探究严重脂血标本对多项生化指标检测结果的影响及解决方案

Investigation on the influence of severe lipemic plasma on the detection results of multiple biochemical indices and solutions

目的建立标本脂血标准,探究严重脂血标本在多项生化指标检测中的影响和评估脂血标本高速离心后检测结果是否临床可接受。方法收集200例严重脂血的标本提取脂液,5例无脂血血清配制严重脂血样本。采用罗氏全自动生化分析仪检测加脂前(无脂血)、加脂后(发生脂血)、高速离心后(处理后)的47项生化指标以及不同浓度三酰甘油(TG)标本的吸光值(ABS),采用贝克曼全自动生化分析仪检测不同浓度TG标本的吸光度(A),检测结果以1/3TEa(最大允许误差)和最小检测差异判断是否在可接受范围内。结果TG与ABS、A的线性方程分别为y=52.15x-6.395、y=0.02146x-0.003073,47项指标中白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、直接胆红素(DBIL)、铁(FE)、类风湿因子(RF)、铜蓝蛋白(CER)、不饱和铁结合力(UIBC)、超敏C反应蛋白(hsCRP)、果糖胺(FRUC)、C反应蛋白(CRP)、前白蛋白(PA)、低密度脂蛋白胆固醇(LDL-C)、α-羟丁酸脱氢酶(HBDH)、肌酸激酶同工酶MB(CK-MB)、抗链球菌溶血素“O”(ASO)、磷(P)、总钙(Ca)检测结果受标本严重脂血(++++)影响,RF、hsCRP、CRP、钠(Na)、脂蛋白(a)[LP(a)]、总蛋白(TP)高速离心后检测结果不在临床接受范围内。脂血程度降为+++,RF检测结果临床可接受,脂血程度降为++,hsCRP、CRP检测结果临床可接受。结论TG浓度与ABS、A存在高度相关,严重脂血可以影响部分生化指标的检测结果,除hsCRP、CRP、RF外,大部分生化指标可以通过高速离心的方法减少脂血对检测结果的影响。

Objective To establish the standard of lipid bloA in specimens,explore the influence of severe lipemic plasma in the detection of multiple biochemical indices and evaluate whether the detection results of lipid bloA samples after high-speed centrifugation are clinically acceptable.Methods The samples of 200 patients with severe lipids were collected to extract lipids and 5 patients with non-lipids were collected to prepare severe lipids.47 biochemical indexes and ABS of triglyceride(TG)specimens with different concentrations were detected by Roche automatic biochemical analyzer,before fat-adding(non-fat bloA),after fat-adding(severe lipemic)and after centrifugation(treatment).Beckman automatic biochemical analyzer was used to detect absorbance(A)of TG specimens with different concentrations,the test results were judged to be within the acceptable range by 1/3TEA(maximum allowable error)and minimum detection difference.Results The linear equations of TG,ABS and A are y=52.15x-6.395 and y=0.02146x-0.003073,Among the 47 indexes,albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBIL),FE,rheumatoid factor(RF),Ceruloplasmin(CER),unsaturated iron binding force(UIBC),hypersensitive C-reactive protein(hsCRP),fructose amine(FRUC),C-reactive protein(CRP),prealbumin(PA),low-density lipoprotein cholesterol(LDL-CH),α-hydroxybutyrate dehydrogenase(HBDH),creatine kinase isoenzyme(CK-MB),anti-streptolysin O(ASO),phosphorus(P),and total calcium(Ca)were affected by severe lipemia(++++),The results of RF,hsCRP,CRP,sAium(Na),lipoprotein a(LP(a))and total protein(TP)after high speed centrifugation are not accepted in clinically acceptable range.When the level of lipemia decreased to+++,the results of RF test were clinically acceptable.when the level of lipemia decreased to++,the results of hsCRP and CRP test were clinically acceptable.Conclusion The concentration of TG is highly correlated with ABS and A.Severe lipemic plasma can affect the test results of some biochemical indexes.Except hsCRP,CRP and RF,most biochemical indexes can be reduced by high speed centrifugation.