不同模式检测尿素水平对透析充分性评估的影响

Effect of Different Modes of Urea Nitrogen Detection on Dialysis Adequacy Evaluation

目的探讨脲酶速率法原倍和稀释模式下检测血清尿素(UREA)、肌酐(CREA)水平及尿素清除率(URR)的差异对透析充分性评估的影响。方法随机收集本院住院患者(UREA水平基本均匀覆盖试剂线性范围)148例作为A组,同期收集透析患者134例作为B组。采用原倍、稀释5倍模式检测A组的UREA和CREA水平,分析不同模式检测下两指标水平的差异。采用原倍、3倍稀释和5倍稀释模式检测B组透析前后的血清UREA水平,计算每个患者URR,分析不同模式检测结果、URR以及透析充分性评估结果的差异。结果稀释模式检测全量程UREA结果和原倍模式结果差异显著(P<0.05),且产生的相对误差和UREA水平呈正相关(r=0.57,P<0.05),而CREA水平基本无影响(P>0.05);两种稀释模式检测B组UREA水平和URR明显高于原倍模式检测UREA水平和URR(P<0.05);稀释模式评估的透析充分百分比显著高于原倍模式(P<0.01),且不同稀释模式对透析充分性评估结果无显著差异(P>0.05)。结论稀释模式下脲酶速率法影响UREA的检测结果,导致透析患者URR升高,降低患者透析充分性评估的准确性。

Objective To investigate the difference of serum urea(UREA),creatinine(CREA)and urea removal rate(URR)between urease rate method and dilution mode and its effect on the evaluation of dialysis adequacy.Methods one hundred and forty-eight inpatients(UREA level basically uniform covering linear range)in our hospital were enrolled as group A and one hundred and thirty-four dialytic patients were enrolled as group B.The level of UREA and CREA levels in group A were detected in original concentration and 5-fold dilution mode.The levels of UREA in serum of group B before and after dialysis were detected by original concentration,3-fold dilution mode and 5-fold dilution mode respectively.We calculated the URR of each patient and compared the difference of urea,URR and dialysis adequacy evaluation.Results The results of full-range UREA detected by dilution mode were significantly different from those of original mode,and the relative error was positively correlated with the level of UREA(r=0.57,P<0.05),while the CREA level has no effect(P>0.05).In group B,the levels of UREA and URR detected by dilution modes were significantly higher than those of original mode(P<0.05).The percentage of dialysis adequacy evaluated by dilution modes were significantly higher than that of original mode(P<0.01),and there was no significant difference among different dilution modes(P>0.05).Conclusion Urease rate method in dilution mode affects the detection results of UREA,which leads to the increase of URR in dialysis patients and reduces the accuracy of dialysis adequacy evaluation.