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对进行动态内分泌功能试验的患者采用液相色谱串联质谱法测定唾液皮质醇

Measurement of salivary cortisol with liquid chromatography-tandem mass spectrometry in patients undergoing dynamic endocrine testing

Perogamvros I, Owen LJ, Keevil BG 2010/6/22 11:48:00

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Clin Endocrinol, 2010,

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Objective:

Liquid chromatography-tandem mass spectrometry (LC-MS/MS) eliminates cross-reactivity, which is a major limitation of immunoassays used for the measurement of salivary cortisol (SalC). We aimed to evaluate the potential of SalC measured by LC-MS/MS in patients undergoing assessment of the HPA axis.

Design and Patients:

Cross-sectional study of 78 patients admitted for routine testing in a specialized endocrine unit.

Measurements:

Matched serum and saliva samples were collected from 68 patients who had a short synacthen test (SST, 250mcg im) and 10 patients who had an insulin tolerance test (ITT, insulin 0·15U/kg iv). Serum cortisol (SerC) was measured with an automated immunoassay and SalC with LC-MS/MS. Adequate SerC responses were >500nmol/l.

Results:

In all patients with adequate responses, the relative increase in SalC was significantly higher than that in SerC [6·4(0·3–26·1) vs. 1·0(0·3–4·9), P<0·0001)]. The SerC–SalC relationship was better explained by an exponential rather than a linear model (R²=0·83 vs. R²=0·65, both P<0·0001). Based on 59 patients with adequate SerC responses to an SST, an adequate SalC response was defined as 8·3nmol/l. Seven patients following an SST and three patients following an ITT showed inadequate responses in both SerC and SalC, but two patients with CBG deficiency showed a low SerC with normal SalC.

Conclusions:

We have shown an excellent diagnostic sensitivity and specificity of LC-MS/MS SalC in the assessment of the HPA axis and superiority over SerC when CBG levels are altered. The exponential relationship between SerC and SalC supports the concept of CBG binding capacity saturation.

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高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

呼吸急促伴精神状态改变——《西氏内科学》病例

摘自：《西氏内科学》，第23版

患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。

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