白细胞去除对葡萄糖-6-磷酸脱氢酶活性测定的影响

Effect of White Blood Cell Removal on Glucose-6-Phosphate Dehydrogenase Activity Analysis

目的探讨全血标本中wBC对RBC的葡萄糖一6一磷酸脱氢酶（G6PD）活性检测的影响，规范G6PD测定标本的前处理过程。方法选择2010年9月8日至10月27日因高胆红素血症于四川大学华西第二医院门诊及住院治疗的新生儿49例为研究对象。采集其全血样本4mL，平均分为2份，分别按照是否洗涤WBC分为洗涤组（n=49）和未洗涤组（n=49）。采用7600—010全自动生化分析仪分别测定两组血样的RBCG6PD活性，wBCG6PD活性以及RBC溶血液中的WBC含量，并根据检测结果考察血样中wBCG6PD活性对RBCG6PD活性测定的影响（本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该伦理会批准，征得受试对象本人的知情同意，并与之签订临床研究知情同意书）。结果未洗涤组血样的RBCG6PD活性中位数[1096U／L，（137～2512）U／L]明显高于洗涤组为[861U／L，（94～2357）U／L]，且差异有统计学意义（Z=-6．093，P〈0．01）；两组RBCG6PD活性呈正相关关系性（r=0．963，P〈O．01）。将RBCG6PD纳入回归方程：y=0．895z-83．365，y为洗涤组RBCG6PD的原始结果，z为未洗涤组RBCG6PD的原始结果，进行线性回归分析的结果显示，洗涤WBC前、后，RBCG6PD活性的偏回归值（6）分别为0．895与-83．365，相关关系密切（r2=0．927，df=47，F=592．797；P〈0．01）。结论全血标本中WBC的存在，使RBCG6PD活性检测值偏高，可能造成处于临界值的G6PD缺乏症漏检。临床进行血液标本RBCG6PD活性测定时，应尽可能清除WBC，为临床诊断提供可靠数据。

Objective To standardize the pre-analytical procedure of RBC glucose-6-phosphate dehydrogenase （G6PD） activity analysis by judging whether WBC could be an interference factor. Methods From 9 September to 27 October 2010, a total of 49 newborns with hyperbilirubinemia who were treated in West China Second University Hospital, Sichuan University, were included in this study. 4 mL whole blood samples were collected from each case. Then according to whether washing the WBC, these samples were divided into two equal parts, as washed group （n = 49） and unwashed group （n = 49）. 7600-010 automatic biochemical analyzer was used to measure RBC G6PD activity and WBC G6PD of blood samples in each group and WBC content in RBC dissolve blood. The relationship between G6PD activity testing in whole blood and WBC G6PD activity was evaluated based on above results （The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University）. Results Median RBC G6PD activity in unwashed group was 1096 U/L [（137-2512） U/L] which was significant higher than in washed group [-861 U/L （94-2357） U/L]. There was a positive correlation between RBC G6PD activities in two groups （r=0. 963 ,P〈0.01）. Regression equation was y= 0. 895x-83. 365 （y stands for the RBC G6PD activity with WBC washing out, whlie x stands for the RBC G6PD activity without WBC washing out）. Linear regression showed that there was close correlation between RBC G6PD activities in groups （r2 =0. 927 ,df=47,F=592. 797;P〈0.01）. Conclusions WBC in whole blood samples would be a interference factor which made a higher RBC G6PD activity results and G6PD deficiency undetected. It is very important to wash out all the WBC in the pre-analytical procedure in RBC activity detection to provide reliable data for clinical diagnosis.