血清与全血离子浓度换算
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Hip Int 2011; 21(5): 587 - 595
Metal ion interpretation in resurfacing versus conventional hip arthroplasty and in whole blood versus serum. How should we interpret metal ion data
Accepted on: 05/07/2011
Published online: 21/09/2011
Published in print: 06/10/2011
DOI 10.5301/HIP.2011.8643
JoséM.H. Smolders, Pepijn Bisseling, Annemiek Hol, Catherine V an Der Straeten, B. Willem Schreurs, Job L.C. van Susante
Abstract
Abstract: Metal ions generated from joint replacements are a cause for concern. There is no consensus on the best surrogate measure of metal ion exposure, and both serum and whole blood measurements are used in clinical practice. This study provides a guideline for interpretation of metal ion analysis in clinical practice. In a prospective trial comparing hip resurfacing (HR) with a conventional metal-on-metal (MoM) total hip arthroplasty (THA) cobalt and chromium levels were determined for whole blood and serum in 343 paired samples at regular intervals up to 24 months postoperatively. Cobalt whole blood and serum levels increased significantly after both procedures. Cobalt concentrations were significantly higher for the HR group compared to the THA group, at 3, 6 and 12 months, for whole blood and serum. At 24 months cobalt levels decreased and differences between HR and THA were no longer significant. In contrast, chromium whole blood levels remained significantly higher for HR until 24 months. Whole blood and serum levels could not be used interchangeably. The mean differences for cobalt and chromium between blood and serum values were +0.13 μg/L and -0.91 μg/L respectively. Regression analysis provided a formula for conversion from serum to blood of 0.34+[0.88*Co serum] for cobalt and 0.14+[0.58*Cr serum] for chromium, with an acce ptable prediction error below ±1.0 μg/L. Cobalt and chromium levels were significantly higher for HR versus THA, especially during the run-in phase of one year. Overall, the metal ion levels were well below 5 μg/L. We cannot recommend the use of whole blood over serum measurements or vice versa. The provided conversion formula between whole blood and serum in combination with the presented practical guidelines may be useful for clinical practice.