Selection of antibodies and epitopes for cardiac troponin immunoassays: should we revise our evidence-based beliefs?
Selection of antibodies and epitopes for cardiac troponin immunoassays: should we revise our evidence-based beliefs?
复制标题
心肌肌钙蛋白免疫测定的抗体和表位的选择：我们是否应该修改我们基于证据的信念？
作者：
M. Panteghini
心肌肌钙蛋白被认为是目前可用的检测心肌损伤的诊断技术中最特异和最敏感的，用于将出现缺血症状的急性冠脉综合征患者分类为心肌梗死患者的重新定义的标准在很大程度上是基于这些标记物在血液中的浓度增加[1]。肌钙蛋白也是识别高危冠状动脉患者的唯一标记物，这些患者应该接受抗血栓药物治疗，如糖蛋白IIb/IIIa拮抗剂，并尽早进行侵入性评估。然而，并不是所有的肌钙蛋白检测都是一样的；因此，临床实验室的方法选择是影响这一重要生物标记物对单个患者进行诊断分类的主要因素之一。最近的实验数据表明，各种商业可用的方法对心肌肌钙蛋白的检测限度(和不精密度)不同(2)。因此，根据肌钙蛋白结果将患者从心绞痛重新归类为心肌梗死的百分比作为诊断标准也严重依赖于所用分析的性能(3)。
分析试剂的配方在尽量减少分析干扰方面也很重要。由于对抗原-抗体反应的干扰，可能会导致肌钙蛋白结果的错误增加或减少。类风湿因子或人类抗鼠抗体可以通过连接捕获抗体和检测抗体来模拟肌钙蛋白，已有报道[4]。在某些免疫分析中，黄斑和溶血的血清样本也可能是一个问题(5)。最后，一种干扰血液成分抑制某些抗体与心肌肌钙蛋白I…中央部分表位的结合
Cardiac troponins are regarded as the most specific and sensitive of the currently available diagnostic techniques for detection of myocardial damage, and the redefined criteria used to classify acute coronary syndrome patients presenting with ischemic symptoms as myocardial infarction patients are heavily predicated on an increased concentration of these markers in blood (1). Troponins also are the only markers identifying high-risk coronary patients who should be treated with antithrombotic agents, such as glycoprotein IIb/IIIa antagonists, and referred for invasive evaluation at the earliest opportunity. Not all troponin assays, however, are created equal; therefore, method selection by the clinical laboratory represents one of the major factors influencing the performance of this important biomarker for the diagnostic classification of an individual patient. Recent experimental data indicated that various commercially available methods have different limits of detection (and imprecision) for cardiac troponins (2). Thus, the percentage of patients recategorized from angina to myocardial infarction based on troponin results as a diagnostic criterion is also critically dependent on the performance of the assay used (3).
Formulation of assay reagents is also important in minimizing analytic interference. Falsely increased or decreased troponin results may occur because of interferences with the antigen–antibody reaction. Interferences from rheumatoid factors or human anti-mouse antibodies, which can mimic troponin by linking the capture and detector antibodies, have been reported (4). Icteric and hemolyzed serum samples might also be a problem in certain immunoassays (5). Finally, an interfering blood component inhibiting the binding of some antibodies against epitopes in the central part of the cardiac troponin I …