STRONG ION GAP - A METHODOLOGY FOR EXPLORING UNEXPLAINED ANIONS
STRONG ION GAP - A METHODOLOGY FOR EXPLORING UNEXPLAINED ANIONS
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DOI：
10.1016/0883-9441(95)90016-0
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发表时间：
1995-06-01
影响因子：
3.7
通讯作者：
PINSKY, MR
中科院分区：
文献类型：
--
作者：
KELLUM, JA;KRAMER, DJ;PINSKY, MR
目的：本文介绍了一种类似于阴离子间隙(AG)的物理化学方法--强离子间隙(SIG)的计算方法，它是一种测量不含钠、钾、氯和碳酸氢盐的阴阳离子平衡的方法。我们在三组受试者中比较了SIG和AG方法，其中有和没有未解释的阴离子。方法：根据原始报告(组1和组2)和回顾图表(组3)计算每组的SIG、AG和校正AG(AGC)。结果：组2的SIG与AG的相关性较差，而组1和组3的SIG与AG无相关性，三组的AGC与SIG的相关系数分别为0.99、0.93和0.91；每组P<；.01)。虽然AG相似，但每组的SIG不同。第1组SIG水平接近于零，第2组和第3组SIG均值分别为4.80+/-4.67mEq/L和9.60+/-6.43mEq/L。阴离子间隙的组成因受试者类型的不同而有显著差异。结论：校正所有已知阴离子后，SIG与AG相关。SIG技术可以在已知存在阴离子的患者群体中检测到未知阴离子，并且在锻炼期间不会在健康志愿者中检测到未知阴离子。这项检测在一些脓毒症或肝病患者中检测到大量未知的阴离子。因此，这项检测在确定代谢性酸中毒的特征方面既敏感又特异。
Purpose: This paper describes the calculation of the strong ion gap (SIG), a physical chemical methodology similar to the anion gap (AG), as a measure of the anion/cation balance exclusive of sodium, potassium, chloride, and bicarbonate. We compared the SIG and AG methodologies in three groups of subjects with and without unexplained anions. These groups were (1) healthy volunteers with hyperlacticemia during exercise; (2) intensive care unit (ICU) patients with sepsis; and (3) ICU patients with severe liver disease.Methods: The SIG, AG, and corrected AG (AGc) were calculated for each group from data available in the original reports (groups 1 and 2) and by retrospective chart review (group 3).Results: The SIG correlated poorly with the AG in group 2, whereas no correlation was seen in groups 1 and 3. The AGc correlated with SIG in all three groups (r = .99, .93, and .91 respectively; P < .01 for each group). Although the AG was similar, the SIG differed for each group. Group 1 had levels of SIG near zero, and groups 2 and 3 had mean SIG's of 4.80 +/- 4.67 mEq/L and 9.60 +/- 6.43 mEq/L respectively. The composition of the anion gap differed markedly among subject types.Conclusions: The SIG correlates with the AG once corrected for all known anions. The SIG technique can detect unknown anions in a patient population known to have them and does not detect unknown anions in healthy volunteers during exercise. This test detects large amounts of unknown anions in some patients with sepsis or liver disease. Therefore, the test is both sensitive and specific in characterizing metabolic acidosis.