2种方法检测高值甲胎蛋白出现钩状效应研究

目的研究血清高值甲胎蛋白在肝细胞癌患者中出现钩状效应对临床检验结果的影响。方法选择2013年3月-2013年12月湖北省肿瘤医院366例住院患者为研究对象;采用2种方法检测不同患者血清AFP水平,对高值甲胎蛋白(浓度>10~6μg/L)样本经倍比稀释后出现的钩状效应进行比较分析;比较2种检测血清AFP水平的相关性以及分析不同组人群AFP水平之间的临床特征关系。结果不同疾病组中,肝细胞癌组血清AFP水平均高于其他组,差异有统计学意义(P<0.01);不同病理分级肝细胞癌患者血清AFP水平差异有统计学意义(P<0.01),即随级别的增加而升高;从65例晚期肝细胞癌患者样本中取其中57例高值AFP(有效信号值换算浓度>10~6μg/L)分别经1000倍稀释检测,发现其结果仍显示超出线性范围;采用以上2种方法将57例高值AFP混合样本经倍比稀释检测,发现在1∶32倍稀释时出现钩状效应。结论2种分析方法相关性良好;高值AFP绝大多数出现在分化程度较高的肝细胞癌患者血清中;钩状效应不会出现在血清AFP浓度低于10~6μg/L的样本中;肝细胞癌患者用电化学发光免疫法和化学发光免疫法检测甲胎蛋白均存在钩状效应,但因出现钩状效应的浓度在线性范围以上从而较好地避免了异常低值结果。建议对于仪器出现超过线性范围的结果应进行倍比稀释,而对于线性范围内的结果可视为试验的真实结果。

Study on hook effect by detecting high value alpha-fetal protein with two different methods

Objective To investigate the hook effect of serum high value alpha-fetal protein(AFP)on the clinical results in hepatocellular carcinoma patients.Methods A total of 366 hospitalized patients at Hubei Cancer Hospital from March 2013 to December 2013 were selected as the research objects.Electrochemiluminescence immunoassay and chemiluminescence immunoassay were adopted to detect serum AFP level of different patient groups,and the hook effect of the high value AFP(>10~6μg/L)samples by double dilution were comparatively analyzed.Statistical methods were employed to compare the correlation of serum AFP levels between the two groups,and the clinical characteristics of AFP levels were analyzed between different groups.Results Among different groups,the serum AFP level of the hepatocellular carcinoma group was higher than that of other groups,and the difference was statistically significant(P<0.01);the serum AFP level of patients with different pathological grades of hepatocellular carcinoma was statistically significant(P<0.01).It increased with the increase of grade;57 high-value AFPs(effective signal value conversion concentration>10~6μg/L)were taken from 65 samples of patients with advanced hepatocellular carcinoma,and the results were shown to be out of linearity after being diluted 1000 times.Using the above two methods,57 cases of high-value AFP mixed samples were tested by doubling dilution,and it was found that a hook effect appeared when the dilution was 1∶32.Conclusion The correlation between the two analysis methods is good;the majority of high-value AFP appears in the serum of patients with highly differentiated hepatocellular carcinoma;the hook effect does not appear in samples with serum AFP concentration below 10~6μg/L;patients with hepatocellular carcinoma,by adopting the chemiluminescence immunoassay and chemiluminescence immunoassay,are conducted to detect alpha-fetoprotein hooking effect,but because the concentration of the hooking effect is above the linear range,the abnormally low value was better avoided.It is recommended to double the dilution of the results of the instrument over the linear range,and the results in the linear range can be regarded as the true results of the experiment.