女性睾酮水平假性升高病例的临床特点和检验验证  

Clinical characteristics and laboratory verification of female patients with pseudo-elevated testosterone

作　　者：尹逸丛 卢琳[2] 朱惠娟[2] 禹松林[1] 邱玲[1] YIN Yi-cong;LU Lin;ZHU Hui-juan;YU Song-lin;QIU Ling(Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730;Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,Translational Medicine Center of Peking Union Medical College Hospital,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院检验科,北京100730 [2]中国医学科学院北京协和医学院卫健委内分泌重点实验室,北京协和医院内分泌科,协和转化医学中心,北京100730

出　　处：《生殖医学杂志》2021年第7期852-857,共6页Journal of Reproductive Medicine

基　　金：中国医学科学院中央级公益性科研院所基本业务费(2017PT32020,2018PT32001);北京市临床重点专科医学检验科卓越项目(ZK201000);郑洛新国家自主创新示范区创新引领型产业集群专项(201200211100)。

摘　　要：目的通过分析女性睾酮水平假性升高患者的临床特点和检验验证,以期为临床决策提供参考。方法对2016年4月至2020年12月北京协和医院诊治的11例睾酮假性升高患者的临床资料进行回顾性分析,包括患者的一般情况、影像学检查、实验室检查、治疗情况等,比较这些患者在两种化学免疫发光平台(Beckman DXI800和Roche e601)及一种质谱平台(Waters TQS)睾酮水平的检测结果。结果11例患者中,5例患者月经欠规律,2例不孕症,1例原发性闭经,1例月经量少,1例面部痤疮,1例因体检来院。经临床医师查体仅1例患者有唇上少许小须,其余患者均无高雄激素血症的临床体征。肾上腺和盆腔影像学检查未发现肾上腺和卵巢肿瘤。所有患者睾酮水平在Beckman DXI800检测平台异常升高,中位数为1.78 ng/ml(1.04,2.28 ng/ml)[6.18 nmol/L(3.61,7.91 nmol/L)]。其中4例患者接受了降雄激素的药物治疗,1例患者接受双侧卵巢手术未见卵巢肿瘤,治疗后睾酮水平均无明显改变。在Roche e601检测平台及Waters TQS质谱平台复测上述睾酮结果均正常,中位数分别为0.19 ng/ml(0.08,0.31 ng/ml)[0.66 nmol/L(0.28,1.08 nmol/L)]和0.19 ng/ml(0.18,0.29 ng/ml)[0.66 nmol/L(0.62,1.01 nmol/L)],Beckman平台的睾酮检测结果与Roche以及质谱平台之间有统计学差异(P<0.05)。结论当临床表现和检测到的高睾酮水平不匹配时,建议进行不同检测平台的复测,以减少检验干扰对鉴别诊断的影响。Objective:To analyze the clinical characteristics and laboratory verification of female patients with testosterone pseudo-elevation,in order to provide reference for clinical decision-making.Methods:The clinical data including general condition,imaging examination,laboratory examination and treatment of 11 female patients with testosterone pseudo-elevation treated in Peking Union Medical College Hospital from April 2016 to December 2020 were retrospectively analyzed.Testosterone levels determined by chemiluminescence platforms(Beckman DXI800 and Roche e601)and one mass spectrometry platform(Waters TQS)were compared in the patients.Results:Among the 11 patients,5 patients had irregular menstruation,2 infertility,1 primary amenorrhea,1 with less menstruation,1 facial acne,and 1 came to hospital for physical examination.After physical examination,the clinician found that only one patient had a little whisker on the lip,and the other patients had no clinical features of hyperandrogenism.Adrenal and pelvic imaging showed no adrenal or ovarian tumors.Testosterone levels determined by Beckman DXI800 were abnormally elevated in all patients,with a median of 1.78 ng/ml(1.04,2.28 ng/ml)[6.18 nmol/L(3.61,7.91 nmol/L)].Among them,four patients received drug therapy to reduce androgen,one received bilateral ovarian surgery and no ovarian tumor was found.However,no significant changes in testosterone levels after treatment.The testosterone levels remeasured by Roche e601 platform and Waters TQS mass spectrometry platform showed that were within normal range,with a median of 0.19 ng/ml(0.08,0.31 ng/ml)[0.66 nmol/L(0.28,1.08 nmol/L)]and 0.19 ng/ml(0.18,0.29 ng/ml)[0.66 nmol/L(0.62,1.01 nmol/L)],which were significantly different with those determined by Beckman DXI800(P<0.05).Conclusions:When clinical manifestations contradict the detected high testosterone levels,it is recommended to retest with different detection platforms to reduce the impact of test interference on the differential diagnosis.

关 键 词：高雄激素血症 睾酮 化学免疫发光 串联质谱检测 

分 类 号：R711.5[医药卫生—妇产科学]