第一滴和第二滴末梢血血糖值差异性的多中心临床研究

目的:本研究旨在探讨在洗手消毒和不洗手消毒两种情况下,第一滴与第二滴末梢血血糖值之间的差异,以及第一滴末梢血血糖值与对照血糖值之间的差异,及此差异对临床治疗决策的影响。方法:研究于2014年5月20日至5月29日在全国四个城市的四家糖尿病专科医院中同步进行,共纳入住院糖尿病患者240例,分别测定洗手消毒以及不洗手不消毒情况下第一滴和第二滴末梢血的血糖值,使用Wilcoxon符号秩和检验方法比较第一滴与第二滴末梢血血糖值及第一滴末梢血与对照血糖值,利用误差栅格分析(Error Grid Analyze,EGA)图分析第一滴与第二滴末梢血血糖值及第一滴末梢血与对照血糖值的一致性。结果:分别获得洗手消毒和不洗手消毒情况下的血糖监测结果 1183对和715对。无论是否洗手消毒,第一滴与第二滴末梢血的血糖值以及第一滴末梢血与对照血糖值之间的差异均具有统计学意义(P值均为0.000)。在洗手消毒和不洗手消毒情况下,第一滴与第二滴末梢血血糖值偏差小于20%的百分比分别为98.6%和97.8%,落于EGA图的A区;第一滴末梢血与对照组血糖值的偏差小于10%的百分比分别为98.2%和97.6%,在EGA图中,落于A区的百分比分别为99.8%和99.6%。结论:在糖尿病的自我管理和临床实践中,无论是否洗手消毒,使用第一滴末梢血进行血糖监测已经足够准确可靠,且更为方便快捷。

Difference between Blood Glucose Values of First and Second Drop of Peripheral Blood

Objective:The blood glucose monitoring is an important part of diabetes care. However, whether the first drop of blood or the second for glucose monitoring is not clearly put forward in the domestic and international guidelines. The purpose of this study is to investigate the difference between the first drop of peripheral blood and the second in the two cases of hand washing and disinfection and no hand washing and disinfection.Methods:The study was conducted in four diabetes special hospitals in four cities in China from May 20, 2014 to May 29th; 240 patients with diabetes were admitted to the four diabetes special hospitals. Blood glucose values of the first and second drops of blood were measured in the two cases of hand washing and disinfection and no hand washing and disinfection. The difference between the first and second drops of capillary glucose concentrations and the difference between the first drop and the control measurement were compared by using the Wilcoxon signed rank test method and the Error Grid Analyze (EGA) graph.Results:A total of 1183 and 715 pairs of blood glucose monitoring results were obtained in the two cases of hand washing and disinfection and no hand washing and disinfection. Whether with or without hand washing and disinfection, there were statistically significant differences in blood glucose values between the first and second drops of blood and between the first drop of blood and control blood glucose (P = 0.000). In the two cases of hand washing and disinfection and no hand washing and disinfection, percent of deviation less than 20% in blood glucose values of the first drop and second drops of blood were 98.6 % and 97.8 %, which were in Zone A of the EGA map; percent of deviation less than 10%in blood glucose values of the first drop and control measurment were 98.2 %and 97.6 %, the percent in Zone A of the EGA map were 99.8 % and 99.6 %.Conclusion:On account of the sufficient accuracy, reliability and convenience, the first drop of blood can be used for self-monitored glucose testing and clinical practice, whether or not hand washing disinfection.