Winter S D, Pearson J R, Gabow P A, Schultz A L, Lepoff R B
Clinical Laboratory, Denver General Hospital, Colo 80204-4507.
Arch Intern Med. 1990 Feb;150(2):311-3.
Using modern electrode technology (Beckman ASTRA analyzer), we evaluated the reference range for the anion gap (calculated as sodium minus chloride minus bicarbonate concentrations) in serum to determine whether the 8 to 16 mmol/L reference range in common use is still valid. After measurement of electrolytes in (1) serum from 29 healthy volunteers, (2) aqueous standards verified against National Bureau of Standards reference material, and (3) serum from 120 blood donors, we drew the following conclusions. (1) The reference range for the anion gap has shifted downward (to 3 to 11 mmol/L in one of our laboratories), primarily because of an upward shift in chloride values. (2) Using the ASTRA analyzer, a majority of normal individuals can be expected to have serum anion gaps of 6 mmol/L or less unless chloride calibration is deliberately altered. (3) If the anion gap is to remain an effective tool in diagnosing acid-base disorders, clinicians need to be aware that the traditional reference range may not be appropriate with new instrumentation.
我们使用现代电极技术（贝克曼ASTRA分析仪）评估了血清中阴离子间隙（计算方法为钠浓度减去氯浓度再减去碳酸氢根浓度）的参考范围，以确定常用的8至16毫摩尔/升的参考范围是否仍然有效。在对以下样本进行电解质测量后：（1）29名健康志愿者的血清；（2）对照国家标准局参考物质验证过的水溶液标准品；（3）120名献血者的血清，我们得出了以下结论。（1）阴离子间隙的参考范围已向下偏移（在我们其中一个实验室为3至11毫摩尔/升），主要原因是氯值向上偏移。（2）使用ASTRA分析仪，除非故意改变氯校准，否则大多数正常个体的血清阴离子间隙预计为6毫摩尔/升或更低。（3）如果阴离子间隙要继续作为诊断酸碱紊乱的有效工具，临床医生需要意识到，对于新仪器而言，传统参考范围可能并不合适。
