CAJ | 학술논문

目的研究异嗜性抗体(HAb)对甲状腺功能测定的干扰,分析其临床特点并探讨减少和排除干扰作用的方法.方法 2008年5月-2009年6月,在我院选择296例甲状腺功能测定表现为血浆TSH水平不适当增高的患者(FT3、FT4测定采用固相放射免疫分析方法,TSH测定采用免疫放射分析方法-IRMA),其中9例疑诊HAb增多症.对同份血清样本采用放射免疫分析方法(RIA)重新测定TSH,经速率散射比浊法除外血清类风湿因子(RF)干扰的可能性后,采用非免疫动物混合血清中和法对疑诊HAb增多患者的同份血清检测HAb.结果 ①9例疑诊HAb增多症的患者RIA法测定的TSH水平低于血清中和前IRMA法(P<0.05),在其余287例TSH不适当增高患者RIA法测定的TSH水与血清中和前IRMA法组间比较,差异无统计学意义(P>0.05).②经非免疫动物血清中和后,上述9例疑诊HAb增多症的患者IRMA法的TSH测定结果明显低于血清中和前(P<0.05),287例TSH不适当增高患者IRMA法的TSH测定结果与血清中和前比较,差异无统计学意义(P>0.05).③9例疑诊HAb增多症的患者非免疫动物血清中和前、后RIA法测定FT3和FT4组间比较,差异均无统计学意义(P均>0.05).④287例TSH不适当增高患者非免疫动物血清中和前、后RIA法测定FT3和FT4组间比较,差异均无统计学意义(P均>0.05).结论 HAb增多可以明显干扰诸如IRMA法进行的非竞争性的双位点免疫分析,造成检测结果假性增高,而竞争性的放免分析方法受HAb干扰作用小.非免疫动物血清中和法能够减少或排除HAb的干扰.
목적 연구이기성항체(HAb)대갑상선공능측정적간우,분석기림상특점병탐토감소화배제간우작용적방법.방법 2008년5월-2009년6월,재아원선택296례갑상선공능측정표현위혈장TSH수평불괄당증고적환자(FT3、FT4측정채용고상방사면역분석방법,TSH측정채용면역방사분석방법-IRMA),기중9례의진HAb증다증.대동빈혈청양본채용방사면역분석방법(RIA)중신측정TSH,경속솔산사비탁법제외혈청류풍습인자(RF)간우적가능성후,채용비면역동물혼합혈청중화법대의진HAb증다환자적동빈혈청검측HAb.결과 ①9례의진HAb증다증적환자RIA법측정적TSH수평저우혈청중화전IRMA법(P<0.05),재기여287례TSH불괄당증고환자RIA법측정적TSH수여혈청중화전IRMA법조간비교,차이무통계학의의(P>0.05).②경비면역동물혈청중화후,상술9례의진HAb증다증적환자IRMA법적TSH측정결과명현저우혈청중화전(P<0.05),287례TSH불괄당증고환자IRMA법적TSH측정결과여혈청중화전비교,차이무통계학의의(P>0.05).③9례의진HAb증다증적환자비면역동물혈청중화전、후RIA법측정FT3화FT4조간비교,차이균무통계학의의(P균>0.05).④287례TSH불괄당증고환자비면역동물혈청중화전、후RIA법측정FT3화FT4조간비교,차이균무통계학의의(P균>0.05).결론 HAb증다가이명현간우제여IRMA법진행적비경쟁성적쌍위점면역분석,조성검측결과가성증고,이경쟁성적방면분석방법수HAb간우작용소.비면역동물혈청중화법능구감소혹배제HAb적간우.
Objectives To analyze heterophilic antibody (HAb) interference in thyroid function assay and investigate the methods of reducing or eliminating the interference. Methods 296 patients with inappropriately elevated thyrotropin levels were selected form May 2008 to June 2009. Serum FT3、FT4 were measured with solid-phase radioimmun assay and TSH with immunoradiometric assay (IRMA), all the results had been verified by retesting. At the same time, radioimmune assay ( R1A) was used to examine serum TSH level of the same samples. After interference probably from rheumatoid factor (RF) was excluded by ratenephelometry,9cases of the all patients were found with suspectably increased HAb, the concentrations of serum FT3、FT4、TSH were further assayed via adding non-immune animal sera from different species. Results ①The concentrate of TSH with RIA was significantly lower than that with IRMA in the 9 increased heterophile antibody cases (P<0.05) ,but there was no obvious difference between the concentrate of TSH with RIA and concentrate of TSH with IRMA in the 287 rest patients with elevated TSH level(P>0.05). ②In the 9 increased heterophile antibody cases after HAb was neutralized by non-immune animal sera, the level of TSH was remarkable reduced (P <0.05),but there was no obvious difference between the concentrate of TSH with IRMA and concentrate of TSH with IRMA in the 287 rest patients after HAb was neutralized by non-immune animal sera (P>0.05). ③The values of serum FT3、FT4with RIA and The values of serum FT3 with RIA after HAb was neutralized by non-immune animal sera were still kept in nearly constant levels in the 9 increased heterophile antibody cases (P>0.05). ④The values of serum FT3、FT4with RIA and The values of serum FT3 with RIA after HAb was neutralized by non-immune animal sera were still kept in nearly constant levels in the 287 rest patients (P>0.05). Conclusions Heterophile antibody can interfere in the non-competitive two-site unmunoassay such as IRMA?and cause the falsely elevated TSH level. Competitive RIA was not susceptible to the interference caused by heterophile antibody. The non-immune animal sera can neutralize and attenuate the interference of HAb.