素。 方法：①于2004—01／12对义马煤业集团下属的某居民区常住职工及家属进行糖尿病高危人群调查。均对调查项目知情同意。②用本院糖尿病诊治协作组自行设计的糖尿病高危人群筛查调查表，调查纳入对象的年龄、性别、疾病史、糖尿病家族史、糖尿病高危因素、体力劳动强度、家庭经济状况等。③测量纳入对象身高、体质量、血压、腰围、臀围的测量，计算体质量指数：体质量（kg）／身高（m）^2。均常规测定空腹血糖和餐后2h血糖。④计量资料比较采用t检验及方差分析，计数资料进行四表格或行&;#215;列χ^2检验。采用多类结果的logistic模型进行多因素分析。 结果：①纳入具有糖尿病高危因素居民2000人，资料完整者1015人进入结果分析，男659人，女356人，平均年龄（51&;#177;9）岁。〈40岁94人，40～49岁409人，50～59例313人，60～69岁149人，70-79岁50人。②男性空腹血糖及餐后2h血糖水平均明显高于女性（t=3．06，2．74，P〈0．01），糖尿病检出率也高于女性（χ^2=5．066,P〈0．05）。血糖异常的检出率由高到低依次为空腹血糖受损、糖耐量减低、糖尿病。③血糖水平随年龄增长有增高趋势（F=10．30，11．73,P=-0．000）。空腹血糖受损和糖耐量受损以50～59和60～69岁年龄段检出率最高，糖尿病检出率随年龄增长逐渐升高（χ^2=-66．6131,P=-0．000）。④糖代谢异常情况随着高血压、糖尿病家族史、曾有血糖升高检出率的增高而加重（χ^2=17.9683，19．9540，12．6355,P〈0．01），少体力活动和高血脂人群以空腹血糖受损最多见。⑤血糖异常影响因素多类结果的Logistic回归分析表明，年龄、糖尿病家族史、收缩压、舒张压、体质量指数、腰臀比均为血糖异常的影响因素（95％CI：0．0128～0．0243。P=0．000；95％CI：0．2352～0．5258，P=0．000；95％CI：0．0020～0．0112。P=0．04；95％CI0．0005～0．0119，P=0．031；95％CI：0．0208～0．0594．P=0．000；95％CI：1．4185～3．7153．P=-0．000）。 结论：①义马矿区居民以空腹血糖受损检出率最高，血糖水平存在性别差异。②糖调节受损（空腹血糖受损、糖耐量减低）在50-69岁时最高，糖尿病检出率随年龄增长而增高。③在各种糖尿病危险因素中，以年龄、糖尿病家族史、高血压史、体质量指数、腰臀比、体力活动少、高血脂史对血糖的影响明显。     

2型糖尿病患者HbAlc、HCY、CysC与肾脏微血管病变的关系探讨

目的探讨2型糖尿病（T2DM）患者糖化血红蛋白（HbAlc）、同型半胱氨酸（Hcy）、胱抑素C（CysC）与肾脏微血管病变的关系。方法196例T2DM患者分为合并微血管病变组（95例）和无微血管病变组（101例）,治疗后按糖化血红蛋白（HbAlc）控制水平又分为HbAlc〈7．0％组、HbAlc〉7．0％组,以健康体检者为对照组（46例）;分别测定空腹血糖（FPG）、HbAlc、Hcy、CysC、脂蛋白a（Loa）和尿微量蛋白（MAU）。结果T2DM患者HbAlc、Hcy、CysC、Lpa和MAU均不同程度的高于正常对照组（P〈0．05）,T2DM合并微血管病变患者HbAlc、Hcv、CysC、Lpa和MAU明显高于无微血管病变患者（P〈0．05）;T2DM合并微血管病变患者治疗后HbAlc〉7．0％组Hcy、CysC、Lpa和MAU水平明显高于HbAlc〈7．O％组（P〈0．05）;T2DM无微血管病变患者治疗后HbAlc〉7．0％组血清Hcy．Lpa水平明显高于HbAlc〈7．0％组fP〈0.05）;治疗后HbAlc〈7．0％的T2DM合并微血管病变患者Hey、CysC、Lpa、MAU水平高于无微血管病患者（P〈0．05）。结论高HbAlc、Hey和Lpa是T2DM微血管病变的重要原因,MAU、CysC是肾微血管受损的早期检测指标,通过联合检测HbAlc、Hcy．CysC、Lpa和MAU可以动态观察DM患者肾脏微血管病变程度;强化血糖控制、改善Hcy、Lpa代谢对于延缓T2DM微血管病变具有重要的临床意义。     

延边农村地区汉族和朝鲜族居民血脂异常分布特征比较

目的：调查分析延边农村地区汉族和朝鲜族居民血脂异常分布特征。方法：调查于2004-08／09完成，随机抽取延边地区汪清县大兴沟镇汉族和朝鲜族居民455名，均自愿参加调查。排除混血民族。①按统一的调查表（包括研究对象的一般情况、心脑血管疾病的既往史及家族史等）进行家访询问调查。②测量身高、体质量、腰围、臀围、血压等。取清晨空腹静脉血，测量血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、空腹血糖等指标，均用全自动生化分析仪测定。③分析血脂异常与其影响因素的关系采用Logistic回归分析。结果：调查问卷、体格检查及生化指标检测结果完整者455人。①两民族血脂异常率比较：朝鲜族男女血脂异常率显著高于汉族[84．1％，88．8％；30．7％，42．1％（x^2=48．9，53．4，P〈0．01）]，而且其高胆固醇血症、低高密度脂蛋白胆固醇血症、单纯高收缩压、单纯高舒张压、高血糖等患病率也均高于汉族（P〈0．05-0．01），朝鲜族女性的高三酰甘油血症患病率高于汉族女性（P〈0．01）。②血脂异常者不同血脂类型构成：延边农村地区的血脂异常以低高密度脂蛋白胆固醇为主要类型。③血脂异常相关因素的多因素分析：最终进入方程的因素分别为：民族、性别、收缩压、空腹血糖及腰围（OR=0．108，95％（21：0．061～0．190；OR=1．539，95％CI：0．970～2．441；OR=1．670．95％CI：1．020～2．757；OR=2．565．95％CI：270～5．183；OR=1．890，95％CI：1．196～3．008）。结论：延边农村地区汉族和朝鲜族人群血脂异常患病率存在差异，该地区的血脂异常与居民的民族、性别、收缩压、空腹血糖及腰围有关，并且以低高密度脂蛋白胆固醇血症为主要类型。     

2家医院2011～2014年POCT血糖仪检测总量和血糖高值与低值分布的调查分析

目的：调查北京市2家大型综合性三级甲等医院自动生化分析仪和POCT血糖仪检测（监测）总量和血糖高值与低值的分布情况,分析可能存在的问题。方法根据2010版糖尿病诊断指南,收集2011～2014年解放军军事医学科学院附属医院（医院A）和解放军空军总医院（医院B）血糖浓度小于3．9 mmol／L、3．9～7．2 mmol／L、大于7．2 mmol／L的检测数据,分析自动生化分析仪和POC T血糖仪检测（监测）总量和血糖高值与低值的分布。结果2家医院2种检测模式的血糖检测总量逐年增长,且POCT检测量明显高于生化分析仪检测总量;2家医院POCT 血糖检查总量增长率呈下降趋势,而 A医院下降更加明显。A医院血糖高值和低值分别占到检测总量的17．71％～18．95％和1．37％～2．03％,B医院血糖高值和低值分别占到检测总量的15．45％～17．98％和1．20％～3．80％。结论 POC T血糖仪的检测已成为血糖检测的重要模式,增幅不大的血糖异常数据,却对应着持续增长的POCT检测总量。POCT血糖仪检测在临床上对患者是否需要血糖监测、监测多少次,值得相关专家关注及探讨。同时,医院应加强临床应用POC T血糖仪规范化及监测次数的管理。     

25台POCT血糖仪与全自动生化分析仪血糖测定结果比对分析

[目的]定期监测全院25台床旁检验血糖仪（以下简称POCT血糖仪）检测结果与贝克曼生化分析仪血糖测定结果的一致性,全面了解医院各病区血糖测定值之间的差异。[方法]挑选10位空腹血糖在3．34mmol／L～23．4mmol／L（生化分析仪血糖检测结果）的患者,分别抽取EDTA抗凝全血和未抗凝血。EDTA抗凝血在POCT血糖仪测定血糖;不抗凝血在贝克曼DXC800生化分析仪测定血清葡萄糖,每份样本测定3次,取均值。经比对,21台POCT血糖仪与生化分析仪测定值偏倚〈20％。对21台仪器按使用年限编号排序,按规则抽样5台,用卫生部POCT血糖室间质评物测定血糖,与卫生部临床检验中心室间质评回报结果的靶值比对,计算偏倚。[结果]POCT血糖仪测定结果与生化分析仪测定结果比对,21台偏倚在1．1％～13．1％范围,4台仪器分别有3—4个浓度的测定值偏倚〉20％（偏倚bias22％～25％）。21台POCT血糖仪测定值变异系数（CV％）为3．4％～8．5％。抽样的5台POCT血糖仪与卫生部临床检验中心POCT血糖室间质评靶值（以下简称“靶值”）的偏倚为0％～11．4％。[结论]25台POCT血糖仪中21台与生化分析仪血糖检测结果比对具有一致性,4台比对差异大。生化分析仪比POCT血糖仪检测结果偏高约7．2％～13．1％。抽样的5台POCT血糖仪与靶值之间的偏倚符合卫生部临床检验中心质评判定标准。     

他汀类药物治疗对胆固醇不高的冠心病患者血管重建术的影响

目的 观察住院期间应用他汀类药物对低密度脂蛋白胆固醇（LDL-C）〈2．6mmol／L的冠心病患者血管重建术后住院和随访结果的影响。方法 我院接受血管重建治疗并且LDL—C〈2．6mmol／L的患者1765例，根据住院期间是否应用他汀类药物分为他汀组1056例与非他汀组709例。结果 他汀组院内主要不良心脑血管事件（MACCE）发生率和随访病死率均较非他汀组明显降低（分别为1．7％比3．8％，P=0．006；2．1％比5．1％，P=0．002），他汀组血管重建后累积病死率（院内及随访）也明显低于非他汀组（3．6％比7．9％，P〈0．001）。经logistic多因素回归分析，住院期间是否应用他汀类药物与累积病死率（院内死亡和随访死亡）显著相关（RR：0．597；95％CI为0．360～0．990；P=0．046），并且与随访病死率显著相关（RR：0．436；95％CI为0．231～0．821；P=0．01）。结论 住院期间应用他汀类药物可以显著减少胆固醇不高的冠心病患者血管重建术后的住院不良事件，降低累积病死率及随访病死率。     

二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价

目的系统评价二甲双胍联合罗格列酮治疗2型糖尿病（T2DM）的疗效及安全性。方法应用Cochrane系统评价方法,计算机检索Cochrane图书馆（2008年第4期）、PubMed（1966～2008．10）、EMbase（1974～2008．10）、CBM（1978～2008．10）、VIP（1989～2008．10）、CNKI（1994～2008．10）、万方数据库（1997～2008．10）．收集以二甲双胍联合罗格列酮（RSGIMET组）与单用二甲双胍（MET组）比较治疗T2DM的随机对照试验（RCT）,根据CochraneHandbook5．0质量评价标准评价,用RevMan5．0软件进行统汁学分析：结果共纳入11个RCT．合计2917例患者？Meta分析结果显示：RSG＋MET组较MET组能更有效地改善糖化血红蛋f{水平：WMD=-0．44％,95％CI（-0．70,-0．17）,P=0．001]、空腹血糖水平[WMD=-1．03mmol／L,95％CI（-1．85,-0．75）],提高胰岛素敏感性和∥细胞功能;在胃肠道反应发生率方面RSG＋MET组低于MET组,但水肿发生率高于MET组：RR=0．82,95％CI（0．71,0．94）;RR=3．27,95％CI（1．80,5．91）]：在体重指数、至少发生一次任何不良事件的患者例数和低血糖方面两组差异无统计学意义：结论RSG＋MET组较单用MET能更有效地控制血糖,提高胰岛素敏感性和β细胞功能,且可以降低胃肠道反应的发生率。     

44台POCT血糖仪与生化分析仪检测血糖结果比对分析

目的通过对便携式血糖仪（POCT）与全自动生化仪检测血糖结果比对试验．掌握3款POCT血糖仪与生化仪结果差异。方法选取15份肝素抗凝血标本,分别用44台3款不同型号的POCT血糖仪测全血血糖浓度和OLYMPUSAU2700全自动生化仪测血浆血糖浓度。结果采用SPSS13．0软件进行统计分析。结果配对t检验显示卓越型血糖仪的血糖检测结果与生化分析仪的差异无统计学意义（P〉0．05）;而稳豪倍优型、安妥超越型2款血糖仪的血糖检测结果与生化分析仪的差异有统计学意义（P〈0．05）。相关分析显示卓越型、稳豪倍优型、安妥超越型血糖仪与生化分析仪结果相关系数。均大于0．95．相关方程分别为Y=1．021X-0．88,Y=0．987X＋0．459,Y=0．960X-0．083。结论44台血糖仪误差均符合我目的POCT血糖仪麻川准则,但不同型号仪器与生化仪结果有一定差异．只能用于血糖监测．不能作为确诊试验。     

Evaluation and quality assessment of glucose concentration measurement in blood by point-of-care testing devices.

BACKGROUND: In this study the analytical performance of eight glucose point-of-care testing (POCT) devices was evaluated. For this purpose, POCT measurement of glucose in heparinized blood collected from patients was paralleled by determination of the glucose concentration in the respective plasma by an analyzer (Hitachi 917) in the central laboratory, providing traceable results. METHODS: Trueness of POCT measurements was studied by comparing the plasma POCT values (mean of five measurements) with the results from the traceable measurement procedure (TMP). RESULTS: The percentage of POCT results within +/-6% of the TMP mean value ranged from 24% to 50%, depending on the POCT device. Within the reference interval of plasma glucose (4.4-6.0 mmol/L), up to 67% of the POCT values were lower than 4.4 mmol/L, leading to a false diagnosis of hypoglycemia. In the hypoglycemic range (<4.4 mmol/L) up to 29% of the POCT analyses were false normoglycemic. CONCLUSIONS: In conclusion, this study shows an insufficient trueness of glucose measurements by POCT devices in the normo- and hypoglycemic range. To improve quality assessment, sample splitting and simultaneous measurement of blood glucose concentration every 4 weeks by POCT devices and of plasma glucose concentration by a reliable TMP is recommended.     

不同类型标本及仪器对血糖检测结果的影响

目的探讨罗氏血糖仪与全自动生化分析仪检测不同类型标本血糖水平的差异。方法收集2017年2-5月于南京市栖霞区妇幼保健院就诊患者及体检者的末梢血及静脉血标本104例。比较罗氏血糖仪检测的末梢血(末梢血POCT组)、静脉全血(全血POCT组)、静脉血浆(血浆POCT组)、静脉血清(血清POCT组)和全自动生化分析仪检测的静脉血浆(血浆生化仪组)、静脉血清(血清生化仪组)的血糖水平;验证罗氏血糖仪的精密度及线性范围。结果3台罗氏血糖仪的批内CV和批间CV均小于7.5%,符合判定标准。罗氏血糖仪检测的静脉全血血糖水平在1.1~24.4 mmol/L呈线性,R 2>0.95;静脉血清血糖水平在0.6~25.3 mmol/L呈线性,R 2>0.95,均符合线性要求。血糖水平<6 mmol/L的检测结果中,全血POCT组血糖水平低于其余各组(P<0.05);血糖水平为6~10 mmol/L的检测结果中,全血POCT组血糖水平低于血浆POCT组、血清POCT组、血浆生化仪组及血清生化仪组(P<0.05)。各组检测的血糖水平两两之间均具有显著相关性(r>0.99,P<0.05)。结论罗氏血糖仪检测精密度高,具有良好的线性,末梢血、静脉血浆、静脉血清等标本在血糖仪上的检测结果与全自动生化分析仪检测结果具有较好的可比性;罗氏血糖仪检测静脉全血时需进行一定程度的校正以保证结果的准确性。     

Relationships of glucose concentrations in capillary whole blood, venous whole blood and venous plasma

We studied the difference in glucose levels between capillary and venous whole blood during 75-g oral glucose tolerance test (OGTT) in 75 healthy subjects. Capillary and venous whole blood glucose values were measured by HK-G6PD method after deproteinization. The post-loaded glucose levels in capillary blood were significantly higher than those in venous blood, and the mean values of capillary and venous difference at 30, 60, 90, 120 and 180 min were 1.37, 1.40, 1.07, 0.95 and 0.52 mmol/l, respectively, with the maximum difference at 60 min. No correlation was found in the magnitude of the differences in glucose between capillary and venous blood specimens. We determined the inaccuracy of six self-monitoring blood glucose devices relative to the reference method using venous plasma, venous whole blood and capillary whole blood from 31 diabetic patients. The differences of mean values of venous whole blood and capillary whole blood, and venous whole blood and venous plasma, and capillary whole blood and venous plasma were 9.6%, 11.3% and -3.2%, respectively. The range of bias and Sy/x were 0.31-1.06 mmol/l and 0.71-1.07 mmol/l, respectively, compared to the reference method using venous plasma.     

Capillary versus venous bedside blood glucose estimations

Objectives: To determine the mean difference and correlation between capillary and venous bedside glucose estimation in comparison to laboratory blood glucose analysis in emergency department (ED) patients.

Methods: Blood glucose levels were synchronously analysed using a bedside blood glucometer on capillary and venous derived samples from consenting ED patients aged >12 years. The venous sample was sent for comparative testing using a laboratory based multichannel analyser. Mean difference and correlation coefficients were determined.

Results: A total of 20 subjects (aged 13–88 years) were enrolled, with 100% data capture. The mean laboratory glucose was 7.075 mmol/l. The mean capillary blood glucose was 7.66 mmol/l (mean difference compared with mean laboratory glucose 0.58 mmol/l; 95% confidence interval 0.3 to 0.9). The mean venous derived blood glucometer glucose was 7.99 mmol/l (mean difference compared with mean laboratory glucose 0.91 mmol/l; 95% CI 0.6 to 1.2). The correlation coefficient for the laboratory blood glucose versus the capillary blood glucometer glucose was 0.97 mmol/l (p<0.001). The correlation coefficient for the laboratory blood glucose and the venous blood glucometer glucose was 0.96 (p<0.001). Variation occurred between the glucometer and the laboratory blood glucose results.

Conclusions: There is a small but significant difference in the blood glucose results analysed on a bedside glucometer when the samples are taken from capillary or venous sources. Although good correlation is the norm between venous and capillary derived samples, caution must be exercised in accepting the results as equivalent or using either as substitutes for a laboratory blood glucose result.

     

两种抗凝血作为POCT血糖仪比对物的评价

[目的]探讨肝素和EDTA抗凝血POCT血糖仪血糖（Glu）检测结果是否存在差异。[方法]采集两种抗凝血,用八台POCT血糖仪（以下简称“仪器1—8”）和全自动干化学仪（以下简称“干化学仪”）检测血糖,以干化学仪检测值为目标“靶值”,将两种抗凝血POCT血糖仪检测结果与之比对,计算偏差,以体外诊断检验系统自测用血糖监测系统通用技术条件（简称“通用技术条件”,GB／T19634—2005）为依据,Glu〉4．2mmo]／L,相对偏差≤20％结果为合格。Glu≤4．2mmo]／L,绝对偏差〈0．83mmol／L为合格,本次比对以每台仪器I〉80％检测结果合格为该血糖仪合格判断标准。然后对每台POCT血糖仪肝素和ED—TA抗凝血检测结果作相关分析。[结果]Glu〉4．2mmol／L时,仪器1—8肝素抗凝血与“靶值”最小偏差0．9％,最大偏差28．6％。EDTA抗凝血与“靶值”最小偏差0．2％,最大偏差30．1％。Glu≤4．2mmol／L时,各台仪器两种抗凝剂检测值与目标“靶值”均小于0．83mmol／L。仪器1—8肝素抗凝静脉血（Y）和EDTA抗凝静脉血（x）相关系数T2〉0．95（P〈0．01）。[结论]本次结果提示,肝素和EDTA抗凝血POCT血糖仪检测血糖没有明显差异。两种抗凝血均可作为POCT血糖仪与强生干化学分析仪性能评价比对物。     

Challenges of implementing point-of-care testing (POCT) glucose meters in a pediatric acute care setting

OBJECTIVES: To investigate factors contributing to analytical bias in POCT glucose values generated by the NICU versus the core laboratory. METHODS: The LifeScan Flexx hospital system glucose meters (SureStep) were used in precision and comparison studies between the NICU and laboratory (ABL715 and Vitros 950). RESULTS: Analysis of 40 neonatal blood samples revealed a positive bias between the NICU glucose meters versus either the laboratory glucose meter or instrument (mean difference of 0.28 and 0.21 mmol/L, respectively). Linear regression analysis (R2 = 0.0584) of the difference in glucose results versus time elapsed between measurements indicated that the bias observed between the NICU and laboratory glucose meters was not due to in vitro glycolysis for samples transported on ice. Further analysis indicated that the bias appeared to be mostly operator driven, with different NICU operators exhibiting different mean biases. Increasing the amount of blood applied to the SureStep Pro test strip (e.g., 60 vs. 20 microL), led to higher values for glucose concentration for the same blood. Nearly 50% of all glucose values reported for the NICU were obtained by the SureStep Flexx glucose meters in a 3-month period following the introduction of POCT, yet the number of laboratory-reported glucose results for the same period increased by 21% as compared to the previous year. CONCLUSIONS: Operator error appears to be a source of bias present between the NICU and laboratory, and despite glucose meter utilization in the NICU, the number of glucose measurements by the central laboratory increased after POCT introduction.     

"Stat" measurements of L-lactate in whole blood and cerebrospinal fluid assessed

A first-generation semi-automatic amperometric lactate analyzer (Yellow Springs Instrument Co.) was assessed for urgent ("stat"), rapid laboratory measurements in whole blood and cerebrospinal fluid. For whole blood, measured lactate concentration and hematocrit were linearly correlated. An improved equation is presented for estimating the concentration of lactate in plasma from measurements in whole blood. The 95% reference range for the concentration of lactate in paired samples of capillary and venous whole blood from 40 healthy laboratory adults was found to be 0.4-1.5 mmol/L and 0.3-1.5 mmol/L, respectively. The 95% ranges for lactate in whole blood from 24 uncomplicated vaginal deliveries at term were established for cord venous blood, 1.2-5.0 mmol/L; cord arterial blood, 1.6-5.5 mmol/L; and maternal venous blood, 1.7-6.6 mmol/L. The 95% paired ranges were established for 20 lumbar-anaesthetized urological patients without neurological disorders after induction of anaesthesia for venous whole blood and cerebrospinal fluid (venous blood, 0.5-1.3 mmol/L; cerebrospinal fluid, 1.1-2.4 mmol/L).     

21台床旁检验血糖仪与生化分析仪血糖检测结果比对

目的定期监测新疆医科大学第一附属医院21台床旁检验血糖仪（以下简称POCT血糖仪）检测结果与贝克曼生化分析仪血糖测定结果的一致性,全面了解医院血糖测定值之间的差异。方法挑选10例空腹血糖在3.76～19.84mmol/L（生化分析仪血糖检测结果）的患者,分别抽取乙二胺四乙酸（EDTA）抗凝全血和未抗凝血。EDTA抗凝血在POCT血糖仪测定血糖;不抗凝血在贝克曼DXC800生化分析仪测定血糖,每份标本测定3次,取均值。对合格的19台仪器按使用年限编号排序,随机抽样5台,用新疆维吾尔自治区临床检验中心POCT血糖室间质评物测定血糖,与靶值比对,计算偏倚。结果 POCT血糖仪测定结果与生化分析仪测定结果比对,19台偏倚在0.93%～11.49%范围,2台仪器测定值偏倚大于20%,19台POCT血糖仪测定值变异系数（CV%）为3.14%～10.82%。抽样的5台POCT血糖仪与新疆维吾尔自治区临床检验中心POCT血糖室间质评靶值（以下简称＂靶值＂）的偏倚为0%～6.87%。结论 21台POCT血糖仪中19台与生化分析仪血糖检测结果比对具有一致性,2台比对差异大。生化分析仪比POCT血糖仪检测结果偏高约0.94%～12.98%。抽样的5台POCT血糖仪与靶值之间的偏倚符合新疆维吾尔自治区临床检验中心质评判定标准。     

Measurement of glucose content in plasma from capillary blood in diagnosis of diabetes mellitus

Overall, there is good correlation between glucose values obtained from ear capillary blood and those from peripheral venous plasma, but there are considerable individual differences. Results obtained with these two methods are generally not interchangeable and the converted values should not be used in the diagnosis of diabetes mellitus, because of the risk of misclassification. In Denmark this can affect 20-24000 persons. The aim of our study was to investigate whether these differences might be less significant if measurements were taken at the plasma phase of capillary blood and expressed directly as capillary plasma results and if finger capillary blood were used instead of ear capillary blood. The Hitachi 717 instrument was used for measurements of glucose concentrations in venous plasma, the Cobas Mira S in capillary whole blood and the Accu-Chek Inform from Roche in capillary plasma. The conclusions drawn were (1) capillary ear blood glucose concentration correlates well with capillary finger blood concentration and the two sites can be used interchangeably, yielding similar results in the individual patient; (2) sampling variation is almost the same (approx. 0.16 mmol/L) on capillary plasma and capillary whole blood from finger and ear. Sampling variation for venous plasma measured on the Hitachi instrument was 0.13 mmol/L; not significantly better; (3) the analytical imprecision of glucose measurements on capillary plasma (Accu-Chek Inform) and capillary whole blood (haemolysate method) is almost the same (approx. 2.0%). The analytical imprecision of glucose measurements on venous plasma is 0.9% using a laboratory method and almost twice as high using Accu-Chek Inform (2.1%); (4) determination of capillary plasma values in the finger did not improve the correlation with venous plasma values. Even though average values were in better concordance, individual differences did not change. For some persons, both ear- and finger capillary blood measurements deviate significantly from results on venous plasma, such that they cannot be used for diagnosis of diabetes mellitus; (5) the main factor for good correlation is the sampling site. Results obtained on plasma and whole blood from the same puncture correlate well; (6) neither capillary blood nor capillary plasma correlates with the venous plasma method recommended by the American Diabetes Association. It is concluded that physiologic differences in glucose content in capillary- and venous blood prohibit the random use of these two materials in the diagnosis of diabetes.     

Correlation of capillary and venous blood glucometry with laboratory determination

Background

During resuscitation in the Singapore Armed Forces, blood glucose samples are often obtained for analysis using the capillary glucometer. A drop of venous blood from the intravenous cannula is sometimes used to ascertain the patient's blood glucose level. Venous samples may be sent to a commercial laboratory, but this does not allow immediate results.

Objective

To establish the correlation between the glucose levels of the capillary fingerprick sample analyzed by the glucometer (Cap), the venous sample analyzed by the glucometer (Ven), and the venous sample tested by the commercial laboratory (Lab).

Methods

This multicenter, prospective study enrolled subjects from Selarang, Clementi, and Maju Camp Medical Centers in the Singapore Armed Forces from November 2002 to January 2003. All subjects provided at least two samples; because provision of the capillary blood glucose sample was voluntary, only some gave consent for capillary fingerprick and provided three samples. There were no exclusion criteria. Bland-Altman plots were then constructed to compare the capillary and venous-on-capillary values with the laboratory results.

Results

A total of 270 subjects were recruited. One hundred seventy subjects (63.0%) gave consent for capillary glucose measurement and, thus, had three readings for comparison. There was a mean difference of 0.97 mmol/L (17.46 mg/dL) between the Ven and Lab results. There was an insignificant mean difference of 0.01 mmol/L (0.18 mg/dL) between the Cap and Lab results.

Conclusion

Capillary whole-blood glucose values best approximated venous plasma glucose values from the laboratory. Measuring the venous whole-blood glucose using the glucometer resulted in an overestimation of the venous plasma glucose compared with the laboratory result by about 0.97 mmol/L (17.46 mg/dL). This may result in the withholding of intravenous glucose for patients who are actually hypoglycemic.