Program Management Office for Paradigms-Establishing Centers for Fostering Medical Researchers of the Future (T.Y., M.K.), Kanazawa University, Kanazawa, Ishikawa 920-8640, Japan; Division of Endocrinology and Hypertension (T.Y., S.K., M.K., M.U., R.O., Yoshim. Takeda, Yoshiyu Takeda), Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa 920-8640, Japan; Departments of Hygiene (M.D.) and Radiology (J.S., T.M., W.K., T.G.), Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8640, Japan; Department of Advanced Medical Imaging (O.M.), Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8640, Japan; Department of Materials Science (K.I., Y.Taka.), School of Material Science, Japan Advanced Institute of Science and Technology, Nomi, Ishikawa 923-1292, Japan; Department of Applied Physics (E.T.), Graduate School of Engineering, Osaka University, Suita, Osaka 565-0871, Japan; Hoju Memorial Hospital (M.O., M.N.), Nomi, Ishikawa 923-1226, Japan; Takaoka Municipal Hospital (S.M., N.T.), Takaoka, Toyama 933-8550, Japan; Sanda Municipal Hospital (Y.M.), Sanda, Hyogo 669-1321, Japan; Akashi Medical Center (K.K.), Akashi, Hyogo 674-0063, Japan; Ishikawa Prefectural Hospital (S.F.), Kanazawa, Ishikawa 920-8530, Japan; Department of Endocrinology (T.Se., T.Sa.), Saisekai Ishikawa Hospital, Kanazawa, Ishikawa 920-0353, Japan; Division of Cardiology (K.H., M.Y.), Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8640, Japan; and Innovative Clinical Research Center (Yoshiyu Takeda), Kanazawa University Hospital, Kanazawa, Ishikawa, 920-8640, Japan.
J Clin Endocrinol Metab. 2016 Jun;101(6):2554-61. doi: 10.1210/jc.2016-1011. Epub 2016 Mar 24.
Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheter's position, thereby increasing the AVS success rate.
We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined.
Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R(2) = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001).
Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.
肾上腺静脉采样 (AVS) 对于确定可通过手术治愈的原发性醛固酮增多症 (PA) 至关重要，但采样导管的准确放置在技术上具有挑战性。术中皮质醇测量可以确认导管的位置，从而提高 AVS 成功率。
我们开发了一种快速皮质醇测定法 (QCA)，该方法使用免疫层析和金纳米粒子，可以进行半定量或定量分析。该测定法在两项研究中进行了评估。在一项单中心研究中，将 PA 患者分为接受 AVS 联合半定量 QCA（n = 30）、定量 QCA（n = 30）或不进行 QCA（n = 30）的三组，并确定了成功进行 AVS 的比例。在一项前瞻性多中心随机对照研究中，确定了使用（n = 148）或不使用（n = 145）半定量 QCA 进行 AVS 的成功率。
在放射科套房中，在 6 分钟或更短的时间内完成了 AVS 期间的皮质醇浓度测量，无需额外的技术协助，并且与常规参考测定法显著相关（R² = 0.994；P <.001）。在单中心研究中，半定量和定量 QCA 与 AVS 成功率相关的差异不显著（均为 93%）；然而，成功率明显高于不使用 QCA 进行 AVS 的成功率（63%；P <.001）。在多中心研究中，半定量 QCA 的 AVS 成功率为 94%，明显高于不使用 QCA 的患者（60%；P <.001）。
我们的新型 QCA 可以在护理点快速简便地进行，并提高了 AVS 的成功率。
