Stanczyk Frank Z
Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA.
Semin Reprod Med. 2006 Apr;24(2):78-85. doi: 10.1055/s-2006-939566.
Much of our knowledge about the physiologic role of androgens in women is based on measurements, primarily in serum, using radioimmunoassay (RIA) methodology that involves purification of the analyte by organic solvent extraction and column chromatography. Although the extraction/chromatographic RIA is highly reliable when properly validated, it is time consuming and costly. For this reason, direct RIA methods were developed. Subsequently, the radioactive marker was replaced by other labels that have been used in direct chemiluminescent, fluorescent, and enzyme immunoassays on autoanalyzers. Although direct immunoassays are simple and rapid, they are seldom thoroughly validated, and generally lack the sensitivity and specificity for reliable measurements of testosterone levels found in postmenopausal serum. In recent years there has been increased use of mass spectrometry assay methods to quantify steroid hormones. These methods are touted to become the gold standard for all steroid hormone measurements. Because urine contains predominantly glucuronidated androgens, multistep procedures are required for the measurement, which is not practical for diagnostic testing. Androgens also can be measured in saliva, but major methodologic problems are associated with the measurements. In addition, there is a misconception that salivary testosterone levels reflect free testosterone levels in serum.
我们对雄激素在女性体内生理作用的许多认识，主要基于使用放射免疫分析（RIA）方法进行的测量，测量对象主要是血清，该方法涉及通过有机溶剂萃取和柱色谱法对分析物进行纯化。尽管经过适当验证后，萃取/色谱RIA非常可靠，但它既耗时又昂贵。因此，开发了直接RIA方法。随后，放射性标记被其他标记物取代，这些标记物已用于自动分析仪上的直接化学发光、荧光和酶免疫分析。尽管直接免疫分析简单快速，但它们很少经过全面验证，并且通常缺乏对绝经后血清中睾酮水平进行可靠测量所需的灵敏度和特异性。近年来，质谱分析方法越来越多地用于定量甾体激素。这些方法被誉为所有甾体激素测量方法的金标准。由于尿液中主要含有葡萄糖醛酸化雄激素，因此测量需要多步程序，这对于诊断测试来说并不实用。雄激素也可以在唾液中进行测量，但测量存在主要的方法学问题。此外，存在一种误解，即唾液睾酮水平反映血清中的游离睾酮水平。
