循环心肌肌钙蛋白Ⅰ自身抗体的检测及临床意义  

Detection of circulating cardiac troponin Ⅰ autoantibodies and its clinical significance

作　　者：吴豫[1] 赵伟国 沈茜[1] 

机构地区：[1]第二军医大学附属上海医院实验诊断科,上海200433 [2]上海博阳生物科技有限公司

出　　处：《中华检验医学杂志》2008年第7期801-806,共6页Chinese Journal of Laboratory Medicine

摘　　要：目的了解急性心肌梗死（AMI）和心肌炎患者循环内抗心肌肌钙蛋白Ⅰ（cTnⅠ）自身抗体的阳性率，促进临床实验室正确认识和了解这种特异性自身抗体对cTnⅠ检测的负性干扰。方法建立检测cTnⅠ自身抗体的ELISA方法，在121例AMI和24例心肌炎患者血清中进行cTnⅠ自身抗体的筛查；采用Western Blot对cTnⅠ自身抗体阳性血清进一步验证；通过回收试验分析cTnⅠ自身抗体对cTnⅠ检测干扰的特异性。结果121例AMI患者中有10．74％（13／121）cTnⅠ自身抗体阳性，24例心肌炎患者中有8．3％（2／24）cTnⅠ自身抗体阳性。将cTnⅠ-C融合蛋白（cTnⅠ终浓度为0．625-100μg／L）加入1例cTnⅠ自身抗体阳性的血清中进行回收试验，各浓度cTnⅠ均出现不同程度的低回收，并呈正相关（Spearman相关系数=0．943，P=0．005）；而加入正常人血清中的cTnⅠ回收率则没有明显的改变（Spearman相关系数=0．377，P=0．461）。当加入终浓度为20μg/L的cTnⅠ时，13份cTnⅠ自身抗体阳性的AMI患者血清中有5份回收率〈80％。结论心肌损伤患者循环中存在cTnⅠ自身抗体并非罕见，所产生的负性干扰足以使cTnⅠ的检测结果失真，应在临床实验室引起高度重视。Objective To detect the positivity of circulating autoantibodies against cardiac troponin Ⅰ （cTnⅠ） in acute myocardial infarction （AMI） and myocarditis patients and investigate the interference of the antibodies with the detection of cTnⅠ. Methods cTnⅠ ELISA was established for assessment of sera obtained from 121 patients with AMI, 24 with myocarditis and 210 healthy subjects. Binding specificity of cTnⅠ antibody from positive sera by ELISA was confirmed with Western Blot. The recovery of cTnⅠ studies was employed to evaluating the effects of cTnⅠ autoantibodies on cTnⅠ immunoassays. Results Thirteen of the 121 AMI patients （ 10. 74% ） and 2 of the 24 myocarditis patients （8.3%） had positive anti-cTnⅠ antibody as compared with none in the healthy subjects. The recovery of cTnⅠ by adding cTnⅠ-C fusion protein corresponding to final cTnⅠ concentration of 0. 625 - 100 μg/L to sample with anti-cTnⅠ antibody was inhibited significantly （ Spearman correlation coefficient r = 0. 943, P = 0. 005 ）. There was no significant change of recovery of cTnⅠ when adding it to a normal sera（ Spearman correlation coefficient r =0. 377 ,P = 0. 461）. When cTnⅠ-C complex corresponding to 20 μg/L cTnⅠ was added, 5 of the 15 sera with anti-cTnⅠ antibody were found with the inhibition of recovery （ 〈 80% ）. Conclusions Autoantibodies against cTnⅠ were increasing in patients with AMI and myocarditis, yet it appears that these autoantibodies could interfere negatively with the cTnⅠ immunoassay. Thus, it should be paid more attention to cTnⅠ immunoassays.

关 键 词：心肌梗塞 心肌炎 肌钙蛋白Ⅰ 自身抗体 

分 类 号：R686[医药卫生—骨科学]