Milani L, Bizzaro N, Sanson A
Servizio di Cardiologia, UCIC, San Donà di Piave Venezia.
G Ital Cardiol. 1992 Jan;22(1):97-101.
Life-threatening digitalis intoxication is treated using digoxin specific antibody fragments (Fab) that bind and inactivate the drug. The free digoxin serum concentration could be useful in the management of Fab-treated patients, but the standard methods of measurement can be clinically misleading because Fab anti-digoxin interferes with digitalis immunoassay measurements. A case involving Fab therapy of a digoxin overdosed patient, in which two laboratory methods gave very different results, is reported. The radioimmunologic assay (RIA), widely used in laboratories, yielded high values without relation to true serum free digoxin concentration. On the contrary, the recently introduced fluoroenzymatic sequential immunoassay (FEIA), which accurately measures free glycoside concentration, was a valuable aid in monitoring Fab treatment. Therefore, cardiologists' knowledge of a possible interference of specific anti-digoxin fragment treatment with many immunoassays may greatly enhance the rational management of these patients.
危及生命的洋地黄中毒使用地高辛特异性抗体片段（Fab）进行治疗，该抗体片段可结合药物并使其失活。游离地高辛血清浓度可能有助于管理接受Fab治疗的患者，但标准测量方法在临床上可能会产生误导，因为Fab抗地高辛会干扰洋地黄免疫测定。本文报道了一例涉及Fab治疗地高辛过量患者的病例，其中两种实验室方法得出了非常不同的结果。实验室广泛使用的放射免疫测定（RIA）得出的值很高，与真实的血清游离地高辛浓度无关。相反，最近推出的荧光酶连续免疫测定（FEIA）能够准确测量游离糖苷浓度，对监测Fab治疗很有帮助。因此，心脏病专家了解特异性抗地高辛片段治疗可能对许多免疫测定产生干扰，这可能会大大提高对这些患者的合理管理。
