采用自动免疫分析和高效液相色谱法分析尿游离皮质醇以诊断库欣综合征。
Urine free cortisol analysis by automated immunoassay and high-performance liquid chromatography for the investigation of Cushing's syndrome.
作者信息
Ching Simon Y L, Lim Ee Mun, Beilby John, Bhagat Chotoo, Rossi Enrico, Walsh John P, Pullan Peter
机构信息
Clinical Biochemistry Department, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.
出版信息
Ann Clin Biochem. 2006 Sep;43(Pt 5):402-7. doi: 10.1258/000456306778519973.
BACKGROUND
We compared a widely used immunoassay method for urine free corticoids with a high-performance liquid chromatography (HPLC) method for the investigation of Cushing's syndrome.
METHODS
Urine free corticoid analysis using an Immulite:2000 automated immunoassay analyser and urine free cortisol analysis by a specific HPLC method on 39 patients with an elevated baseline immunoassay 24 h urine free corticoid result who were referred from 2000 to 2004.
RESULTS
Reference ranges for urine free corticoids by immunoassay and for urine free cortisol by HPLC were <900 and <170 nmol/day, respectively. Of the 39 patients with an elevated immunoassay urine free corticoid result, Cushing's syndrome was surgically proven in 22 patients, giving a positive predictive value of 56%. Cushing's syndrome was excluded in 12 of the remaining 17 patients by applying the specific HPLC method and at least one of the following: a clinical evaluation which was not suggestive or adequate suppression of plasma cortisol following dexamethasone. Urine free cortisol analysis by HPLC gave a positive predictive value of 81% for Cushing's syndrome.
CONCLUSIONS
Although immunoassay has a low specificity for urine cortisol, it is a widely available test which serves as a valid initial investigation of Cushing's syndrome.
背景
我们比较了一种广泛使用的尿游离皮质激素免疫测定方法和一种高效液相色谱（HPLC）方法，用于库欣综合征的研究。
方法
对2000年至2004年转诊的39例基线免疫测定24小时尿游离皮质激素结果升高的患者，使用Immulite:2000自动免疫分析仪进行尿游离皮质激素分析，并采用特定的HPLC方法进行尿游离皮质醇分析。
结果
免疫测定法测定的尿游离皮质激素参考范围和HPLC法测定的尿游离皮质醇参考范围分别为<900和<170 nmol/天。在39例免疫测定尿游离皮质激素结果升高的患者中，22例经手术证实为库欣综合征，阳性预测值为56%。通过应用特定的HPLC方法以及以下至少一项：不提示库欣综合征的临床评估或地塞米松后血浆皮质醇的充分抑制，在其余17例患者中的12例中排除了库欣综合征。HPLC法测定尿游离皮质醇对库欣综合征的阳性预测值为81%。
结论
尽管免疫测定法对尿皮质醇的特异性较低，但它是一种广泛可用的检测方法，可作为库欣综合征的有效初始检查。
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