三类即时诊断检测项目在社区卫生中心的应用探讨

王茜青 洪娟 陆波

(上海市浦东新区浦兴社区卫生服务中心检验科 上海 200129)

摘 要目的：探讨社区常用即时诊断（point-of-care testing，POCT）方法包括快速血糖、心肌梗死三合一和妊娠试验的使用价值及缺陷。方法：收集2013年7月至2014年3月浦兴社区卫生服务中心187例2型糖尿病患者，采用快速血糖仪检测血糖，对87例疑似心肌梗死患者行心肌梗死三合一（肌钙蛋白cTnI、肌红蛋白MYO、肌酸激酶MB同工酶CK-MB）测试，对79例停经待检妊娠患者进行尿妊娠试验检查，比较三类POCT方法与常规法检测的差异。结果：POCT法检测血糖、肌钙蛋白、肌红蛋白、肌酸激酶MB同工酶结果与常规方法差异无统计学意义（P＞0.05）。79例早早孕测试结果与临床诊断全部符合。结论：三类POCT方法对临床均有诊断价值，具有检测时间短、操作简单、标本无需特殊处理、仪器小型等优势，但对其监管、能力验证、质量控制、安全性等还需加强和统一。

关键词糖尿病 心肌梗死 妊娠 即时诊断

Exploration of the application of three kinds of point-of-care testing items in the community health service center

WANG Qianqing, HONG Juan, LU Bo

(Lab. Department of Puxing Community Health Service Center of Pudong New District, Shanghai 200129, China)

ABSTRACTObjective: To study the useful value and defect of the point-of-care testing (POCT) method used commonly in the community, which includes the fast blood glucose, myocardial infarction three in one and a pregnancy test. Methods: The blood glucose of 187 cases with type II diabetes detected by the fast blood glucose meter, test of the myocardial infarction three in one (cTnI, MYO and CK-MB) of 87 suspected cases of myocardial infarction and examination of the urine pregnancy test of 79 cases of amenorrhea pregnancy for inspection were collected from July 2013 to March 2014 in Puxing Community Health Service Center and the differences of the three kinds of POCT method from the conventional detection method were compared. Results: The differences in the results of the blood glucose test, cTnI, MYO and CK-MB detected with POCT from the conventional method had no statistical significance (P>0.05). The early pregnant test results of 79 cases were all consistent with the clinical diagnosis. Conclusion: The three kinds of POCT methods have the clinical diagnostic value, their detection time is short, the operation is simple, the specimens need no special treatment and the apparatus is small and there are other advantages. But the supervision, proficiency testing, quality control and safety still need to be strengthened and unified.

KEY WORDSdiabetes; myocardial infarction; pregnancy; point-of-care testing

早在公元1500年前医师就已利用蚂蚁发现糖尿病患者，这是最原始的即时诊断（point-of-care testing，POCT）。POCT始于1959年，因为操作简便、快速，随即扩展到其他许多项目，并得到商品化。最近，美国国家临床生化科学院（NACB）在其指定的“POCT循证文件”草案中，将POCT定义为“在接近患者治疗处，由未接受临床实验室学科训练人员或者患者进行的临床检验，是在传统实验模式以外进行的一切检验”。POCT的基本原理是将滤纸和各种微孔膜的吸水材料浸于传统方法的相关液体试剂中制成诊断试剂条；或……