Grzych Guillaume, Zerimech Farid, Touze Benjamin, Descamps Clarence, Bout Marie-Adélaïde, Joncquel Marie, Douillard Claire, Kim Isabelle, Tard Céline, Brousseau Thierry
CHU Lille, Service Biochimie Automatisée-Protéines, F-59000 Lille, France.
CHU Lille, Service Hormonologie Métabolisme Nutrition Oncologie, F-59000 Lille, France.
J Xenobiot. 2024 Sep 27;14(4):1332-1342. doi: 10.3390/jox14040075.
Historically used as a marker for inherited disorders, the current interest in plasma homocysteine measurement lies in its ability to provide valuable information about the metabolic and nutritional status of patients. Specifically, nitrous oxide (NO) abuse can lead to functional vitamin B12 deficiency by oxidation and increase oxidative stress, resulting in elevated plasma homocysteine levels, which mimic neurological conditions such as Guillain-Barré syndrome. Rapid identification of hyperhomocysteinemia is crucial for timely intervention and avoiding costly, unnecessary treatments.
This study evaluates the performance of a rapid immunoassay technique (Snibe) compared to mass spectrometry (LC-MS/MS) for measuring plasma homocysteine levels in patients with nitrous oxide abuse and non-inherited caused of elevated homocysteine, aiming to enhance differential diagnosis related to oxidative stress.
235 patients from Lille University Hospital were included. EDTA blood samples were collected and analyzed using both rapid immunoassay (Snibe) and LC-MS/MS. Neurological assessment was performed using the peripheral neuropathy disability (PND) score.
Firstly, significant elevations in plasma homocysteine levels were observed in patients abusing nitrous oxide measured by LC-MS/MS. Secondly, the immunoassay provided rapid results, essential for early clinical decision-making, but tended to underestimate high values compared to LC-MS/MS. A good correlation was found between the methods for low and moderate values.
The immunoassay tended to underestimate high-value samples compared to LC-MS/MS, which is a common problem with the competitive methodology. The rapid immunoassay technique is effective for initial screening and early intervention, aiding in the differential diagnosis of conditions related to oxidative stress. Therefore, it is recommended to use the CLIA method for initial screening and confirm with mass spectrometry if there are abnormal samples. Integrating both techniques can enhance diagnostic accuracy and improve patient outcomes.
血浆同型半胱氨酸测量过去用作遗传性疾病的标志物，目前其受关注之处在于它能够提供有关患者代谢和营养状况的有价值信息。具体而言，滥用一氧化二氮（NO）可通过氧化导致功能性维生素B12缺乏并增加氧化应激，从而导致血浆同型半胱氨酸水平升高，这与吉兰 - 巴雷综合征等神经系统疾病相似。快速识别高同型半胱氨酸血症对于及时干预和避免昂贵且不必要的治疗至关重要。
本研究评估一种快速免疫测定技术（Snibe）与质谱法（LC-MS/MS）相比，在测量滥用一氧化二氮及非遗传性高同型半胱氨酸血症患者血浆同型半胱氨酸水平方面的性能，旨在加强与氧化应激相关的鉴别诊断。
纳入来自里尔大学医院的235名患者。采集乙二胺四乙酸（EDTA）血样，并用快速免疫测定法（Snibe）和LC-MS/MS进行分析。使用周围神经病变残疾（PND）评分进行神经学评估。
首先，通过LC-MS/MS测量发现，滥用一氧化二氮的患者血浆同型半胱氨酸水平显著升高。其次，免疫测定法能快速得出结果，这对早期临床决策至关重要，但与LC-MS/MS相比，往往会低估高值。两种方法在低值和中值之间具有良好的相关性。
与LC-MS/MS相比，免疫测定法往往会低估高值样本，这是竞争方法的常见问题。快速免疫测定技术对于初始筛查和早期干预有效，有助于与氧化应激相关疾病的鉴别诊断。因此，建议使用化学发光免疫分析法（CLIA）进行初始筛查，若样本异常则用质谱法进行确认。整合这两种技术可提高诊断准确性并改善患者预后。
