静脉血糖1.1,末梢血糖5.1,这样的危急值你敢报吗?

2021-09-14 检验医学网 检验医学网

血糖(GLU),顾名思义就是血液中的葡萄糖,正常人空腹血糖参考值为3.9~6.1mmol/L。血糖是人类能量的重要来源,人体需要补充适量的葡萄糖来提供能量,为各种组织、脏器的正常运作提供动力。

前言

血糖(GLU),顾名思义就是血液中的葡萄糖,正常人空腹血糖参考值为3.9~6.1mmol/L。血糖是人类能量的重要来源,人体需要补充适量的葡萄糖来提供能量,为各种组织、脏器的正常运作提供动力。因此,血糖检测在临床上尤其是糖尿病方面具有非常重要的意义。在检验科的日常工作中,各种危急值早就司空见惯,但是血糖危急值出现在你面前时,你真的敢向临床报告吗?

案例经过

郑某,男,62岁,因皮肤瘙痒来我院皮肤科门诊就医。医生让郑某做血糖血脂检查(糖尿病也会引起皮肤瘙痒),结果发现血糖为1.1mmol/L,见图1。血糖值这么低,已经达到了危急值,在此之前郑某从未在我院做过血糖检测,无法参照其血糖历史结果。

图1

出现危急值,按照流程需要复查一下,排除一切可能造成干扰的因素才能向临床报危急值。复查后血糖为1.07mmol/L,见图2和原始结果无明显差别。查看标本发现无溶血和脂血等异常状态且在1小时内检测,机器无故障,试剂没过期,质控也在控。

图2

如此低的血糖值,即便患者没有严重到住院的地步,最起码也会有低血糖的临床表现。于是打电话向皮肤科医生询问患者情况,医生表示患者并没有低血糖的病史,不仅没有低血糖的临床表现,而且还很精神抖擞,采血之前也没有给患者用药或输液。检验结果与临床症状不相符,到底是哪里出现了问题?为了查找真相,我建议皮肤科医生给患者加做一个指尖血糖(也称快速血糖或末梢血糖),医生立即采纳了我的建议。

过了一会儿,医生打电话过来说,患者指尖血糖为5.10mmol/L(我院指尖血糖由护士做),在正常参考值之内。这就奇了怪了,静脉血糖居然低于指尖血糖。一般来说指尖血糖不可能高于静脉血糖,因为指尖血糖测的是全血血糖,静脉血糖测的是血浆血糖,全血血糖含有红细胞,而红细胞中的血糖含量极低,因此全血血糖会低于血浆血糖。

百思不得其解,排除了标本、机器、试剂、质控、药物等原因,实在想不出还有其他原因导致了患者低血糖。难道是患者除了有皮肤疾病还有血液疾病?

有文献报道白血病会造成假性低血糖[1-2],我于是询问患者是否有血液系统疾病,患者说他去年开始就有白血病,治疗未见明显好转。查看患者血常规发现白细胞高达103.7×10^9/L,其中淋巴细胞就高达100×10^9/L,见图3。其历史结果也是白细胞和淋巴细胞高,见图4。

图3

案例分析

假性低血糖是指患者实际上没有低血糖,但是由于某种原因比如疾病本身或者检测方法等导致了血糖低于正常值或静脉血糖低于指尖血糖的现象。引起假性低血糖的因素比较多,常见的有以下几种:

(1)血液系统疾病

临床上最常见的导致假性低血糖的白血病有慢性粒细胞性自血病、急性单核细胞性白血病、急性淋巴细胞白血病等。[3-4]患者通常表现为静脉血糖假性降低,而指尖血糖正常。此外,真性红细胞增多症也会引起假性低血糖,国内的学者已相继报道了多例真性红细胞增多症导致的假性低血糖 。

(2)标本放置时间与温度

血液离体后,由于红细胞糖酵解作用及细菌污染分解葡萄糖,再加上细胞降解酶的作用使血糖浓度逐渐降低。有研究显示,标本放置时间越长,血糖降低越多;温度越高,血糖降低越快。

(3)药物干扰检测方法

维生素C、还原型谷胱甘肽等药物可以干扰检测方法,导致假性低血糖。[9]大部分实验室检测血糖采用己糖激酶法或葡萄糖氧化酶法,服用维生素C、还原型谷胱甘肽等药物会干扰其显色反应,导致血糖测定结果偏低。

通过以上的案例分析,我们可以得知郑某因白血病造成了假性低血糖,因为白细胞增生极度活跃,消耗了大量的葡萄糖,从而导致患者假性低血糖。

总结

在检验科工作中,我们每天都在和大量标本打交道,有时候容易因为标本量多或检验人员不足很难做到明察秋毫。

作为检验人,当我们遇到患者的血糖结果与临床表现严重不符时,除了要排除标本和仪器原因之外,我们还要及时询问患者的病史和用药情况,最好做个指尖血糖来对照,排除各种干扰因素为患者提供一个准确可靠的化验单。

因为每一份标本背后都是一个生命,我们必须要认真对待;每一个检测结果的背后,都隐藏着各种秘密,而这些秘密,需要我们细心的检验人去发现,去探索。

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    2022-08-29 xue8602
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    2021-12-14 jmtang
  5. [GetPortalCommentsPageByObjectIdResponse(id=1955554, encodeId=2068195555476, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon Aug 29 08:51:22 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053313, encodeId=1893205331375, content=<a href='/topic/show?id=5d76991927f' target=_blank style='color:#2F92EE;'>#静脉血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99192, encryptionId=5d76991927f, topicName=静脉血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Tue Apr 19 22:51:22 CST 2022, time=2022-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698262, encodeId=0daa169826296, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Nov 14 11:51:22 CST 2021, time=2021-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1683386, encodeId=482c1683386be, content=<a href='/topic/show?id=67a136e2988' target=_blank style='color:#2F92EE;'>#危急值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36729, encryptionId=67a136e2988, topicName=危急值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42627960172, createdName=jmtang, createdTime=Tue Dec 14 04:51:22 CST 2021, time=2021-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006896, encodeId=78ad2006896e6, content=<a href='/topic/show?id=a9ab6091868' target=_blank style='color:#2F92EE;'>#末梢血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60918, encryptionId=a9ab6091868, topicName=末梢血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0d342500153, createdName=12498bf3m25暂无昵称, createdTime=Wed Jun 15 08:51:22 CST 2022, time=2022-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053431, encodeId=c5591053431b6, content=白细胞增生极度活跃,消耗了大量的葡萄糖。为什么是假性低血糖呢?静脉血糖与指尖血糖为什么差异这么大?如何解释?, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=fc2c28843, createdName=keping2001, createdTime=Tue Sep 21 09:50:03 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1955554, encodeId=2068195555476, content=<a href='/topic/show?id=0aeb991e44c' target=_blank style='color:#2F92EE;'>#静脉血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99174, encryptionId=0aeb991e44c, topicName=静脉血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Mon Aug 29 08:51:22 CST 2022, time=2022-08-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053313, encodeId=1893205331375, content=<a href='/topic/show?id=5d76991927f' target=_blank style='color:#2F92EE;'>#静脉血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99192, encryptionId=5d76991927f, topicName=静脉血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Tue Apr 19 22:51:22 CST 2022, time=2022-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698262, encodeId=0daa169826296, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Sun Nov 14 11:51:22 CST 2021, time=2021-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1683386, encodeId=482c1683386be, content=<a href='/topic/show?id=67a136e2988' target=_blank style='color:#2F92EE;'>#危急值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36729, encryptionId=67a136e2988, topicName=危急值)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f42627960172, createdName=jmtang, createdTime=Tue Dec 14 04:51:22 CST 2021, time=2021-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006896, encodeId=78ad2006896e6, content=<a href='/topic/show?id=a9ab6091868' target=_blank style='color:#2F92EE;'>#末梢血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60918, encryptionId=a9ab6091868, topicName=末梢血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0d342500153, createdName=12498bf3m25暂无昵称, createdTime=Wed Jun 15 08:51:22 CST 2022, time=2022-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053431, encodeId=c5591053431b6, content=白细胞增生极度活跃,消耗了大量的葡萄糖。为什么是假性低血糖呢?静脉血糖与指尖血糖为什么差异这么大?如何解释?, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=fc2c28843, createdName=keping2001, createdTime=Tue Sep 21 09:50:03 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-21 keping2001

    白细胞增生极度活跃,消耗了大量的葡萄糖。为什么是假性低血糖呢?静脉血糖与指尖血糖为什么差异这么大?如何解释?

    0

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