脂血对SysmexXE-5000血液分析仪检测指标的影响

目的探讨脂血对SysmexXE-5000血液分析仪测定血常规主要指标的影响。方法取30例无溶血、黄疸、脂血标本,每例平均分为4管,每例标本取一管组成一组,将所有标本分为4个组。第1组不做处理,设为对照组。其余3组标本以1000r／min离心10min,第2组将上层血浆分别吸出5μL,加入5μL脂肪乳剂;第3组上层血浆分别吸出10μ,加入10μL脂肪乳剂;第4组上层血浆分别吸出50μL,加入50μL脂肪乳剂。用日立7600全自动生化分析仪测定三酰甘油（TG）,根据TG的水平不同,将脂血的程度进行分级,第2组TG3．0～7．0mmol／L,设为轻度脂血组;第3组TG〉7．0～11．0mmol／L,设为中度脂血组;第4组TG〉11．0mmol／L,设为重度脂血组,剔除不符合的标本,每组标本选取20例,对照组取相应20例标本,测定血常规,将其结果与对照组进行比较。结果对照组与轻度脂血组比较白细胞（WBC）计数、红细胞（RBC）计数、血小板计数（PLT）、血红蛋白（Hb）水平、平均红细胞容积（MCV）、平均红细胞血红蛋白含量（MCH）、平均红细胞血红蛋白浓度（MCHC）结果差异均无统计学意义（P〉0．05）;中度脂血组与对照组比较,Hb、MCH、MCHC均升高,差异有统计学意义（P〈0．05）;重度脂血组与对照组比较,Hb、MCH、MCHC、MCV均升高,差异有统计学意义（P〈0．05）。结论中、重度脂血对SysmexXE-5000血液分析仪检测血液常规Hb、MCH、MCHC、MCV参数影响较大,并随着脂血程度加深而加重。     

脂血对Sysmex XE-2100D血液分析仪检测指标的影响研究

目的探讨脂血对Sysmex XE-2100D血液分析仪测定血常规主要指标的影响。方法取20例无溶血、黄疸、脂血标本设为对照组,将这20例标本去除上层血浆成分,加入同体积的Sysmex XE-2100D血液分析仪原装配套稀释液,测定血常规设为实验组,将其结果与对照组进行比较;取66例无溶血、黄疸、脂血已测定的血常规标本,随机分为3组,用实验组相同的方法去除10、50和100μL血浆后,加入等体积脂肪乳剂,用日立7600全自动生化分析仪测定甘油三酯(TG),根据TG的含量不同,将脂血的程度进行分级,TG 6.0～10.0 mmol/L 21例,设为轻度脂血组,未加脂肪乳剂测定结果设为对照组A;TG 10.1～14.0 mmol/L 21例,设为中度脂血组,未加脂肪乳剂测定结果设为对照组B;TG﹥14.0 mmol/L 24例,设为重度脂血组,未加脂肪乳剂测定结果设为对照组C,将测定结果分别与其未加脂肪乳剂者的测定结果进行比较。结果对照组A与轻度脂血组比较13项参数结果差异均无统计学意义;中度脂血组与对照组B和重度脂血组与对照组C比较,血红蛋白(Hb)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)、白细胞(WBC)均升高,其4项指标差异有统计学意义(P<0.05)。结论中、重度脂血对Sysmex XE-2100D血液分析仪检测血液常规Hb、MCH、MCHC、WBC参数影响较大,并随着脂血程度加深而加重。     

脂血对Sysmex XE-2100D血液分析仪检测指标的影响研究

目的观察脂血对Sysmex XE-2100D血液分析仪检测指标的影响情况。方法选择40例没有溶血和黄疸以及脂血的标本命作对照组;选择132例没有溶血和黄疸以及脂血且已经进行血常规检测的标本,划分出3组且各组内有44例。按照TG含量的差异,明确分级出患者脂血程度,即轻度脂血组、中度脂血组、重度脂血组,检测结果作为对照组Ⅰ、Ⅱ、Ⅲ。结果各组之间进行对比,相关指标差异小,且P>0.05。结论Sysmex XE-2100D血液分析仪进行血常规检测,不同脂血浓度对于其检测指标的影响不同,脂血浓度越高影响越大。     

自配MEK-4200血细胞分析仪稀释液应用评价

使用日本光电公司生产的血细胞分析仪M EK-4200,购买原装试剂成本高,其稀释液用量大,为解决依赖进口试剂价格昂贵、运输不便等问题,查阅了大量资料[1~4],自配了稀释液,经几次改动,经过一段时间使用,效果良好。其实验评价报告如下:1材料与方法1.1仪器M EK-4200型血细胞分析仪(日     

新鲜血比对在血细胞分析质量控制中的应用探讨

为了保证血细胞分析仪检测结果的准确性和不同实验室检测结果的可比性，解决使用配套校准物进行校准存在成本高、不易及时获得以及一些检测系统缺乏配套校准物无法校准的问题，许多专家建议通过参考实验室利用新鲜血液对血细胞分析仪进行校准，以保证检测质量。据此，我们应用新鲜血对我市8台血细胞分析仪进行比对并校准。现将结果报道如下：     

乳糜血标本对血细胞分析仪测定结果影响因素的探讨

目的：评价乳糜血标本血浆置换前后对血细胞分析仪测定结果影响的临床应用价值。方法采集乳糜血标本22例,使用血细胞分析仪对血浆置换前后的标本进行检测,并与手工显微镜计数结果进行比对。结果非乳糜血样本 WBC、NEU、LY、MO、RBC、HGB 和 PLT 结果与置换前的原始血样本测定结果的差异无统计学意义（P ＞0．05）;在22例乳糜血样本检测中, WBC 计数分类、HGB、PLT 在置换前后结果差异有统计学意义（P ＜0．05）,置换后乳糜血标本血细胞分析仪 WBC 计数分类和PLT 结果与显微镜计数法相关性较好（r2＝0．936;r2＝0．918）;在三酰甘油的干扰试验中,发现 WBC 计数分类、HGB、PLT 结果会随着三酰甘油浓度的增加而变化。结论采用血浆置换方法可以明显改善乳糜血标本对血细胞分析仪测定结果的影响,为临床提供准确的结果。     

全自动血细胞分析仪RBC／PLT稀释液的研制与应用

目的研制 ADVIA2120/2120i 血细胞分析仪红细胞/血小板（RBC/PLT ）稀释液配制方法,并应用于临床。方法对自制试剂与原装试剂分别进行 pH 、电导率、渗透压等理化参数测试,并在 ADVIA 2120/2120i 五分类血细胞分析仪上进行空白及100例临床标本对比测试,同时进行精密度、准确度、稳定性试验,对自制试剂与原装试剂两种试剂各测试指标进行比较,对所测得的数据用配对 t 检验进行统计学处理。结果自制试剂与原装试剂主要理化参数（pH 、电导率、渗透压）比对基本一致。自制试剂与进口试剂对100例血样标本各测试参数比较,其差异无统计学意义（P＞0．05）。结论自制 ADVIA2120/2120i 血细胞分析仪 RBC/PLT 稀释液与原装试剂比较,各项参数均符合要求,可以取代进口试剂。     

稀释回归法在脂血标本凝血检测中的应用探讨

目的探讨稀释回归法在脂血标本凝血凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)检测中应用的可行性。方法随机收集昆明市延安医院40例门诊及住院外观正常(无脂血、无黄疸、无溶血)凝血标本,分别检测原血浆和3倍、5倍稀释后血浆的PT、APTT两项指标,将稀释前与稀释后两组数据进行线性回归分析,得到各指标的回归方程。另外收集昆明市延安医院门诊及住院外观脂血标本33例,根据三酰甘油(TG)的不同浓度分成3组,轻度脂血组(1.7mmol/L≤TG11.0mmol/L)12例,中度脂血组(11.0mmol/L≤TG20.0mmol/L)13例,重度脂血组(TG≥20.0mmol/L)8例,检测3倍稀释血浆和高速离心后血浆的PT、APTT两项指标,并将稀释后结果带入正常凝血标本的回归方程所得结果与高速离心法结果进行比较。结果正常凝血标本5倍稀释血浆绝大部分标本无法检测出结果,所以取3倍稀释血浆稀释前后结果进行线性回归分析得到PT、APTT的回归方程。3组脂血标本3倍稀释后的PT、APTT两项指标经过相应回归方程计算,所得结果与原血浆高速离心后检测结果的差异均无统计学意义(P0.05)。结论稀释回归法可以用于临床脂血标本的凝血PT和APTT检测。     

通过监测中心血容量评估血液透析干体重的新方法-超声稀释

目的观察血液透析过程中患者血压变化的影响因素,并用超声稀释的方法测定中心血容量（CentralBloodVolumeCBV）变化对预防透析过程中低血压,及对调整透析患者干体重的作用。方法将60名患者按照以往的透析记录分为高血压组（HighbloodpressureHBP）、低血压组（Low blood pressureLBP）、正常血压组（Normal blood pressure NBP）。所有患者分别在透析治疗1h和透析3h时采用超声稀释的方法检测中心血容量（CBV）,心输出量（c0）,心脏指数（cI）,外周血管阻力（PVR）。结果对整体分析,C0、CI、CBV下降,平均下降（-12．3±15．8）％、（-18．2±21．0）％、（-0．12±0．16）％,变化有统计学意义,而血压变化和外周阻力变化无统计学意义,以低血压组下降较为明显;透析过程中CBV变化与CO变化呈正相关（,值为0．648,P值〈0．001）,与外周阻力变化、超滤速度呈负相关（r值分别为-0．487,和-0．524;P〈0．001和〈0．005）;根据CBV变化对20例血压未达标患者101次透析例次中予以逐步评估干体重后,透析过程中及透析结束后患者血压能够维持正常。结论CBV是反应中心血容量的有效指标,透析过程中CBV下降,说明患者在透析治疗期间细胞外液逐渐减少;透析过程中CBV变化与C0变化呈正相关,与PVR变化、超滤速度呈负相关;血压变化与心率变化呈负相关;不同分组PVR变化的影响因素不确定。我们可以根据患者超声稀释的方法测定透析前后CO、CI、CBV,来指导超滤量,设置合适的干体重,并对于防治血液透析中血压波动过大具有积极的意义。     

Effects of hemolysis and lipemia interference on kaolin-activated thromboelastography,and comparison with conventional coagulation tests

The effects of hemolysis and lipemia on thromboelastography (TEG) analysis have been scarcely evaluated in human samples, and neglected in clinical practice. We aimed to investigate the effects of in vitro mechanical hemolysis and lipemia on TEG analysis and conventional coagulation tests. Twenty-four healthy volunteers were enrolled in the study. Besides the controls, three groups with slight, moderate and severe mechanical hemolysis were constituted according to free hemoglobin (Hb) concentrations of 0.5–1.0, 2.0–6.0 and 7.0–13.0?g/L, respectively; and three groups with mild, moderate and high lipemia were established according to triglyceride concentrations of ～6.0, ～12.0, and ～18.0?mmol/L, respectively. Four TEG parameters, reaction time (R), coagulation time (K), angle (α), and maximum amplitude (MA), were measured alongside conventional plasma tests including prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) by mechanical method, and platelet count by optical method. Results showed that the median R and MA values at moderate and severe hemolysis and K at severe hemolysis exceeded respective reference intervals, and were considered unacceptable. Median values of TEG parameters in lipemic samples were all within reference intervals. Bias values of conventional plasma tests PT, APTT and FIB in hemolyzed or lipemic samples were all lower than the Clinical Laboratory Improvement Amendments (CLIA) allowable limits. Bias values of platelet count at moderate to severe hemolysis and lipemia exceeded the CLIA allowable limits. In conclusion, the detection of TEG was in general more affected by mechanical hemolysis than plasma coagulation tests. Pre-analytical variables should be taken into account when unexpected TEG results are obtained.     

急性超容量血液稀释对高龄患者心排量及凝血功能的影响

目的探讨急性超容量血液稀释对高龄患者心排量及凝血功能的影响。方法选取大关节手术患者60例,随机分成实验组30例和对照组30例。实验组给予6%羟乙基淀粉和乳酸林格氏液15 m L/kg行AHH;对照组不行AHH,予常规补液。比较2组患者心排量及凝血功能。结果实验组患者行AHH后,心排量(CO)有所增加,凝血功能有所降低。2组各时点的CO、红细胞压积(HCT)、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)以及血浆纤维蛋白原(Fib)比较,差异均无统计学意义(P0.05)。结论急性超容量血液稀释对高龄患者心排量及凝血功能的影响较小。     

Effects of fenofibrate on endothelial function and cell adhesion molecules during post-prandial lipemia in hypertriglyceridemia

BACKGROUND: Fasting and post-prandial hypertriglyceridemia have been associated with endothelial dysfunction. OBJECTIVE: To investigate the effects of a 3-month treatment with fenofibrate (200 mg daily) on endothelial reactivity and inflammatory state in hypertriglyceridemic patients at fast and after an oral fat load. METHODS: Brachial flow-mediated vasodilation (FMV) and the circulating levels of intercellular adhesion molecule (ICAM) and vascular cellular adhesion molecule (VCAM) were determined in 10 hypertriglyceridemic patients. RESULTS: Before treatment, post-prandial phase was characterized by an increase in triglycerides (3.7 +/- 1 mmol/L at baseline vs. 4.2 +/- 1, 6.5 +/- 1, 6.6 +/- 2, and 5.3 +/- 2 mmol/L after 2, 4, 6, and 8 h), a decrease in FMV (4.3 +/- 2% at baseline vs. 2.8 +/- 1, 2.2 +/- 1, and 1.3 +/- 1% after 2, 4, and 6 h), and an increase in ICAM and VCAM. After fenofibrate there was a significant reduction in fasting triglycerides (3.7 +/- 1.3 vs. 2.1 +/- 0.8 mmol/L), ICAM (480 +/- 113 vs. 269 +/- 65 ng/mL) and VCAM (1821 +/- 570 vs. 1104 +/- 376 ng/mL), and an increase in FMV (4.3 +/- 2 vs. 7.1 +/- 2%). Post-prandially triglycerides increased (2.1 +/- 1 at baseline vs. 2.4 +/- 2 and 3.6 +/- 1 mmol/L after 4 and 6 h), FMV decreased (7.1 +/- 2 at baseline vs. 5.8 +/- 2, 5.5 +/- 2, 5.9 +/- 2, 6.4 +/- 2% after 2, 4, 6, and 8 h), and there was an increase of ICAM and VCAM. Before therapy post-prandial changes in FMV had an inverse correlation with the changes in triglycerides (r = -0.34; P < 0.05) and ICAM (r = -0.66; P < 0.001). CONCLUSIONS: The transient endothelial dysfunction observed in hypertriglyceridemic subjects during post-prandial lipemia is mediated by post-prandial triglyceride increase and by the activation of inflammatory response. The anti-inflammatory activity of fenofibrate may represent an additional mechanism of its favorable action on the endothelial function during fasting and the post-prandial phase.     

同位素稀释-超高效液相色谱串联质谱法测定人体血清/全血中维生素B1

目的建立快速、灵敏测定人体血清/全血中维生素B_1的稳定同位素稀释-超高效液相色谱串联质谱(ID-UPLC-MS/MS)法。方法血清/全血样本经蛋白质沉淀处理,上清液用双蒸水稀释,采用Thermo Hypersil GOLD a Q色谱柱分离,以10 mmol/L甲酸铵水溶液~乙腈为流动相,梯度洗脱。采用电喷雾离子源电离,正离子模式下,采用多反应监测(MRM)扫描方式检测,维生素B_1和同位素内标的离子通道分别为m/z 265.2→122.0和269.2→122.0。结果维生素B_1在0.446~89.2 ng/m L范围内线性关系良好,r=0.999 6;低、中、高质控样本的日内、日间精密度的相对标准偏差(RSD)均5.34%;平均加样回收率在96.9%~102.6%,RSD均6.61%。结论建立的方法简单快速、灵敏度好、准确度高,可用于人体血清/全血中维生素B_1的测定。     

Extravascular lung water volume measurement by a novel lithium-thermal indicator dilution method: comparison of three techniques to post-mortem gravimetry

Objective  To compare the lithium-thermal double indicator dilution (Li-thermal), indocyanine green-thermal double indicator dilution (ICG-thermal), single thermal indicator dilution (single-thermal) and gravimetric techniques of extravascular lung water volume (EVLW) measurement in porcine models of acute lung injury. Design  Two animal models designed to invoke a systemic inflammatory response. Setting  Laboratory study. Subjects  A total of 12 immature Deutsches Landschwein pigs. Interventions  Extravascular lung water volume was measured at four time points using Li-thermal, ICG-thermal and single-thermal techniques. Measurements were performed using existing technology according to manufacturer’s instructions. Post-mortem gravimetric EVLW measurements were performed by measuring wet and dry mass of lung tissue. Measurements were compared using the Bland–Altman method. Data are presented as mean (SD). Measurements and main results  Data were collected in 12 animals and comparison between all 4 techniques was possible in 10 animals. EVLW measured by gravimetry was 9.2 (±3.0)ml kg⁻¹. When compared to gravimetry, both Li-thermal and ICG-thermal techniques showed minimal bias but wide limits of agreement (LOA) [Li-thermal: bias −1.8 ml kg⁻¹ (LOA ± 13.1); ICG-thermal bias −1.0 ml kg⁻¹ (LOA ± 6.6)]. Comparison between the single-thermal and gravimetric methods identified both considerable bias and wide LOA [+8.5 ml kg⁻¹ (LOA ± 14.5)]. Conclusion  Clinically significant differences between EVLW measurements obtained with the gravimetric method and three in vivo indicator dilution techniques were identified. While none of the techniques could be considered ideal, the ICG-thermal method appeared more reliable than either the Li-thermal or single thermal techniques. Further research is required to determine whether the accuracy of the prototype Li-thermal technique can be improved. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

倍比稀释法在医学实验室试剂筛选应用中的研究

目的探讨倍比稀释法在指导实验室筛选质量可靠检测试剂中的应用价值。方法通过对丙型肝炎病毒阳性血清标本进行倍比稀释,采用3种不同的酶联免疫吸附试验(ELISA)试剂盒检测结果比对,并结合聚合酶链反应(PCR)检测结果实施验证。结果 A、B和C 3种ELISA试剂检测结果阳性率之间差异有统计学意义;ELISA试剂检测出现全部阳性结果到全部阴性结果的梯度间均存在1个梯度差,PCR试剂检测全部阳性结果最大稀释梯度与ELISA(C)试剂检测结果具有较好的一致性。结论倍比稀释法为实验室筛查与选用质量可靠的检测试剂提供了良好的技术方法。     

Total lung capacity measured by body plethysmography and by the helium dilution method. A comparative study in different patient groups

Summary. The helium dilution method is known to underestimate the total lung capacity (TLC) in patients with poorly or non-ventilated areas in the lungs. The standard plethysmographic method has been reported to overestimate TLC in patients with severe airway obstruction. To determine the magnitude of the difference between the two methods, a comparison was made in different patient groups. In a group of patients with normal lung function tests (n= 20) there was a small but significant average difference in TLC between plethysmography and the helium dilution method, the larger values being obtained with the latter. In patient groups with moderately obstructed airways (n= 23), severely obstructed airways (n= 20), or emphysema (n= 19), there were no significant average differences, although in two patients in the emphysema group the plethysmographic values were considerably larger than those obtained by helium dilution. We conclude that the gas dilution methods and plethysmography with a pressure-compensated volume displacement plethysmograph gave estimates of TLC which agreed even in patients with airway obstruction or emphysema, except in patients with very severe lung disease.     

ATB嗜血杆菌药敏试验和肉汤稀释法检测流感嗜血杆菌药物敏感性的比较

目的 比较ATB嗜血杆菌药敏试验和肉汤稀释法检测流感嗜血杆菌药物敏感性的性能.方法 收集临床分离的流感嗜血杆菌共96株,采用ATB嗜血杆菌药敏试验板条和肉汤稀释法药敏试验测定氨苄西林、氨苄西林-克拉维酸、复方磺胺甲(口恶)唑、氯霉素、头孢呋辛和头孢噻肟对96株流感嗜血杆菌的最低抑菌浓度(MIC).结果 2种方法检测结果的符合率分别为:氨苄西林96.9%、头孢噻肟100.0%、氨苄西林-克拉维酸91.7%、复方磺胺甲(口恶)唑92.7%、氯霉素95.8%和头孢呋辛97.9%.结论 ATB嗜血杆菌药敏试验和肉汤稀释法均可用于临床分离的嗜血杆菌药敏试验.