Adcock D M, Kressin D C, Marlar R A
Department of Pathology, Colorado Permanente Medical Group, Denver, USA.
Am J Clin Pathol. 1997 Jan;107(1):105-10. doi: 10.1093/ajcp/107.1.105.
The effects of 3.2% and 3.8% sodium citrate concentration on the results of routine coagulation assays (prothrombin time [PT] and activated partial thromboplastin time [aPTT]) were evaluated by means of two sets of reagents, one responsive and the other nonresponsive. Five groups were entered in the study: healthy volunteers; outpatients receiving stable oral anticoagulant therapy; and hospitalized patients receiving intravenous (i.v.) heparin therapy, both i.v. heparin and oral anticoagulant therapy, or no anticoagulant therapy. With use of nonresponsive PT and aPTT reagents, varying the citrate concentration has little clinical significance except in patients receiving i.v. heparin therapy. In contrast, when responsive PT and aPTT reagents are used, the concentration of sodium citrate anticoagulant has a significant effect on assay results. Eighteen percent of samples from patients receiving stable oral anticoagulant therapy demonstrated a change of less than 0.7 INR (International Normalized Ratio) units between citrate concentrations. Nineteen percent of patients receiving i.v. heparin therapy had a greater than 7-second difference when aPTT results were compared. These data demonstrate that citrate concentration affects the results of coagulation tests. On the basis of these data, it is recommended that 3.2% citrate be used for all coagulation tests.
通过两组试剂（一组有反应性，另一组无反应性）评估了3.2%和3.8%柠檬酸钠浓度对常规凝血试验（凝血酶原时间[PT]和活化部分凝血活酶时间[aPTT]）结果的影响。该研究纳入了五组人群：健康志愿者；接受稳定口服抗凝治疗的门诊患者；以及接受静脉注射肝素治疗、同时接受静脉注射肝素和口服抗凝治疗或未接受抗凝治疗的住院患者。使用无反应性的PT和aPTT试剂时，除接受静脉注射肝素治疗的患者外，改变柠檬酸盐浓度几乎没有临床意义。相比之下，当使用有反应性的PT和aPTT试剂时，柠檬酸钠抗凝剂的浓度对检测结果有显著影响。接受稳定口服抗凝治疗的患者中，18%的样本在不同柠檬酸盐浓度之间的国际标准化比值（INR）变化小于0.7个单位。比较aPTT结果时，接受静脉注射肝素治疗的患者中有19%的差异大于7秒。这些数据表明柠檬酸盐浓度会影响凝血试验结果。基于这些数据，建议所有凝血试验均使用3.2%的柠檬酸盐。
