免疫测定法与放射免疫分析法测定促肾上腺皮质激素用于库欣综合征鉴别诊断的比较
A comparison of immunometric and radioimmunoassay measurement of ACTH for the differential diagnosis of Cushing's syndrome.
作者信息
Lindsay J R, Shanmugam V K, Oldfield E H, Remaley A T, Nieman L K
机构信息
Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda MD 20892-1109, USA.
出版信息
J Endocrinol Invest. 2006 Dec;29(11):983-8. doi: 10.1007/BF03349211.
OBJECTIVE
Measurement of plasma ACTH levels by radioimmunoassay (RIA) is used to identify adrenal causes (AA) of Cushing's syndrome (CS) and to distinguish ectopic CS (EAS) from Cushing's disease (CD) using CRH stimulation testing and inferior petrosal sinus sampling (IPSS). We wished to determine whether diagnostic criteria developed with RIA would also be applicable for immunoradiometric (IRMA) or immunochemiluminescent (ICMA) assays.
SUBJECTS AND METHODS
ACTH was measured by RIA, immunoradiometric and/or immunochemiluminescent assay on samples obtained during three types of diagnostic testing in a tertiary referral setting: a) basally (63 CD, 5 AA, 2 EAS and 37 non-CS patients); b) in 44 CD patients following CRH; c) in 6 ectopic CS and 17 CD patients during IPSS. The primary outcome was comparison of diagnostic utility.
RESULTS
a) IRMA results, while lower, correlated highly with RIA (r=0.9, p<0.0001) and had similar sensitivity (100 vs 80%) and specificity (89 vs 94%) for the diagnosis of AA (p=0.3); b) the sensitivity for CD of CRH testing using IRMA was similar to that of RIA (85 vs 83%, p=1.0); c) during IPSS, IRMA had similar sensitivity (100%) and specificity (100 vs 83%) compared with ICMA or RIA (p=1.0).
CONCLUSIONS
ACTH immunometric assays correlate closely to RIA and offer similar diagnostic utility.
目的
通过放射免疫分析法（RIA）测定血浆促肾上腺皮质激素（ACTH）水平，以识别库欣综合征（CS）的肾上腺病因（AA），并通过促肾上腺皮质激素释放激素（CRH）刺激试验和岩下窦采血（IPSS）将异位CS（EAS）与库欣病（CD）区分开来。我们希望确定用RIA制定的诊断标准是否也适用于免疫放射分析法（IRMA）或免疫化学发光分析法（ICMA）。
对象与方法
在三级转诊机构进行的三种诊断测试中，通过RIA、免疫放射分析和/或免疫化学发光分析法对样本中的ACTH进行测量：a）基础状态下（63例CD、5例AA、2例EAS和37例非CS患者）；b）44例CD患者在CRH刺激后；c）6例异位CS和17例CD患者在IPSS期间。主要结果是比较诊断效用。
结果
a）IRMA结果虽较低，但与RIA高度相关（r = 0.9，p < 0.0001），且对AA诊断的敏感性（分别为100%和80%）和特异性（分别为89%和94%）相似（p = 0.3）；b）使用IRMA进行CRH试验对CD的敏感性与RIA相似（分别为85%和83%，p = 1.0）；c）在IPSS期间，与ICMA或RIA相比，IRMA的敏感性（100%）和特异性（分别为100%和83%）相似（p = 1.0）。
结论
ACTH免疫分析法与RIA密切相关，且具有相似的诊断效用。
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