Moyo Sikhulile, Bussmann Hermann, Mangwendeza Phibeon, Dusara Priti, Gaolathe Tendani, Mine Madisa, Musonda Rosemary, van Widenfelt Erik, Novitsky Vladimir, Makhema Joseph, Marlink Richard G, Essex Max, Wester C William
Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
J Antivir Antiretrovir. 2011 Oct;3(4):45-48. doi: 10.4172/jaa.1000034. Epub 2011 Sep 20.
Nucleoside reverse-transcriptase inhibitors (NRTIs) are a major component of combination antiretroviral therapy (cART) worldwide but they have been associated with mitochondrial toxicities, with one of the most significant being lactic acidosis. In southern Africa, being female and overweight (BMI > 25) as well as receiving d4T and/or ddI-based cART are risk factors for the development of this potentially life-threatening complication. It is challenging in many resource-limited settings to obtain reliable serum lactate measurements while screening for the presence of lactic acidosis. Point-of-care devices, however, are now available that provide simple, accurate measurements of serum lactate levels at relatively low cost. The objective of this study was to assess the agreement of the portable (Accutrend™ handheld) lactate analyzer to the conventional laboratory system for obtaining serum lactate. METHODS: Eighty two "at-risk" cART-treated adults were evaluated, having their lactate levels tested in parallel using both modalities. RESULTS: The mean (range) lactate level for the portable device was 2.28 (0.9-5.0) compared to 1.96 (0.7-5.4) using the conventional method. There was a strong correlation (p<0.05) between the portable device and the conventional means with a Pearson correlation coefficient of 0.92 [95% CI: 0.88-0.95]. The mean bias was 0.33 [95% CI: -0.39-1.04], with the portable device having slightly higher values. CONCLUSION: The use of a portable lactate device provides an accurate and user-friendly means of screening at-risk patients for the presence of lactic acidosis in resource-limited settings with limited laboratory capacity.
核苷类逆转录酶抑制剂（NRTIs）是全球抗逆转录病毒联合疗法（cART）的主要组成部分，但它们与线粒体毒性有关，其中最严重的一种是乳酸性酸中毒。在非洲南部，女性、超重（BMI>25）以及接受基于司他夫定（d4T）和/或去羟肌苷（ddI）的cART是发生这种潜在危及生命并发症的危险因素。在许多资源有限的环境中，在筛查乳酸性酸中毒时获得可靠的血清乳酸测量值具有挑战性。然而，现在有即时检测设备可以以相对较低的成本提供简单、准确的血清乳酸水平测量。本研究的目的是评估便携式（Accutrend™手持式）乳酸分析仪与传统实验室系统在获取血清乳酸方面的一致性。
对82名接受cART治疗的“高危”成年人进行评估，使用两种方法并行检测他们的乳酸水平。
便携式设备测得的乳酸水平平均值（范围）为2.28（0.9 - 5.0），而传统方法测得的为1.96（0.7 - 5.4）。便携式设备与传统方法之间存在强相关性（p<0.05），Pearson相关系数为0.92 [95% CI：0.88 - 0.95]。平均偏差为0.33 [95% CI：-0.39 - 1.04]，便携式设备的值略高。
在实验室能力有限的资源有限环境中，使用便携式乳酸检测设备为筛查高危患者是否存在乳酸性酸中毒提供了一种准确且用户友好的方法。
