不同方法检测血醛固酮浓度的一致性比较

郑枫凡; 宋颖; 杨淑敏; 胡金波; 何文雯; 汪志红; 程庆丰; 李启富

doi:10.3760/cma.j.issn.1000-6699.2019.11.003

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中华内分泌代谢杂志

• 醛固酮增多症的诊断 •

ENGLISH ABSTRACT

不同方法检测血醛固酮浓度的一致性比较

作者及单位信息

出版日期： 2019 -11 -25 ·

DOI： 10.3760/cma.j.issn.1000-6699.2019.11.003

On the consistency of different methods for detecting aldosterone concentration in blood

Authors Info & Affiliations

Zheng Fengfan

Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Song Ying

Yang Shumin

Hu Jinbo

He Wenwen

Wang Zhihong

Cheng Qingfeng

Li Qifu

Published： 2019 -11 -25 ·

DOI： 10.3760/cma.j.issn.1000-6699.2019.11.003

1879

577

APP内阅读

摘要

目的比较化学发光法、放射免疫法与高效液相色谱-串联质谱法(质谱法)测定血醛固酮浓度的一致性；建立质谱法测定健康成人立位血醛固酮浓度参考值范围。

方法化学发光法(进口、国产A、国产B 3种检测系统)、放射免疫法、质谱法检测138名健康成人、67例原发性高血压患者和23例原发性醛固酮增多症患者血醛固酮浓度。

结果不同方法测定的血醛固酮浓度存在明显差异( P<0.01)。质谱法与化学发光法(进口、国产A)测定血醛固酮浓度呈正相关( r＝0.776, P<0.01; r＝0.805， P<0.01)；与化学发光法(国产B)测定血醛固酮浓度无显著相关性( r＝0.058， P>0.05)；与放射免疫法测定血醛固酮浓度呈低度相关( r＝0.338， P<0.01)。Bland-Altman分析示3种方法检测血醛固酮浓度不具有一致性。以 P2.5～ P97.5建立的质谱法测定成人立位血醛固酮浓度参考值范围为15.2～222.2 pg/ml。

结论不同方法测定的血醛固酮浓度一致性较差，测定值间不能直接相互替换；临床上使用不同检测方法可能需要采用不同参考值范围。

关键词：醛固酮;高效液相-患联质谱法;化学发光法;放射免疫法

ABSTRACT

ObjectiveTo evaluate the consistency of different methods for detecting aldosterone concentration in blood and to establish a reference interval of serum aldosterone concentration by liquid chromatography-tandem mass spectrometry(LC-MS/MS).

MethodsConcentrations of blood aldosterone were measured by LC-MS/MS, chemiluminescent assays (Diasorin, Domestic A and B systems) and radioimmunoassay (RIA) in 138 healthy adults, 67 patients with essential hypertension and 23 patients with primary aldosteronism.

ResultsAldosterone concentrations measured by various methods were quiet different( P<0.01). Spearman correlation analysis showed that the correlation coefficient were 0.776( P<0.01) between CLIA (Diasorin) and LC-MS/MS, 0.805( P<0.01) between CLIA (Domestic A) and LC-MS/MS, 0.058( P>0.05) between CLIA(Domestic B) and LC-MS/MS, 0.338( P<0.01) as well as between RIA and LC-MS/MS. Bland-Altman analysis for the measurements showed poor consistency among methods for aldosterone concentrations. The reference interval was 15.2-222.2 pg/ml for serum aldosterone concentrations by LC-MS/MS.

ConclusionsThere are significant differences of blood aldosterone concentrations determined by different methods. Clinically, a specified reference interval might be needed while using different methods.

KEYWORDS： Aldosterone;Liquid chromatography-tandem mass spectrometry;Chemiluminescent assays;Radioimmunoassay

Corresponding author: Li Qifu, Email: tendef.habaeyufiqil

FUNDING:

Natural Science Foundation of China（81800701）

Chongqing Science and Technology Committee Innovation Project（cstc2016shms-ztzx1003）

Chongqing Science and Health Joint Medical Research Project（2018QNXM001）

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

郑枫凡,宋颖,杨淑敏,等. 不同方法检测血醛固酮浓度的一致性比较[J]. 中华内分泌代谢杂志,2019,35(11)：934-938.

DOI:10.3760/cma.j.issn.1000-6699.2019.11.003

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

醛固酮是肾上腺皮质球状带分泌的一种类固醇激素，其主要作用于肾脏，具有保钠排钾的作用。血中醛固酮浓度是原发性醛固酮增多症(原醛)、先天性肾上腺皮质增生、Liddle综合征等疾病筛查及诊断的重要指标。血醛固酮增高也是心脑血管事件、慢性肾脏病、代谢综合征的危险因素 ^{[
1
,

2
,

3
]}。因此准确地检测血醛固酮浓度具有重要的临床意义。目前醛固酮浓度检测方法主要有放射免疫法、化学发光法、质谱法。质谱法以其灵敏度高、特异性高、可重复性强等优势，成为醛固酮浓度测定的"金标准" ^{[
4
]}，但因其成本及检验技术要求较高，临床开展受限 ^{[
5
,

6
]}，故目前临床常用的检测方法为放射免疫法和化学发光法。然而，鲜有将其与质谱法比较，并验证其准确性的研究报道。此外，目前尚无基于我国人群建立的质谱法测定血醛固酮浓度的参考值范围。故本研究旨在比较不同方法测定血醛固酮浓度的一致性，并建立质谱法测定成人立位血醛固酮浓度的参考值范围。

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摘要
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备注信息

通信作者：李启富，Email： tendef.habaeyufiqil

作者贡献声明

郑枫凡、宋颖、杨淑敏、胡金波、何文雯、汪志红、程庆丰、李启富：实验操作、论文撰写、数据整理、统计学分析、研究指导、论文修改、经费支持

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基金项目：

国家自然科学基金 (81800701) 查看更多基金信息

重庆市社会事业与民生保障科技创新专项子课题 (cstc2016shms-ztzx1003) 查看更多基金信息

重庆市科卫联合医学科研项目 (2018QNXM001) 查看更多基金信息

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