Kost G J, Nguyen T H, Tang Z
Medical Pathology and Clinical Chemistry, University of California, Davis, School of Medicine 95616, USA.
Arch Pathol Lab Med. 2000 Aug;124(8):1128-34. doi: 10.5858/2000-124-1128-WBGAL.
To assess the effects of 30 of the most commonly used critical care drugs on measurements obtained with trilayer electrochemical biosensors on a reference analyzer (ABL625-GL), to determine metabolic changes in glucose and lactate in vitro, and to formulate guidelines for whole-blood analysis of these 2 analytes.
Serial measurements were taken of changes in glucose and lactate levels caused by metabolism in whole blood in vitro over time. A parallel control study of drug interference with measurements of glucose and lactate in whole blood and of dose-response relationships in whole-blood samples and in plasma samples also was conducted.
At room temperature, whole-blood metabolism decreased glucose levels -2.3% at 15 minutes, -4.6% at 30 minutes, and -6.4% at 45 minutes. Metabolism increased lactate levels 11.4% at 15 minutes, 20.6% at 30 minutes, and 26.7% at 45 minutes in vitro. Paired differences between drug-spiked and control samples were calculated to determine interference (corrected for metabolism). The threshold for determination of interference was +/-2 SD from within-day precision, equal to +/-0.18 and +/-0.10 mmol/L for glucose and lactate, respectively. Only mannitol (C(6)H(14)O(6)) interfered with glucose and lactate measurements. At a concentration of 24 mg/mL, mannitol decreased whole-blood glucose levels by an average of 0.711 mmol/L (12.8 mg/dL) and whole-blood lactate levels by 0.16 mmol/L (1.4 mg/dL). Mannitol interference with measurements may have resulted from suppression of hydrogen peroxide formation in the enzymatic reactions in the biosensors, repartitioning of water between erythrocytes and plasma, or from other mechanisms.
Most critical care drugs had no significant effects on the trilayer electrochemical biosensors. Whole-blood analysis should be performed within 15 minutes for lactate and within 30 minutes for glucose because of metabolism in vitro. Mannitol effects on glucose measurements may be clinically significant in mannitol-induced acute renal failure and therefore should be considered for appropriate diagnosis and treatment of critically ill patients.
评估30种最常用的重症监护药物对参考分析仪（ABL625 - GL）上三层电化学生物传感器所测结果的影响，确定体外葡萄糖和乳酸的代谢变化，并制定这两种分析物全血分析的指南。
对体外全血中随着时间推移因代谢引起的葡萄糖和乳酸水平变化进行连续测量。还进行了一项平行对照研究，观察药物对全血中葡萄糖和乳酸测量的干扰以及全血样本和血浆样本中的剂量 - 反应关系。
在室温下，全血代谢使葡萄糖水平在15分钟时下降2.3%，30分钟时下降4.6%，45分钟时下降6.4%。体外代谢使乳酸水平在15分钟时升高11.4%，30分钟时升高20.6%，45分钟时升高26.7%。计算加药样本与对照样本之间的配对差异以确定干扰（校正代谢因素）。干扰判定阈值为日内精密度的±2标准差，葡萄糖和乳酸分别等于±0.18和±0.10 mmol/L。只有甘露醇（C₆H₁₄O₆）干扰葡萄糖和乳酸测量。在浓度为24 mg/mL时，甘露醇使全血葡萄糖水平平均降低0.711 mmol/L（12.8 mg/dL），全血乳酸水平降低0.16 mmol/L（1.4 mg/dL）。甘露醇对测量的干扰可能是由于抑制了生物传感器酶促反应中过氧化氢的形成、红细胞与血浆之间水的重新分配或其他机制。
大多数重症监护药物对三层电化学生物传感器无显著影响。由于体外代谢，乳酸全血分析应在15分钟内进行，葡萄糖全血分析应在30分钟内进行。甘露醇对葡萄糖测量的影响在甘露醇诱导的急性肾衰竭中可能具有临床意义，因此在危重病患者的适当诊断和治疗中应予以考虑。
