Simona Ferraro, Elia Mario Biganzoli, Mario Plebani
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引用次数: 0
摘要
Dorizzi等[1]报道了一个相关的临床病例,即游离/总前列腺特异性抗原(free/total prostate specific antigen, fPSA/tPSA)异常百分比增加超过100%,以及不同检测方法获得的tPSA和fPSA结果存在差异。我们同意作者的观点,这些病例应该深入调查并在文献中报道,因为实际上不常见。我们应该提醒,在这些罕见的情况下,生物标志物的测量结果对患者和医疗保健系统分别不利的风险-收益和成本-效果比。事实上,正如本例所述,需要更多的调查(即活检、磁共振成像、额外的PSA测量……)来试图解释异常的fPSA/ tPSA比率,这导致医疗成本的进一步增加,并使患者的生活质量恶化[2]。因此,需要实验室专业人员(如本例所述)、泌尿科医生和制造商之间的相互作用来增加知识、分享证据并最终改进技术。我们应该提醒,这些努力是为了恢复生物标志物评估对医疗保健和患者的益处。在我们看来,实验室专业人员的管理不受实验室报告中缺乏用于PSA检测的免疫测定指示的影响,而是由于缺乏对PSA免疫测定的协调状态的知识和缺乏临床-实验室界面[2,3]。对于tPSA方法(检测间变异系数(CV)=11.5%)来说,一致性状态无疑是次优的,但对于fPSA(检测间CV=20.4%)方法来说,一致性状态确实很差,然而考虑到这些结果是在筛选环境中产生的,其特征是像本案例中报道的那样,出现异常结果的风险最低[4,5]。Dorizzi等人[1]报道了Beckman和Roche免疫测定法之间的异常结果,我们将谨慎地考虑罗氏测定法与人钾likrein (hK2)的交叉反应性,因为在高级别肿瘤患者中可能检测到hK2的相关(可能是干扰性的)增加,而事实并非如此[6,7]。我们鼓励使用其他技术(如质谱)作为辅助来调查可能被fPSA免疫测定识别并导致虚假增加的同种异构体的存在[8]。总之,本病例报告[1]可能被认为是实验室管理的一个很好的例子,进一步鼓励对fPSA和tPSA分析协调的更多研究进行投资。它提醒我们,为了提高实验室检测和实践的成本效益,需要进行上市后评估。
期刊介绍:
Nature Cell Biology, a prestigious journal, upholds a commitment to publishing papers of the highest quality across all areas of cell biology, with a particular focus on elucidating mechanisms underlying fundamental cell biological processes. The journal's broad scope encompasses various areas of interest, including but not limited to:
-Autophagy
-Cancer biology
-Cell adhesion and migration
-Cell cycle and growth
-Cell death
-Chromatin and epigenetics
-Cytoskeletal dynamics
-Developmental biology
-DNA replication and repair
-Mechanisms of human disease
-Mechanobiology
-Membrane traffic and dynamics
-Metabolism
-Nuclear organization and dynamics
-Organelle biology
-Proteolysis and quality control
-RNA biology
-Signal transduction
-Stem cell biology