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引用次数: 0
摘要
简介皮质醇浓度通常采用竞争性化学发光免疫测定法进行估算，这种方法容易因交叉反应而产生干扰。不同肾上腺疾病和不同分析仪的干扰程度并不一致。虽然液相色谱-质谱法（LC-MS/MS）具有更好的分析特异性，但并不普及。我们旨在比较四种不同分析仪在不同肾上腺疾病中测得的皮质醇值：我们使用以下分析仪测量了先天性肾上腺增生症（CAH）（12 人）、原发性肾上腺功能不全（PAI）（11 人）、内源性库欣综合征（CS）（6 人）、肾上腺偶发瘤（AI）（8 人）和健康受试者（HS）（10 人）血清中的皮质醇浓度：Advia Centaur XP（西门子）（SACXP）、Immulite1000（西门子）（SI1000）、Cobas e411（罗氏）（RCe411）和Architect（雅培）（AA）：在 CAH 患者中，SAC XP [中位数（IQR）14.6 (4.7) μg/dL]与 RC e411 [中位数（IQR）4.6 (3.9) μg/dL]之间的一致性较差[ICC：-0.016, (-0.55, 0.55)]。SAC XP 和 SI 1000 [ICC: 0.00, (0.558, 0.551)]以及 SAC XP 和 AA [ICC: 0.089, (-0.488, 0.612)]之间的相关性也很差。同组的 RCe411、SI 1000 [中位数（IQR）9.6 (3) μg/dL]和 AA [中位数（IQR）5.1 (3.4) μg/dL]平台之间的一致性很好。在 PAI、CS、AI 和 HS 中，所有分析仪的皮质醇测量值相关性良好：结论：在不同肾上腺疾病中，不同分析仪的皮质醇浓度显示出不同的一致性。在 CAH 中，SAC XP 测得的皮质醇值与 RC e411、SI 1000 和 AA 平台的相关性较差。因此，在这部分患者中，使用另一种分析仪重新评估皮质醇是明智之举，以避免因未识别皮质醇过低而造成严重后果。在其他情况下，各平台之间的一致性也很好。
A Cross-Sectional Study on Comparison of Serum Cortisol Concentration Measured by Chemiluminescent Immunoassay in Four Different Automated Analyzers in a Variety of Adrenal Disorders.
Introduction: Cortisol concentration is often estimated by competitive chemiluminescent immunoassays, which are prone to interference due to cross-reactivity. The extent of interference is inconsistent across different adrenal disorders and among different analyzers. Although liquid chromatography-mass spectrometry (LC-MS/MS) possesses better analytical specificity, it is not widely available. We aimed to compare cortisol values measured across four different analyzers across different adrenal disorders.
Methods: Cortisol concentrations were measured in the serum of patients with congenital adrenal hyperplasia (CAH) (n = 12), primary adrenal insufficiency (PAI) (n = 11), endogenous Cushing's syndrome (CS) (n = 6), adrenal incidentaloma (AI) (n = 8), and healthy subjects (HS) (n = 10) in the following analyzers: Advia Centaur XP (Siemens) (SACXP), Immulite1000 (Siemens) (SI1000), Cobas e411 (Roche) (RCe411), and Architect (Abbott)(AA).
Results: In CAH patients, a poor agreement was observed between SAC XP [median (IQR) 14.6 (4.7) μg/dL] and RC e411 [median (IQR) 4.6 (3.9) μg/dL] [ICC: -0.016, (-0.55, 0.55)]. The correlation was also poor between SAC XP and SI 1000 [ICC: 0.00, (0.558, 0.551)] as well as between SAC XP and AA [ICC: 0.089, (-0.488, 0.612)]. The agreement was good between RCe411, SI 1000 [median (IQR) 9.6 (3) μg/dL], and AA [median (IQR) 5.1 (3.4) μg/dL] platforms in the same group. Measured cortisol values correlated well across all analyzers in PAI, CS, AI, and HS.
Conclusions: Cortisol concentration demonstrated variable agreement among different analyzers in different adrenal disorders. In CAH, cortisol values measured by SAC XP poorly correlate with RC e411, SI 1000, and AA platforms. Reassessment in another analyzer therefore would be prudent to avoid devastating consequences of unrecognized hypocortisolism in this subset of patients. A good concordance was observed among platforms in other conditions.
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