探讨质谱MRM方法对于糖化血红蛋白准确测定的应用  

The application of mass spectrometry MRM to the accurate determination of glycosylated hemoglobin

作　　者：宋智心[1] 王默 张顺利[2] 张瑞[2] 马怀安[3] 张景丹[1] 王清涛[2] SONG Zhixin;WANG Mo;ZHANG ZHANG;Jingdan Shunli;ZHANG Rui;MA Huai＇an;WANG Qingtao(Department of Laboratory Medicine,Liangxiang Hospital of Beijing Fangshan District,Beijing 102401,China;Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China;Department of Laboratory Medicine,Ophthalmology Hospital of Chinese Academy of Chinese Medical Sciences,Beijing 100040,China)

机构地区：[1]北京市房山区良乡医院,北京102401 [2]首都医科大学附属北京朝阳医院,北京100020 [3]中国中医科学院眼科医院,北京100040

出　　处：《国际检验医学杂志》2018年第22期2729-2732,共4页International Journal of Laboratory Medicine

基　　金：首都临床特色应用研究项目(Z151100004615001)

摘　　要：目的应用质谱多反应监测扫描(MRM)技术准确测定糖尿病患者体内糖化血红蛋白的水平。方法在国际临床化学和实验室医学联盟(IFCC)推荐的质谱法测定糖化血红蛋白参考方法的基础上,利用IFCC参考实验室一级校准物质绘制标准曲线,使用质谱单离子检测扫描(SIM)和MRM 2种模式测定IFCC参考实验室国际比对样本及临床患者标本,计算2种方法的均值、精密度和偏倚,评价质谱MRM方法测定糖化血红蛋白的优势。结果在SIM和MRM 2种监测模式下,均以峰面积为计算依据,横坐标为峰面积比值,纵坐标为浓度CONC比值,绘制标准曲线,在给定的浓度范围内,2种检测方法r^2分别为0.998 8和0.999 2;测定IFCC参考实验室国际比对样本中糖化血红蛋白的水平,SIM模式下,精密度为0.77%～1.81%,偏倚为-0.35～0.30mmol/mol;MRM模式下,精密度为0.81%～1.84%,偏倚为-0.20～0.40mmol/mol。结论在质谱法测定血液样本中糖化血红蛋白水平时,应用MRM监测模式可以获得与SIM模式一致的结果,检测值和精密度等监测结果均符合IFCC参考实验室国际比对要求,同时灵敏度和信噪比进一步提升,抗干扰能力更好,应用前景广阔。Objective To accurately determine the content of glycosylated hemoglobin （HbAlc） in patients with diabetes mellitus by multi reaction monitoring （MRM） technique. Methods Based on the reference method recommended by IFCC for the determination of glycosylated hemoglobin by mass spectrometry, the standard curve was drawn by using the primary calibration material of IFCC reference laboratory,and the in ternational comparative samples and clinical patient samples of IFCC reference laboratory were determined by single ion monitoring （SIM） and MRM. Calculate the mean, precision and bias of the two methods. Results The standard curves were drawn under the SIM and MMR monitoring modes with the peak area as the calcula tion basis,the abscissa as the peak area ratio, and the ordinate as the concentration CONC ratio. Within the given concentration range,the two R2 were 0. 998 8 and 0. 999 2, respectively. The glycosylated hemoglobin content and the SIM model were determined in the international comparison samples of IFCC reference experi ments. The CV were 0.77% 1. 81%, The bias was 0.35 0.30 retool/tool; and the CV were 0.81 1.84% and the bias in MRM mode was 0. 20 0. 40 retool/tool. Conclusion In the determination of HbAlc in blood samples by mass spectrometry,MRM monitoring model can be used to obtain consistent re suits with SIM. The detection values are in line with the international comparison requirements of IFCC reference laboratory. The sensitivity and signal to noise ratio are further improved, and the application prospect is good.

关 键 词：质谱多反应监测扫描质谱法 糖化血红蛋白测定 参考方法 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R446.1[医药卫生—内科学]