两种检测骨髓移植患者环孢素A血药浓度方法的比较

Comparison of blood concentration monitoring of Cyclosporine A in bone marrow transplant patients by two methods

目的探讨化学发光微粒子免疫(chemiluminescence microparticle immunoassays,CMIA)法与电化学发光(Elecsys)法检测骨髓移植患者全血中环孢素A(Cyclosporine A,CSA)浓度的相关性,为临床用药方案调整提供依据。方法分别用CMIA法和Elecsys法检测简单随机直抽法收集的骨髓移植患者服药后有效的83份全血标本中CSA水平,并分析两种方法检测CSA的相关性及差异。结果 CMIA法和Elecsys法检测结果线性相关性方程为Y=1.4618 X-2.2309,相关性较好(r=0.9105);CMIA法测定CSA(195.75 ng/ml)>Elecsys(135.44 ng/ml);CMIA测定CSA的最佳均值为181.97 ng/ml,Elecsys法为117.49 ng/ml。且两种方法检测CSA呈对数正态分布,其换算系数为1.55。据骨髓移植患者CMIA法的临床参考范围150~250 ng/ml,可得Elecsys临床参考范围为100~200 ng/ml。结论两种方法检测CSA血药浓度均具有临床应用价值,但结果存在差异,临床调整用药时应注意根据不同的检测方法选用不同的参考区间。

Objective To discuss the correlation of chemiluminescence microparticle immunoassays and Elecsys for the determination of blood concentration of cyclosporine A(CSA)in bone marrow transplant patients,providing the basis for the adjustment of clinical medication regime.Methods Whole blood samples of83patients underwent bone marrow transplant were randomly collected and determined by CMIA and Elecsys respectively.The difference and correlation of2kinds of determination methods were investigated.Results The linear correlation of CMIA and Elecsys results was good and the regression equation was Y=1.4618X-2.2309(r=0.9105).CSA determination results by CMIA(195.75ng/ml)>Elecsys(135.44ng/ml);CSA mean best estimate by CMIA(181.97ng/ml)and Elecsys(117.49ng/ml);The results of the two methods are logarithmic normal distribution,and the conversion coefficient is1.55.According to the clinical reference range(150-250ng/ml)of CMIA method of bone marrow transplant patients,the clinical reference range of Elecsys was100-200ng/ml.Conclusions Both methods are feasible for blood concentration monitoring of CSA but there are difference in determination result.Great importance should be paid to CSA monitoring method reference interval in the adjustment of medication method in the clinic.