不同预分析条件对血浆乳酸浓度的影响。

Effect of different pre-analytical conditions on plasma lactate concentration.

机构信息

Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia.

Department of Biochemistry and Haematology, General Hospital "Dr. Ivo Pedišić", Sisak, Croatia.

出版信息

Biochem Med (Zagreb). 2018 Jun 15;28(2):020701. doi: 10.11613/BM.2018.020701. Epub 2018 Apr 15.

DOI:10.11613/BM.2018.020701

PMID:29666554

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5898961/

Abstract

INTRODUCTION

Plasma lactate is a frequently used and important parameter for medical decision making. To setup a pre-analytical algorithm, we aimed to investigate the influence of different test tube additives, aliquoting, ice storage and haemolysis on plasma lactate concentrations for possible sparing critically ill (ICU) patients of additional blood drawing.

MATERIALS AND METHODS

In our study (N = 177), lactate concentration and haemolysis index (HI) were measured in aliquoted (AHP) and unaliquoted (HP) Li-heparin, NaF/KEDTA and NaF/KOX plasma, centrifuged within 15 minutes after venipuncture, on Cobas c501 analyzer. Differences were tested using the Wilcoxon's test and Passing-Bablok regression. Clinical accuracy of results was assessed in 107 ICU patients based on reference interval and clinical decision limits.

RESULTS

Lactate concentrations did not differ in NaF/KEDTA and NaF/KOX plasma (P = 0.855). No clinically significant difference of AHP compared to NaF/KEDTA lactate was found (y = 0.13 (0.08 to 0.19) + 1.02 (0.99 to 1.08) x) if samples were aliquoted within 30 minutes after venipuncture. On contrary, lactate concentrations in HP showed significant proportional difference (y = 0.07 (- 0.12 to 1.24) + 1.37 (1.22 to 1.56) x) and were clinically incorrect in 14% of patients. Transport in ice bath increases HI in NaF/KEDTA (P < 0.001), but without influencing lactate results compared to room temperature (y = 0.03 (- 0.06 to 1.00) + 1.05 (0.99 to 1.11) x).

CONCLUSIONS

Lactate determination in HP is unacceptable because of high proportional error and high risk of clinical inaccuracy compared to NaF/KEDTA. If pre-analytical conditions are met, AHP, NaF/KEDTA and NaF/KOX plasma can be used interchangeably. Aliquoted Li-heparin samples alow measurement of other biochemical tests from a single tube and can spare ICU patients from additional blood drawing. Storage in ice bath provides no additional stabilization in NaF/KEDTA tubes.

摘要

简介

血浆乳酸是用于医疗决策的常用且重要的参数。为了建立一个分析前的算法，我们旨在研究不同测试管添加剂、分装、冰存和溶血对血浆乳酸浓度的影响，以避免给重症监护病房（ICU）患者带来额外的采血。

材料和方法

在我们的研究中（N=177），使用 Li-肝素、NaF/KEDTA 和 NaF/KOX 血浆对分装好的（AHP）和未分装好的（HP）样本进行了乳酸浓度和溶血指数（HI）的测量，在静脉穿刺后 15 分钟内离心，在 Cobas c501 分析仪上进行。使用 Wilcoxon 检验和 Passing-Bablok 回归来检验差异。根据参考区间和临床决策限值，在 107 名 ICU 患者中评估了结果的临床准确性。

结果

NaF/KEDTA 和 NaF/KOX 血浆中的乳酸浓度没有差异（P=0.855）。如果在静脉穿刺后 30 分钟内分装样本，与 NaF/KEDTA 乳酸相比，AHP 没有发现具有临床意义的差异（y=0.13（0.08 至 0.19）+1.02（0.99 至 1.08）x）。相反，HP 中的乳酸浓度表现出显著的比例差异（y=0.07（-0.12 至 1.24）+1.37（1.22 至 1.56）x），并且在 14%的患者中存在临床不准确。在冰浴中运输会增加 NaF/KEDTA 的 HI（P<0.001），但与室温相比，不会影响乳酸结果（y=0.03（-0.06 至 1.00）+1.05（0.99 至 1.11）x）。

结论

与 NaF/KEDTA 相比，HP 中的乳酸测定由于高比例误差和高临床不准确性而不可接受。如果满足分析前条件，则 AHP、NaF/KEDTA 和 NaF/KOX 血浆可以互换使用。分装好的 Li-肝素样本允许从单个管中测量其他生化测试，可避免 ICU 患者进行额外的采血。在 NaF/KEDTA 管中，冰浴储存不能提供额外的稳定性。