Journal of the International Federation of Clinical Chemistry最新文献

The measurement of thyrotropin (TSH) by a third-generation assay (functional sensitivity 0.01-0.02 mU/L) offers the single best test of assessing thyroid status and is more cost effective than measurement of thyroxine (T4) as a first-line test. However, in certain situations, e.g., nonthyroidal illness (NTI), secondary thyroid disease, early treatment of hyperthyroidism, early pregnancy, and heterophilic antibody interference, TSH alone may be misleading, and thyroid hormone measurements are also required. The author's laboratory has found that the measurement of TSH together with free thyroxine (by a nonanalogue method) offers the most speedy and effective first-line strategy for thyroid function testing. Abnormalities in thyroid function tests in euthyroid patients are most likely found in NTI and the elderly. For this reason, thyroid function tests (TFTs) should not be requested in elderly or hospitalized patients unless the presenting complaint is considered to be because of a thyroid problem.

Selected combinations of tests for growth hormone and the growth mediating peptides, insulin-like growth factors, and their binding proteins have improved the diagnostic reliability of the procedures used in the investigation of growth abnormalities (GH deficiency, GH and IGF receptor deficiencies, GH excess, diabetes, or undernutrition) and in malignancies associated with hypoglycemia.

Advances in genetic research make laboratory specimens a valuable source of DNA. Regulations call for quick turnaround time in locating stored specimens. Personal computers and database software make it possible to store, locate, and inventory samples efficiently and assist in research work and cooperation between laboratory sites.

Hemoglobinopathies are the most frequent and severe inherited diseases worldwide. Prenatal diagnosis is an effective way of controlling severe hemoglobin disorders for which effective treatments are not yet available everywhere. It is a multidisciplinary process requiring knowledge of the spectrum of molecular defects and involving laboratory investigations and genetic counseling. Hematological screening for these disorders is simple, rapid, and reliable. Carrier screening in populations at risk and genetic counseling are part of a number of European health programs, offering many couples at risk the chance of having a healthy child. This article describes the current molecular biology techniques for prenatal diagnosis of hemoglobinopathies.

Two types of human immunodeficiency viruses are known. Both type 1 (HIV-1) and type 2 (HIV-2) can lead to AIDS. This article describes laboratory tests that are used for diagnosis of HIV infection and for monitoring disease progression or the effects of therapy. These tests are based on detection of host antibodies, viral antigens, viral nucleotide sequences, or cultivation of the virus in vitro. The principles underlying test methods for differentiation between HIV-1 and HIV-2 are described.

Neopterin is a marker for activation of the immune system. Serum or urine neopterin can increase in infection, transplant rejection, or in other disturbances of the immune system. Measurement of neopterin concentrations in body fluids offers a way to monitor the patient's immune system in some disorders. However, the nonspecificity of this biochemical marker for particular diseases raises problems in the interpretation of the results. This paper discusses the effects of disease and other factors on the levels of neopterin in biological fluids.

Cytokines mediate and modulate different physiological systems. Accurate and sensitive methods for their measurement are being developed using bioassays, immunoassays, measurement of their mRNA, receptor binding assays, and immunochemical procedures. The most clinically significant cytokines and their assay methods are briefly reviewed. The need for standardization of assays is stressed.

The OpenLabs project is a major European initiative in laboratory medicine with a global audience in mind. OpenLabs aims to improve the efficiency and effectiveness of clinical laboratory services by integrating knowledge-based systems (using OpenLabs modules) with laboratory information systems and equipment. Standards for electronic data interchange between laboratories and other medical systems using the OpenLabs coding system and an open architecture for clinical laboratory information systems are being specified.

Several biochemical markers are available for the study of bone metabolism. The characteristics of these markers are reviewed and their potential application in osteoporosis is examined. It is concluded that biochemical markers are potentially useful in identifying those at risk of developing osteoporosis, selecting appropriate treatment, monitoring therapy, and studying the pathogenesis of osteoporosis.