标本溶血对常规凝血试验和纤溶标志物测定结果的影响  

The effect of specimen hemolysis on routine coagulation test and fibrinolytic marker results

作　　者：聂群 董晶[2] 聂李平[2] 周宇[2] 谢闻悦[2] 李建新[2] 

机构地区：[1]深圳市大鹏新区妇幼保健院检验科,广东深圳518120 [2]北京大学深圳医院检验科,广东深圳518036

出　　处：《中国实验诊断学》2017年第12期2115-2118,共4页Chinese Journal of Laboratory Diagnosis

基　　金：深圳市科技创新委基础研究资助项目(JCYJ20150403091443282)

摘　　要：目的探讨标本溶血对常规凝血试验(包括PT、APTT和Fbg)和纤溶标志物(包括D-dimer和FDP)测定结果的影响。方法对48例溶血标本和2h内(平均65min)重新采集的未溶血配对标本分别进行常规凝血试验和纤溶标志物测定;另对30例未溶血标本体外机械诱导溶血,分别于溶血前后进行常规凝血试验和纤溶标志物测定。结果对于临床溶血和未溶血配对标本,PT、APTT、Fbg、D-dimer和FDP在两者间均无显著性差异;对于诱导溶血标本,诱导溶血前后PT、APTT、Fbg和FDP均无显著性差异;诱导溶血后较溶血前D-dimer降低(361.10±493.40VS 396.37±494.47μg/L,P<0.001)。以上参数结果在溶血和未溶血标本之间,Pearson相关分析均呈高度相关(r均>0.97,P均<0.001),Bland-Altman图均显示一致性良好。以上参数改变值和溶血程度均不相关(P均>0.05)。结论标本溶血对常规凝血试验和FDP的测定结果无明显影响,体外机械诱导溶血对D-dimer测定结果造成较小的负性影响,但不影响临床决定。应对拒收溶血标本用于常规凝血测试的规定进行再评估。Objective To evaluate the effect of specimen hemolysis on routine coagulation test （including PT,APTT and Fbg）and fibrinolytic marker （including D-dimer and FDP）results.Methods Routine coagulation test and fibrino-lytic marker were executed for 48 consecutive hemolyzed patient samples and paired re-collected （within 2 hours）non-hemolyzed specimens,and for randomly collected 30 nonhemolyzed specimens before and after mechanically induced he-molysis.Results In 48 paired patients,there were no statistically significant differences in PT,APTT,Fbg,D-dimer and FDP results between hemolyzed and nonhemolyzed specimens,respectively.In 30 randomly collected specimens,sig-nificant differences were not seen in PT,APTT,Fbg and FDP values before and after induced hemolysis.Dimer de-creased （361.10±493.40 vs 396.37±494.47 μg/L,P 〈0.001）after induced hemolysis.Pearson correlation analysis showed high correlation （all r〉0.97,P 〈0.001）,and Bland-Altman plot exhibited good agreement,in results of above-mentioned tests between hemolyzed and nonhemolyzed specimens.Differences in the results of above tests were not cor-related with the degree of hemolysis （all P 〉0.05）.Conclusion There was no significant effect of specimens hemolysis on the results of routine coagulation test and FDP.Minor negative effect on D-dimer determination was seen in mechani-cally induced hemolyzed specimens in vitro,which is unlikely to be considered clinically meaningful.A policy of rejecting hemolyzed specimens for coagulation tests should be reevaluated.

关 键 词：溶血 常规凝血试验 D-DIMER FDP 

分 类 号：R446.1[医药卫生—诊断学]