Impact of New Quick Gold Nanoparticle-Based Cortisol Assay During Adrenal Vein Sampling for Primary Aldosteronism
Impact of New Quick Gold Nanoparticle-Based Cortisol Assay During Adrenal Vein Sampling for Primary Aldosteronism
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DOI：
10.1210/jc.2016-1011
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发表时间：
2016-06-01
影响因子：
5.8
通讯作者：
Takeda, Yoshiyu
中科院分区：
文献类型：
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作者：
Yoneda, Takashi;Karashima, Shigehiro;Takeda, Yoshiyu
背景：肾上腺静脉采血（AVS）对于确定原发性醛固酮增多症（PA）的一种可手术治愈的形式至关重要，但准确放置采血导管在技术上具有挑战性。操作过程中的皮质醇测量可确认导管位置，从而提高AVS成功率。
目的和方法：我们开发了一种快速皮质醇检测法（QCA），它使用免疫层析法和金纳米粒子，可进行半定量或定量检测。该检测法在两项研究中进行了评估。在一项单中心研究中，PA患者被分配接受结合半定量QCA的AVS（n = 30）、定量QCA的AVS（n = 30）或不使用QCA的AVS（n = 30），并确定AVS成功的比率。在一项前瞻性多中心随机对照研究中，确定了使用（n = 148）或不使用（n = 145）半定量QCA进行AVS的成功率。
结果：在放射科检查室，无需额外技术协助，在6分钟或更短时间内即可在AVS过程中测量皮质醇浓度，且与常规参考检测法显著相关（R² = 0.994；P <.001）。在单中心研究中，与半定量和定量QCA相关的AVS成功率差异不显著（均为93%）；然而，成功率显著高于不使用QCA进行AVS的成功率（63%；P <.001）。在多中心研究中，使用半定量QCA进行AVS的成功率为94%，显著高于未使用QCA的患者的成功率（60%；P <.001）。
结论：我们的新型QCA可在床旁快速、简便地进行，并提高了AVS的成功率。
Context: Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheter's position, thereby increasing the AVS success rate.Objective and Methods: We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined.Results: Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R-2 = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001).Conclusions: Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.