溶血对生化检验准确性的影响及纠正

Influence and Correction of Hemolysis on the Accuracy of Biochemical Tests

目的探讨不同溶血标本对临床常规化学检验准确性的影响、干扰及纠正措施。方法用HITACHI 7600-020全自动生化分析仪测定不同溶血标本的溶血指数(H)、血红蛋白(HGB)、血清总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总蛋白(TP)、清蛋白(ALB)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆汁酸(TBA)、α-L-岩藻糖苷酶(AFU)、葡萄糖(GLU)、尿素(UREA)、肌酐(CREA)、尿酸(UA)、胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo-A1)、载脂蛋白B(Apo-B)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、钾(K+)、钠(Na+)、氯(Cl-)、钙(Ca2+)、无机磷(IP)、二氧化碳(CO2)、淀粉酶(AMY)32项生化指标,并以未溶血血清(H=0)为对照,进行多元回归分析,观察各项目的变化及纠正值的预期可接受性。结果溶血对常规生化指标ALT,AST,TP,ALB,GLU,LDH,CK,CK-MB,K+,Na+,Cl-、Ca2+、IP、CO2产生正干扰,对TBIL,DBIL,GGT,ALP,TBA,AFU,UA产生负干扰,与H=0组相比有统计学意义,P<0.01或P<0.05。且溶血指数(H)越大,干扰越明显。根据美国CL1A'88能力比对检验的分析质量要求,经二元回归纠正后,TBIL,DBIL,GGT,ALP,LDH,CK,Ca2+纠正值100%达到预期可接受范;ALT,TP,ALB,UA,GLU,K+,Na+,Cl-,CO2,IP纠正值90%以上达到预期可接受范围;AST纠正值87.5%达到预期可接受范围;AFU,CK-MB,TBA分别有77.5%,72.5%和47.5%的纠正值达到预期可接受范围。结论不同溶血标本对常规化学检验的不同检测项目产生不同的影响及干扰,经二元回归纠正后,90%(28/31)的检测项目获得较为满意的预期可接受性(预期可接受值≥90%),AFU,CK-MB,TBA纠正不理想(预期可接受值<77.5%),溶血标本不适宜进行AFU,CK-MB,TBA测定。

Objective To study the influence,interference and corrective measures of different hemolysis sample on the accuracy of conventional chemical test. Methods Measuring 32 biochemical tests markers,including H,HGB,TBIL,DBIL, ALT, AST, TP, ALB, GGT, ALP, TBA, AFU, GLU, UREA, CREA, UA, CHO, TG, HDL-C, LDL-C, Apo-Al, Apo-B, LDH,CK,CK-MB,K^＋ ,Na^＋ ,Cl^- ,Ca^2＋ ,IP,CO2 and AMY of different hemolysis sample by HITACHI 7600-020 automatic biochemical analyzer ,and multiple regression analysis was used through comparing with the hemolytic serum （H= 0） to obsearve changes of biochemical markers and expected acceptability of corrected value. Results Hemolysis had a produced inter ference on conventional biochemical including ALT, AST, TP, ALB, GLU, LDH, CK, CK-MB, K^＋,Na^＋, Cl^-, Ca^2＋, IP, CO2 and had a negative interference on TBIL,DBIL,GGT, ALP, TBA, AFU, UA and had statistical significance compared with H= 0 when P〈0.05 or P〈0. 01 ,especially the higher hemolytic index （H） ,the more obvious interference. According to the standard of the CL1A＇ 88 and using method of binary regression correction,correct value of TBIL,DBIL,GGT,ALP and LDH, CK, Ca reached 100% expected acceptable range. More than 90% correct value of ALT,TP, ALB,UA, GLU, K^＋,Na^＋ ,Cl^- ,CO2,IP reached anticipated acceptable range;87.5 % correct value of AST reached desired acceptable range; 77.5% ,72.5% and 47.5% correct value of AFU,CK-MB,TBA respectively achieved the desired acceptable range, Conclusion Different hemolytic specimens have a different interference and influence on conventional chemical testing of the different biochemical markers. By binary regression correction,90% （28/31） biochemical markers acheve the requirment of the expected acceptability （expected acceptable value ≥ 90%） ; however, AFU, CK-MB, TBA are rectified unsatisfactory （expected acceptable value〈77.5 %）,that is,hemolytic specimens are not suitable for AFU,CK-MB,TBA determination.