在患有骨质疏松症的患者中虚假增加副甲状腺激素:一个病例报告和综述
Kevin McCarroll1,2, Donal Fitzpatrick3,4, Margaret McCormack5
1Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland.
概括
假高的副甲状腺激素 (PTH) 水平可能由于免疫测试干扰而发生. 这一案例凸显了临床相关性和实验室沟通的重要性,以避免误诊并确保适当的患者护理.
科学领域:
- 内分泌学 在内分泌学.
- 临床化学 临床化学
- 免疫学 免疫学 免疫学
背景情况:
- 副甲状腺激素 (PTH) 水平对于诊断骨和矿物质疾病至关重要.
- 通过各种抗体的宏PTH或免疫试验干扰,可以错误地表明PTH升高.
- 这种不准确可能导致误诊,不必要的测试或不适当的治疗决定.
研究的目的:
- 报告一个由测试干扰引起的虚假高PTH水平的病例.
- 审查关于虚假升高PTH的类似病例的文献,并强调诊断方面的考虑.
主要方法:
- 研究了一例87岁的骨质疏松症患者,持续高PTH (383-784 pg/ml) 的女性,她接受了罗氏科巴斯e801免疫试验.
- 进行了聚乙烯糖醇 (PEG) 沉试验,恢复了<10%的PTH,表明干扰.
- 在西门子Atellica试验中重新测试了PTH,结果为正常 (27 pg/ml).
主要成果:
- 患者呈现出持续升高的PTH水平,尽管血清,酸盐,维生素D和eGFR正常.
- PEG测试证实了干扰的存在,PTH恢复显著减少.
- 在替代免疫测试平台上的测试将PTH水平修正为正常,与异性恋抗体干扰相一致.
结论:
- 意想不到的高PTH水平应提醒临床医生注意测试干扰或宏PTH的潜在错误结果.
- 实验室结果的临床相关性和与测试实验室的沟通对于准确的诊断至关重要.
- 这一案例强调了识别和调查免疫测试干扰的重要性,特别是异构性抗体介导PTH的升高.
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