一种基于免疫胶体金技术的快速术中甲状旁腺激素检测法，用于甲状腺手术中甲状旁腺的识别
A Rapid Intraoperative Parathyroid Hormone Assay Based on the Immune Colloidal Gold Technique for Parathyroid Identification in Thyroid Surgery.
作者信息
Xia Wenfei, Zhang Jinjun, Shen Wenzhuang, Zhu Zhi, Yang Zhifang, Li Xingrui
机构信息
Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Endocrinol (Lausanne). 2021 Apr 22;11:594745. doi: 10.3389/fendo.2020.594745. eCollection 2020.
OBJECTIVE
A novel immunochromatographic test strip method was developed to detect tissue parathyroid hormone (PTH) using the immune colloidal gold technique (ICGT). The accuracy and application value of this method for intraoperative parathyroid identification were evaluated.
METHODS
Serum samples were collected to measure PTH by both ICGT and electrochemiluminescence immunoassay (ECLIA). Patients who underwent unilateral and total thyroidectomy were enrolled to evaluate the feasibility and clinical efficacy of rapid intraoperative identification of parathyroid glands PTH determination using ICGT. Two sample preparation methods, fine needle aspiration (FNA) and tissue block homogenate (TBH), were used for PTH-ICGT analysis.
RESULTS
Bablok analysis showed a linear relationship between the serum PTH measurements obtained by ICGT and ECLIA. Non-parathyroid tissues had much lower PTH concentrations (14.8 ± 2.1 pg/ml, n = 97) detected by ICGT, compared to the parathyroid gland tissues (955.3 ± 16.1 pg/ml, n = 79; P < 0.0001), With biopsy results as the standard, ICGT showed higher diagnosis rates as compared with direct visual inspection, for identifying both parathyroid glands (97.4 vs. 78.2%) and non-parathyroid tissues (100 vs. 68.9%). The cut-off values for parathyroid identification by FNA and TBH methods were 63.99 and 136.30 pg/ml, respectively. The detection time was 2 min by TBH method for tissue detection and 6 min by FNA method for tissue detection, both of which were faster than traditional intraoperative cryopathological examination (usually >30 min). Intraoperative application of ICGT method was associated with higher postoperative serum calcium and blood PTH levels at 1 and 3 months as well as a lower incidence of postoperative transient hypocalcemia, as compared with direct visual inspection.
CONCLUSION
PTH-ICGT assay shows high potential as a rapid, novel alternative for intraoperative parathyroid identification.
目的
开发一种新型免疫层析试纸条法，利用免疫胶体金技术（ICGT）检测组织甲状旁腺激素（PTH）。评估该方法在术中甲状旁腺识别中的准确性和应用价值。
方法
收集血清样本，采用ICGT和电化学发光免疫分析（ECLIA）检测PTH。纳入接受单侧和全甲状腺切除术的患者，以评估使用ICGT快速术中识别甲状旁腺的可行性和临床疗效。两种样本制备方法，细针穿刺抽吸（FNA）和组织块匀浆（TBH），用于PTH-ICGT分析。
结果
Bablok分析显示ICGT和ECLIA检测的血清PTH测量值之间呈线性关系。与甲状旁腺组织（955.3±16.1 pg/ml，n = 79；P < 0.0001）相比，ICGT检测的非甲状旁腺组织的PTH浓度低得多（14.8±2.1 pg/ml，n = 97）。以活检结果为标准，ICGT在识别甲状旁腺（97.4%对78.2%）和非甲状旁腺组织（100%对68.9%）方面的诊断率高于直接目视检查。FNA和TBH方法识别甲状旁腺的临界值分别为63.99和136.30 pg/ml。TBH方法检测组织的时间为2分钟，FNA方法检测组织的时间为6分钟，两者均比传统术中冷冻病理检查快（通常>30分钟）。与直接目视检查相比，术中应用ICGT方法术后1个月和3个月的血清钙和血PTH水平较高，术后短暂性低钙血症的发生率较低。
结论
PTH-ICGT检测作为术中甲状旁腺识别的一种快速、新颖的替代方法具有很高的潜力。
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