指尖及小腿毛细血管血糖与静脉血浆血糖测定值的对比研究

[目的]探讨小腿毛细血管血糖值监测的可行性.[方法]用利舒坦血糖仪对门诊糖尿病病人同步测定空腹及餐后2 h小腿毛细血管血糖、指尖毛细血管血糖,并与用全自动生化仪测定的静脉血浆血糖值做比较.[结果]空腹及餐后2 h小腿毛细血管血糖值、指尖毛细血管血糖与静脉血浆血糖值比较,差异无统计学意义;空腹及餐后2 h静脉血浆血糖、指尖毛细血管血糖、小腿毛细血管血糖值3组相关性良好,r值均在0.990以上,P＜0.01.[结论]小腿毛细血管血糖监测能精确反映糖尿病病人空腹及餐后2 h血糖,且腿部疼痛轻,病人依从性高.     

拜安易血糖仪测定血糖的准确性临床研究

[目的]评价拜安易血糖仪测定指尖毛细血管血耱(CG)与实验室生化分析仪测定静脉血浆血糖(VG)的相关性.[方法]选取37例住院糖尿病病人.采用实验室生化分析仪和拜安易床边血糖仪测定早餐前和餐后2 h静脉血浆血糖和指尖毛细血管全血血糖.[结果]空腹厦餐后2 hCG与VG相关性良好.相关系数(r)均在0.900以上;空腹及餐后2 h CG与VG均值差异百分比分别为5.79%和13.94%.均在15%以下.[结论]拜安易血糖仪测定毛细血管血糖有良好的稳定性.CG可比较精确地反映空腹及餐后2 h vG,并可对VG做粗略的估算.     

拜安易血糖仪测定血糖的准确性临床研究

[目的]评价拜安易血糖仪测定指尖毛细血管血糖（CG）与实验室生化分析仪测定静脉血浆血糖（VG）的相关性。[方法]选取37例住院糖尿病病人,采用实验室生化分析仪和拜安易床边血糖仪测定早餐前和餐后2h静脉血浆血糖和指尖毛细血管全血血糖。[结果]空腹及餐后2hCG与VG相关性良好,相关系数（r）均在0.900以上;空腹及餐后2hCG与VG均值差异百分比分别为5.79%和13.94%,均在15%以下。[结论]拜安易血糖仪测定毛细血管血糖有良好的稳定性,CG可比较精确地反映空腹及餐后2hVG,并可对VG做粗略的估算。     

强生稳步倍加血糖仪与实验室生化分析仪测定血糖的准确性比较

目的评价强生稳步倍加血糖仪测定指尖毛细血管血糖（CG）与实验室生化分析仪测定静脉血浆血糖（VG）的相关性,并评价该血糖仪的准确性和精确性。方法选取290例住院糖尿病患者,采用实验室生化分析仪和强生稳步倍加血糖仪测定早餐前及餐后2h的静脉血浆血糖和指尖毛细血管全血血糖。分析其结果及相关性。结果空腹和餐后2hCG与VG相关性良好,相关系数（r值）均在0．90以上;空腹及餐后2hCG与VG均值差异百分比分别为5．82％和13．98％,均在15％以内。结论强生稳步倍加血糖仪的准确性高,可以比较精确地反映空腹及餐后2h的VG水平,为临床提供可靠地参考依据。     

快速毛细血管血糖测定和静脉血浆血糖测定的临床对比研究

目的:评价稳豪型血糖仪的稳定性及其测定指尖毛细血管血糖(CGF)、手臂毛细血管血糖(CGA)与自动生化仪测定静脉血浆血糖(VG)的相关性。方法:选取正常血糖、轻度高血糖、和中高度高血糖的指尖血样用稳豪型血糖仪做批内和批间测定。221例糖尿病或非糖尿病患行常规静脉血浆血糖测试的同时用稳豪型血糖仪测定指尖毛细血管血糖和(或)手臂毛细血管血糖。结果:3种不同浓度的血糖标本测定的批内、批间变异系数均小于5%。VG与CGF、VG与CGA、CGF与CGA3组的空腹血糖及餐后2h血糖相关性良好,r均在0.900以上。血糖浓度<7.0mmol/L时CGA明显高于VG,r=0.757;血糖浓度>11.1mmol/L时,r=0.667,其余各组在不同血糖浓度的相关性均在0.850以上。VG与CGF及VG与CGA的相对差值均在7%以下。结论:稳豪血糖仪有良好的稳定性,CGF及CGA均可比较精确的反应空腹及餐后2h各种血糖浓度的VG并可对VG做初略的估算。     

罗氏活力型血糖仪测定血糖与生化血糖对比分析

目的评价罗氏活力型血糖仪测定的精确性及该血糖仪测定毛细血管血糖(CBG)与实验室生化分析仪测定的静脉血浆血糖(VPG)的相关性。方法选取160例住院的糖尿病患者,采用实验室生化分析仪和罗氏活力型血糖仪测定空腹和餐后2 h静脉血浆血糖和末梢毛细血管血糖。结果在空腹和餐后2 h,使用罗氏活力性血糖仪测定的末梢血糖与生化仪测定的静脉血浆血糖值差异无统计学意义(P>0.05)。结论罗氏活力型血糖仪的准确性和精确性高,在空腹和餐后不同血糖浓度下均能较准确地反映血糖的真实水平,可以作为临床床边血糖测定及糖尿病患者的家庭自我检测。     

前臂毛细血管采血检测血糖的可行性研究

目的探讨采用快速血糖仪检测前臂毛细血管血糖的可行性。方法对67例2型糖尿病住院患者同期于空腹、餐后2 h、出现第1次低血糖时3个时间点采静脉血检测血浆血糖,同时使用快速血糖仪检测前臂和指尖毛细血管全血血糖;比较前臂、指尖两种不同采血方法测定血糖值的准确性以及患者对采血时的疼痛感。结果 3种方法的空腹、低血糖时血糖值差异无统计学意义(P>0.05),餐后2 h静脉血血糖值高于同期前臂、指尖所测血糖值,组间比较差异具有统计学意义(P<0.05);前臂采血比指尖采血的疼痛感低(P<0.01)。结论虽然前臂毛细血管血糖所反映的餐后2 h血糖值的准确性低于静脉血血糖值,但与指尖所测的血糖值无差异,且疼痛感明显轻于指尖部位,故前臂可作为检测血糖的采血部位。     

腹壁采血检测血糖的可行性

目的 探讨腹壁毛细血管采血快速血糖仪检测全血血糖的可行性.方法 连续入选40例2型糖尿病住院患者,患者BMI均≤26 kg/m2,同一患者于空腹、餐后2 h、出现第1次低血糖时3个时间点采静脉血检测血清血糖,同时使用拜安康多部位采血快速血糖仪检测腹壁和指尖毛细血管全血血糖,以静脉血糖值为金标准比较腹壁、指尖两种不同部位采血测定血糖值的准确性以及采血时疼痛感.结果 3个部位的空腹、餐后2 h、首次低血糖时血糖值差别无显著性(P>0.05),并具有良好的线形相关(r=0.972～0.993,P<0.01);腹壁采血的疼痛感较指尖采血弱,差异有统计学意义(P<0.05).结论 检测腹壁毛细血管全血血糖能较为准确地反映BMI≤26 kg/m2的2型糖尿病患者空腹、餐后2 h以及低血糖时的血糖,且疼痛感轻,是患者检测血糖可以选择的部位.     

饮食干预对糖尿病患者血糖的影响

目的 探讨饮食干预对糖尿病患者血糖的影响。方法 对36例已确诊2型糖尿病患者随机分成干预组和非干预组，分别于干预前和干预后1、2、3、4个月进行空腹血糖和餐后2h血糖的测定。结果 两组患者于干预后1、2、3、4个月测的空腹血糖和餐后2h血糖比较有显著性差异（P〈0．05）。结论 饮食干预可降低糖尿病患者餐后血糖，对糖尿病患者控制血糖起到了一定的作用。     

果糖胺与血糖、糖化血红蛋白的关系研究

目的探讨果糖胺（fructosamine,FMN）与血糖、糖化血红蛋白（HbA1c）的关系。方法 2009年5月-2009年8月,以75例糖尿病患者作为糖尿病组,36例健康志愿者作为正常对照组,进行口服糖耐量试验,检测其空腹血糖及餐后2h血糖水平,并同时检测FMN与HbA1c水平。结果糖尿病组空腹血糖、餐后2h血糖、FMN、HbA1c均高于正常对照组（P〈0.05）。FMN与HbA1c、空腹血糖、餐后2h血糖均呈正相关关系（P〈0.05）。FMN与空腹血糖的相关系数高于HbA1c与空腹血糖的相关系数,FMN与餐后血糖的相关系数也高于HbA1c与餐后血糖的相关系数。结论果糖胺与HbA1c相比有一定的优势,可作为监测糖尿病患者血糖控制的良好指标。     

危重症患者末梢血糖值的相关因素分析

目的 比较ICU危重症患者动脉血气血糖和末梢血糖值的可靠性;分析影响动脉血气血糖值和末梢血糖值之间差异的相关因素。 方法 选取ICU重症患者40例,晨间同时检测患者动脉血气和快速末梢血糖。 结果 动脉血气分析和快速末梢血糖检测的血糖值与静脉血生化中的血糖值均高度相关(r=0.952,P<0.01)。动脉血气血糖和末梢血糖之前存在差异,具有统计学意义（P<0.05）。动脉血气血糖和末梢之间的差异受末梢循环的影响。 结论 危重症患者采用末梢血糖测量结果作为控制血糖策略的可靠性还有待进一步研究,末梢血糖测量结果受末梢循环的影响。       

Measurement of glucose content in plasma from capillary blood in diagnosis of diabetes mellitus

Overall, there is good correlation between glucose values obtained from ear capillary blood and those from peripheral venous plasma, but there are considerable individual differences. Results obtained with these two methods are generally not interchangeable and the converted values should not be used in the diagnosis of diabetes mellitus, because of the risk of misclassification. In Denmark this can affect 20-24000 persons. The aim of our study was to investigate whether these differences might be less significant if measurements were taken at the plasma phase of capillary blood and expressed directly as capillary plasma results and if finger capillary blood were used instead of ear capillary blood. The Hitachi 717 instrument was used for measurements of glucose concentrations in venous plasma, the Cobas Mira S in capillary whole blood and the Accu-Chek Inform from Roche in capillary plasma. The conclusions drawn were (1) capillary ear blood glucose concentration correlates well with capillary finger blood concentration and the two sites can be used interchangeably, yielding similar results in the individual patient; (2) sampling variation is almost the same (approx. 0.16 mmol/L) on capillary plasma and capillary whole blood from finger and ear. Sampling variation for venous plasma measured on the Hitachi instrument was 0.13 mmol/L; not significantly better; (3) the analytical imprecision of glucose measurements on capillary plasma (Accu-Chek Inform) and capillary whole blood (haemolysate method) is almost the same (approx. 2.0%). The analytical imprecision of glucose measurements on venous plasma is 0.9% using a laboratory method and almost twice as high using Accu-Chek Inform (2.1%); (4) determination of capillary plasma values in the finger did not improve the correlation with venous plasma values. Even though average values were in better concordance, individual differences did not change. For some persons, both ear- and finger capillary blood measurements deviate significantly from results on venous plasma, such that they cannot be used for diagnosis of diabetes mellitus; (5) the main factor for good correlation is the sampling site. Results obtained on plasma and whole blood from the same puncture correlate well; (6) neither capillary blood nor capillary plasma correlates with the venous plasma method recommended by the American Diabetes Association. It is concluded that physiologic differences in glucose content in capillary- and venous blood prohibit the random use of these two materials in the diagnosis of diabetes.     

Relationships of glucose concentrations in capillary whole blood, venous whole blood and venous plasma

We studied the difference in glucose levels between capillary and venous whole blood during 75-g oral glucose tolerance test (OGTT) in 75 healthy subjects. Capillary and venous whole blood glucose values were measured by HK-G6PD method after deproteinization. The post-loaded glucose levels in capillary blood were significantly higher than those in venous blood, and the mean values of capillary and venous difference at 30, 60, 90, 120 and 180 min were 1.37, 1.40, 1.07, 0.95 and 0.52 mmol/l, respectively, with the maximum difference at 60 min. No correlation was found in the magnitude of the differences in glucose between capillary and venous blood specimens. We determined the inaccuracy of six self-monitoring blood glucose devices relative to the reference method using venous plasma, venous whole blood and capillary whole blood from 31 diabetic patients. The differences of mean values of venous whole blood and capillary whole blood, and venous whole blood and venous plasma, and capillary whole blood and venous plasma were 9.6%, 11.3% and -3.2%, respectively. The range of bias and Sy/x were 0.31-1.06 mmol/l and 0.71-1.07 mmol/l, respectively, compared to the reference method using venous plasma.     

The Reflotron Total Cholesterol assay in heparinized venous and capillary blood

We recently evaluated the Reflotron Total Cholesterol dry chemistry assay by examining the calibration and the accuracy of the assay in serum, whole venous EDTA-blood and capillary EDTA blood. We now describe a study on the analysis in heparinized venous and heparinized finger stick blood. Cholesterol assays in venous serum and plasma, and in finger capillary blood and plasma (all with heparin) were compared. Finger capillary blood was obtained in two ways: 1. in heparinized capillaries; 2. in a Becton Dickinson microtainer that could be centrifuged for separation of the plasma. Venous blood was obtained in plain tubes (for serum) and heparinized tubes to obtain venous whole blood and also venous plasma. We did not, on average, find large differences between the concentrations of cholesterol in the various materials. The regression equations for finger capillary whole blood and venous whole blood however show higher slopes than the others. Inaccuracy due to the sampling technique appears to be no greater for finger capillary samples than for venous samples.     

Rapid changes in postprandial blood glucose produce concentration differences at finger,forearm, and thigh sampling sites

OBJECTIVE: To compare pre- and postmeal capillary blood glucose concentrations measured at the finger, forearm, and thigh in adults with diabetes. RESEARCH DESIGN AND METHODS: For phase 1, capillary blood glucose concentrations were measured at six time points (premeal and at approximately 60, 90, 120, 150, and 180 min postmeal) using a blood glucose monitoring system and technician-obtained samples collected from finger, forearm, and thigh sites of 42 adults with diabetes. The finger samples were also tested with a laboratory instrument. For phase 2, approximately 14 weeks later, the testing procedures were repeated with 38 subjects from the original study population. RESULTS: Meter finger results were accurate at all time points. Alternate sites tended to produce lower glucose readings compared to finger readings at times when glucose was increasing rapidly (60 and 90 min postmeal). Forearm-to-finger differences correlated with rates of glucose change (r = 0.56, P < 0.001), as did the thigh-to-finger differences (r = 0.52, P < 0.001). Other factors, such as subject age, BMI, diabetes type, and insulin dependence did not have a significant impact on site differences. When the testing procedures were repeated with the same subjects, the pattern of site differences was consistent, although individual results were variable. CONCLUSIONS: Changes in blood glucose immediately after a meal may be identified at finger sites before detection at forearm or thigh sites. Alternate site testing appears to be a useful option for routine self-monitoring before meals; however, patients and clinicians should recognize that results may be different from fingertip results when glucose levels are changing rapidly.     

丙泊酚、瑞芬太尼全身麻醉对剖宫产术母婴血糖的影响

目的探讨全身麻醉对剖宫产母亲产时血糖及新生儿血糖的影响。方法全身麻醉下行剖宫产的初产孕妇20例(全麻组)及同期腰硬联合麻醉下行剖宫产年龄、体重相近的足月孕妇20例(腰麻组)。全麻组采用丙泊酚100 mg+瑞芬太尼100μg+琥珀胆碱100 mg;腰麻组采用蛛网膜下腔匀速推注0.5%盐酸罗哌卡因注射液(商品名:耐乐品)2.5～2.6 ml。分别于麻醉前、胎儿娩出后即刻测母亲指尖血糖,新生儿出生后10分钟足跟血血糖,同时记录孕妇围术期血压、心率和新生儿Apgar评分。结果全麻组产妇分娩时血糖水平降低(P<0.05);腰麻组分娩时血糖升高(P<0.05);全麻组新生儿生后血糖明显低于腰麻组(P<0.01);新生儿生后血糖与产妇产时血糖呈显著正相关(r=0.73,P<0.01)。结论全身麻醉产妇分娩时血糖水平降低,新生儿生后血糖明显低于腰硬联合麻醉产妇,应该关注和预防新生儿低血糖的发生。     

Validation of capillary glucose measurements to detect glucose intolerance or type 2 diabetes mellitus in the general population

BACKGROUND: The use of an oral glucose tolerance test (OGTT) has been recommended to diagnose type 2 diabetes, but an OGTT with venous blood sampling may not be feasible in the screening phase preceding large epidemiological studies. We have conducted a population-based screening in 2715 men and women and evaluated the diagnostic validity of capillary plasma glucose concentration measurements versus venous plasma glucose concentration measurements in a subset of 350 subjects. METHODS: During a single OGTT, glucose concentrations were measured in venous plasma as well as in capillary plasma. RESULTS: Based on the 1999 WHO criteria for venous glucose concentrations, the study population (n=350) yielded 97 subjects with type 2 diabetes mellitus, 77 subjects with impaired glucose tolerance and 176 subjects with normal glucose tolerance. Sensitivity and specificity to diagnose type 2 diabetes mellitus by capillary plasma were 84% and 98%, respectively. Consistent classification by either venous or capillary plasma glucose measurements was 78% (kappa=0.65, p<0.001). CONCLUSION: Capillary glucose measurements are suitable for use in epidemiological studies to diagnose and detect type 2 diabetes and normal glucose tolerance. Use of capillary measurements can result in cost-effective inclusion schemes in epidemiological studies.     

即时检验血糖仪检测指尖血及静脉全血的血糖结果比对分析

目的探讨指尖毛细血管血及抗凝静脉全血在即时检验(POCT)血糖仪检测结果的可行性。方法分别采取指尖血及静脉血22例,用POCT血糖仪检测血糖,同时在生化分析仪上检测血浆葡萄糖,对两部位血样检测结果与生化分析仪检测结果的偏倚程度进行比对。结果两部位血样POCT血糖仪检测结果与生化分析仪检测结果比对均为负偏倚,偏倚范围最低为-1.5%,最高为-13.9%,均未大于20%;静脉全血血糖偏倚比指尖血血糖偏倚程度高,两偏倚比较差异有统计学意义(P<0.01)。结论无论采用指尖血还是静脉全血,其POCT结果都可以接受,但采用指尖血样其检测结果更接近血浆葡萄糖。     

Renal extraction of insulin and C‐peptide in man before and after a glucose meal

It was recently shown that the early rise in arterial insulin concentration after an oral glucose meal is largely because of a decreased extraction of the hormone. The kidney is a major site for extraction of insulin and C‐peptide. We therefore measured the renal extraction of insulin and C‐peptide in eight healthy individuals before and after ingestion of 75 g of glucose. Arterial, renal venous and hepatic venous catheters were inserted. Splanchnic and renal plasma flow were measured, as well as arterial, hepatic venous and renal venous concentrations of insulin and C‐peptide. Renal fractional extraction of insulin increased significantly, from 21% to a maximum of 48% after the meal while the renal fractional extraction of C‐peptide did not change significantly. Renal blood flow decreased slightly but significantly after the meal. It is concluded that renal fractional extraction of insulin increases and that renal blood flow decreases after a glucose meal.