高出檢測限濃度的腫瘤標(biāo)志物的準(zhǔn)確值檢測

1、高出檢測限濃度的腫瘤標(biāo)志物的準(zhǔn)確值檢測    【關(guān)鍵詞】高出檢測限濃度;CEA;T-PSA;CA125;4號緩沖液;生理鹽水 Higher than the detection limit concentration of tumor markers in detection of the exact value QIAN Ming,YUAN Jun-jun,SHU Xiao-chun.Clinic Laboratory The 5th Affiliated Hospital of Sun Yat-sen University,Zhuhai,519000

2、 【Abstract】 Objective In order to meet the needs of the clinical observation on the therapeutic effect,we have to seek a kind of buffer which we can use to dilute the samples,and then we can get the values of the serum concentration of tumor markers which are too higher than the detection limit of t

3、esters.Methods With three various of diluents solutions:NO.4 buffer,normal saline,negative serum of tumor markers.the tumor markers:CEA,CA125 and T-PSA,detected by the United States Abbott AXSYM automatic chemiluminescent instrument which were higher in serum concentration were diluented by hand.Res

4、ults Comparison with the automatic dilution by the instrument,the difference of 4 buffer,saline and negative serum,there was significant statistic difference between the samples diluted with saline and negative serum when tested CA125.And there was no significant statistic difference between the oth

5、er groups.Conclusion The no.4 buffer as the corollary reagent of the United States Abbott AXSYM automatic chemiluminescent instrument has the best delution effect.Although the negative serum has the poorest effect,it can be used to dilute CEA and T-PSA. 作者單位:519000珠海市中山大學(xué)附屬第五醫(yī)院檢驗科 各種腫瘤的發(fā)生發(fā)病隨著環(huán)境污染,食品

6、污染,工作壓力等等的因素呈上升趨勢1,2。而腫瘤標(biāo)志物的廣泛應(yīng)用,其對腫瘤的診斷及療效監(jiān)測越來越重要3。但由于儀器的線性范圍有限,高出檢測限濃度的腫瘤標(biāo)志物結(jié)果的準(zhǔn)確報告顯得尤為重要。本實驗對CEA、CA125、T-PSA三種腫瘤標(biāo)志物高出檢測限的標(biāo)本進(jìn)行不同稀釋劑的稀釋,從中選擇一種最為準(zhǔn)確的稀釋劑,而更加準(zhǔn)確地報告腫瘤標(biāo)志物的具體檢測值。滿足臨床醫(yī)生對療效地監(jiān)測和觀察。 1 資料與方法 1.1 標(biāo)本來源 15份標(biāo)本為中山大學(xué)附屬第五醫(yī)院2009年12月至2010年元月住院及門診患者,已經(jīng)用美國雅培AXSYM全自動化學(xué)發(fā)光儀測得的高濃度腫瘤標(biāo)志物的血清,即高濃度的CEA,CA125,T-PS

7、A,的血清標(biāo)本。陰性血清為:檢測當(dāng)天的健康體檢血清標(biāo)本,CEA1.2 實驗儀器及方法 儀器:美國雅培AXSYM全自動化學(xué)發(fā)光儀,加樣槍(上海大龍醫(yī)療設(shè)備有限公司) 試劑:美國雅培AXSYM全自動化學(xué)發(fā)光儀配套試劑及配套4號緩沖液,生理鹽水。 1.3 標(biāo)本采集 用一次性真空抽血管抽取全血3 ml,分離血清待測。 1.4 統(tǒng)計學(xué)方法 統(tǒng)計學(xué)處理采用SPSS 11.5軟件統(tǒng)計與分析,采用t檢驗。 2 結(jié)果 2.1 不同稀釋液稀釋樣品后測定CA125的濃度,比較測定結(jié)果,見表1。 表1 不同稀釋液處理樣品CA125濃度的比較(U/ml) 樣品編號儀器自動稀釋4號緩沖液生理鹽水陰性血清 1743.927

8、46.00715.50978.50 2630.40632.40600.00845.10 3850.90853.20810.401132.30 41689.351680.541598.501965.20 52380.462375.252248.402983.60 4號緩沖液、生理鹽水、陰性血清稀釋樣品的測定結(jié)果與儀器自動稀釋測定的結(jié)果進(jìn)行雙側(cè)配對t檢驗,所得P4號緩沖液=0.544>0.05,P生理鹽水=0.0342.2 不同稀釋液稀釋樣品后測定CEA的濃度,比較測定結(jié)果,見表2。        表2 不同稀釋

9、液處理樣品CEA濃度(ng/ml)的比較 樣品編號儀器自動4號緩沖液生理鹽水陰性血清 1182.56185.20189.71192.50 2256.14253.46260.35262.19 3310.25311.58312.70294.68 4358.23357.28355.10358.10 5427.13428.00430.35410.52 4號緩沖液、生理鹽水、陰性血清稀釋樣品的測定結(jié)果與儀器自動稀釋測定的結(jié)果進(jìn)行雙側(cè)配對T檢驗,所得P4號緩沖液=0.807,P生理鹽水=0.173,P陰性血清=0.583。三者均>0.05,表明用這三種稀釋液稀釋高出檢測限的樣品CEA濃度與儀器自動稀

10、釋均無顯著性差異。 2.3 不同稀釋液稀釋樣品后測定T-PSA的濃度,比較測定結(jié)果,見表3。 表3 不同稀釋液處理樣品T-PSA濃度的比較(ng/ml) 樣品編號儀器自動稀釋4號緩沖液生理鹽水陰性血清 175.1274.3678.2379.56 2120.12119.80118.36124.56 3210.45209.95209.45206.48 4350.70351.64350.56353.70 5460.43458.90453.10468.45 4號緩沖液、生理鹽水、陰性血清稀釋樣品的測定結(jié)果與儀器自動稀釋測定的結(jié)果進(jìn)行雙側(cè)配對T檢驗,所得P4號緩沖液=0.340,P生理鹽水=0.448,

11、P陰性血清=0.181。三者均大于0.05,表明用這三種稀釋液稀釋高出檢測限的樣品T-PSA濃度與儀器自動稀釋均無顯著性差異。 3 討論 由于CEA>500 ng/ml儀器不能自動稀釋,T-PSA和CA125雖然可以自動稀釋10倍,但是檢測上限分別只有500 ng/ml和6000 U/ml,還是不能夠滿足臨床的需要,本實驗對這三種腫瘤標(biāo)志物分別用美國雅培AXSYM全自動化學(xué)發(fā)光儀配套的第4號緩沖液,生理鹽水,陰性血清(CEA參 考 文 獻(xiàn) 1 粟爽,李萬甫.惡性腫瘤的姑息治療.現(xiàn)代醫(yī)藥衛(wèi)生,2008,1(24):86-87. 2 王進(jìn)軍,劉占旗,古曉娜.環(huán)境致癌物的健康風(fēng)險評價方法.國外醫(yī)學(xué)衛(wèi)生學(xué)分冊,2009,1(36):50-58. 3 Bjerner J,Hogetveit A,Wold Akselberg K et al.Reference intervals for carcinoembryo