Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Scand J Clin Lab Invest. 2024 Jul;84(4):225-229. doi: 10.1080/00365513.2024.2359091. Epub 2024 Jun 10.
Neuron-specific enolase (NSE) derived from neurons and peripheral neuroendocrine cells is a biomarker for neuroendocrine tumors and for prognostication in comatose cardiac arrest survivors. However, as platelets and erythrocytes contain NSE, hemolysis causes falsely elevated NSE. We used native serum and hemolysate derived from the same patients to make serial dilutions, and subsequently measured NSE (mNSE) and hemolytic index (HI) in each dilution. An algorithm suitable for the laboratory information system was developed based on the mNSE, HI and the estimated gradient of hemolytic interference from 30 patients. We estimated the associated uncertainty of the corrected NSE (cNSE) results based on the observed range of the gradient and derived an equation for cNSE for samples with limited hemolysis (i.e. 5 < HI ≤ 30): cNSE = mNSE - HI × (0.34 ± 0.23) µg/L. By semi-quantitatively grading the contribution from limited hemolysis, a texted result noting the hemolysis-associated degree of uncertainty can accompany the cNSE result. The major challenge of hemolysis when using serum NSE as a biomarker can be managed using an automated algorithm for correction of NSE results based on degree of hemolysis. However, laboratorians and clinicians should be aware of the limitations associated with hemolysis.
神经元特异性烯醇化酶（NSE）来源于神经元和外周神经内分泌细胞，是神经内分泌肿瘤的生物标志物，也是昏迷性心脏骤停幸存者预后的预测指标。然而，由于血小板和红细胞中也含有 NSE，因此溶血会导致 NSE 假性升高。我们使用来自同一患者的天然血清和溶血产物进行连续稀释，然后测量每个稀释液中的 NSE（mNSE）和溶血指数（HI）。根据 30 名患者的 mNSE、HI 和估计的溶血干扰梯度，为实验室信息系统开发了一种适合的算法。我们根据梯度的观察范围，估计了校正后 NSE（cNSE）结果的相关不确定性，并为溶血程度有限（即 5<HI≤30）的样本推导了 cNSE 方程：cNSE=mNSE-HI×（0.34±0.23）µg/L。通过对有限溶血的贡献进行半定量分级，可以在 cNSE 结果旁边附加一个带有文字的结果，提示与溶血相关的不确定程度。当使用血清 NSE 作为生物标志物时，溶血的主要挑战可以通过基于溶血程度的自动算法来校正 NSE 结果来管理。然而，检验人员和临床医生应该意识到与溶血相关的局限性。
