항응고제와 검사지연이 D-Dimer 검사결과에 미치는 영향
The Influence of Anticoagulants and Time of Measurements on D-Dimer Determinations
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배경 : 구연산염첨가혈장 대신 혈청이나 EDTA첨가 혈장을 사용할 수 있는 지 알아보고, 검체 채취후 시간이 경과한 검체를 사용하여도 되는 지 알아보고자, 항응고제 종류와 시간의 경과가 D-dimer 검사 결과에 미치는 영향을 연구하였다. 방법 : 32예의 구연산염첨가혈장, 23예의 혈청 및 EDTA첨가혈장을 검사하였다. D-dimers 검사는 VIDAS analyzer로 enzymelinked fluorescent assay를 하였다. 결과 : 채혈 즉시 실시한 구연산염첨가혈장, 혈청, EDTA첨가혈장의 D-dimer 평균± SD (중앙값)는, 각각 282.7± 201.1 (224.6)g/L, 255.1± 206.8 (197.3) g/L, 313.3± 230.8 (246.4) g/L였다. 구연산염첨가혈장, 혈청, EDTA첨가혈장의 D-dimer 검사결과는 서로 상관관계가 좋았다. 구연산염첨가혈장의 D-dimer 검사 참고치 상한은 500 g/L 일 때, 혈청의 참고치는 400 g/L, 민감도와 특이도는 100%, EDTA첨가혈장의 경우는 585 g/L, 민감도는 100%, 특이도는 94.7%였다. 결론 : 구연산염첨가혈장과 함께 혈청과 EDTA첨가혈장도 참고치 교정을 하면 D-dimer 검사에 사용을 할 수가 있다. 검체 채취 후 시간이 경과한 검체는 대부분 유의한 영향을 미치지 않았으나 검체에 따른 변이가 있으므로 지체 후 검사는 추천되지 않는다.
Abstract
Background : We evaluated the effects of anticoagulants used in blood sampling and time of mesurements after blood collection on D-dimer determinations. Methods : A total of 32 samples of sodium citrated plasma, and 23 samples each of serum and ethylene diamine tetraacetic acid (EDTA) plasma, were studied. D-dimer was measured by enzyme linked fluorescent assay using a VIDAS analyzer. Results : The mean±SD (median) of D-dimer titers in citrated plasma, serum, and EDTA plasma samples immediately after blood collection were 282.7±201.1 (224.6) g/L, 255.1±206.8 (197.3) g/L, and 313.3±230.8 (246.4) g/L respectively. The results obtained for the three different sample groups were well correlated. While the upper limit of the reference range for D-dimer for citrated plasma has been set at 500 g/L, the cut-off values for serum and EDTA plasma were 400 g/L (100% sensitivity and specificity), and 585 g/L (100% sensitivity and 94.7% specificity), respectively Conclusions : In addition to citrated plasma, both serum and EDTA plasma can be used for D-dimer assay. A delay in the time of measurements after blood collection does not influence the results significantly. (Korean J Lab Med 2004; 24: 7-10)
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