CN104017858A - Chromosomal abnormality karyotype external quality assessment diagram and preparation method thereof - Google Patents
Chromosomal abnormality karyotype external quality assessment diagram and preparation method thereof Download PDFInfo
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- G01N21/00—Investigating or analysing materials by the use of optical means, i.e. using sub-millimetre waves, infrared, visible or ultraviolet light
- G01N21/84—Systems specially adapted for particular applications
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N1/00—Sampling; Preparing specimens for investigation
- G01N1/28—Preparing specimens for investigation including physical details of (bio-)chemical methods covered elsewhere, e.g. G01N33/50, C12Q
- G01N1/30—Staining; Impregnating ; Fixation; Dehydration; Multistep processes for preparing samples of tissue, cell or nucleic acid material and the like for analysis
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Abstract
The invention relates to a chromosomal abnormality karyotype external quality assessment diagram and a preparation method thereof, belonging to the field of medical treatment. The diagram is mainly characterized by taking an excessive residual cell suspension which is subjected to conventional chromosome disease laboratory diagnosis according to clinical diagnosis needs and is diagnosed as difficult and rare chromosomal abnormality. One or more cell suspensions is/are proportionally mixed according to the external quality assessment diagram to be made, so that each cell suspension contains multiple chromosomal abnormality karyotypes in different proportions which can easily cause misdiagnosis instead of one chromosomal abnormality karyotype; conventional chromosome preparation and taking of the external quality assessment diagram of the chromosome image increase the difficulty and complexity for differential diagnosis and chimera diagnosis; the specimens are accessible; and waste excessive cells are converted into materials available for teaching demonstration, technical examination, external quality assessment and resource sharing applicable to chromosome karyotype analysis. The method has unexpected effects for enhancing the diagnosis level and strengthening the quality control.
Description
The present invention relates to a kind of Chromosomal Abnormal Karyotype chamber interstitial and comment figure and preparation method, the teaching teaching of chromosome karyotype analysis, technical examination are made in the cytogenetic diagnosis laboratory that is mainly used in medical field, chamber interstitial is commented and resource sharing and storage.
Karyomit(e) is the genetic material in nucleus, and the mankind have 23 pairs of karyomit(e)s, and wherein 22 pairs is euchromosome, and 1 pair for determining gender's sex chromosome.On karyomit(e), be loaded with the gene of genetic information, wherein DNA accounts for more than 90%, and rna content changes to some extent with cell cycle and growing state, generally accounts for 1%～10%.
Chromosomal structural abnormality, numerical abnormality and mosaic, show as chromosomal disorder clinically, belongs to common inborn defect, as mongolism, primary amenorrhea, androgyny etc.Chromosomal structural abnormality comprises chromosome translocation, disappearance, inversion, ring-type etc.; Numerical abnormalities of chromosomes refers to many 1 or several karyomit(e)s, many 1 or several chromosome segments; Mosaic caryogram refers to the individual also poke kind karyotype of same case.The ordinary method of present analysis karyotype is with tested tissue or cell, through conventional cell cultures, 0.02 μ l/ml colchicine stop Growth of Cells, separated medium cell, after the chromosome sectioning program such as 0.075mol/L KCl is hypotonic, methyl alcohol-glacial acetic acid (3: 1) is fixing, finally with trysinization, dyeing, show band, thereby make chromosome structure and the whether abnormal judgement of number.
Along with the development of country to the pay attention to day by day of antenatal diagnosis work and medical science, by chromosome analysis, diagnose chromosomal disorder by antenatal diagnosis at different levels center or hospital laboratory, to be carried out at large at present, and be widely used in that antenatal, embryo implants the diagnosis of prochromosome disease and as the important indicator of the clinical diagnosises such as abnormal pregnancy, hemopathy, tumour or study of pathogenesis.As carried out laboratory diagnosis project, all should there is the quality control method of corresponding standard, this has become the Administrative Action of government and has built consensus.Owing to diagnosing chromosomal disorder by chromosome analysis, it is emerging project, technician often lacks experience to the difficulty of chromosome structure and numerical abnormality, diagnosis rare, the first case, easily cause mistaken diagnosis, just more need to strengthen quality control, carry out chamber interstitial and comment.There is in recent years more bibliographical information will strengthen and carry out the quality control of iconography, cytogenetics, molecular genetics antenatal diagnosis and female serum Prenatal Screening.Bastien P etc. has done quality control between the chamber of 3 years by a definite date to Duo Jia laboratory with regard to the antenatal molecular diagnosis of toxoplasma gondii in amniotic fluid; Tosto F etc. to thalassemic gene type, report the result and test method has been done the investigation of 5 years, and the implementation plan that local chamber interstitial is commented has been proposed; Ramsden SC etc. has reported over 3 years and has utilized molecular genetic technique to quality evaluation experience between the chamber of the Rapid prenatal of numerical abnormalities of chromosomes.Although there is document to comment method to propose opinion to the quality control of cytogenetic diagnosis and chamber interstitial thereof, the problem because of aspect its preparation at Quality Control thing, granting and karyomit(e) making, is also difficult to comment middle application in the chamber of cytogenetic diagnosis interstitial.
In order to address the above problem, the inventor has proposed the present invention.
The object of the invention is to provide a kind of Chromosomal Abnormal Karyotype chamber interstitial to comment figure and preparation method.
The object of the present invention is achieved like this: take from because of clinical diagnosis and treatment need to do the sick laboratory diagnosis of routine chromosome after and be diagnosed as difficulty, the unnecessary cell suspension that retains of rare chromosome abnormalty, according to chamber interstitial to be produced, comment the requirement of figure, the cell suspension that extracts a kind or several difficult chromosome abnormalties mixes in needed ratio, thereby make to only have in original general every part of cell suspension a kind of Chromosomal Abnormal Karyotype to change into contain in every part of cell suspension more than one different ratioss, be easy to the multiple Chromosomal Abnormal Karyotype of mistaken diagnosis, through film-making, dry, trysinization, the aobvious band of dyeing, picked-up karyotype image, concentrate and preserve, as Chromosomal Abnormal Karyotype chamber interstitial, comment figure standby.
The present invention take from because of clinical diagnosis and treatment need to do the sick laboratory diagnosis of routine chromosome after and be diagnosed as difficulty, the unnecessary cell suspension make-up room interstitial that retains of rare chromosome abnormalty is commented figure, prepared chamber interstitial comments figure to have to contain in commenting figure with a matter multiple different ratios simultaneously, the feature of dissimilar easy mistaken diagnosis Chromosomal Abnormal Karyotype, thereby just easily on the basis of mistaken diagnosis, more increased differential diagnosis original, difficulty and the complicacy of chromosomal chimaera diagnosis, sample is easy to get and is the teaching teaching that can be used for chromosome karyotype analysis by discarded unnecessary cell transformation, technical examination, chamber interstitial is commented and the useful materials of resource sharing, after application to improving diagnostic level, the tool that tightens quality control has an unexpected effect.
Fig. 1 is that a kind of Chromosomal Abnormal Karyotype chamber interstitial proposing according to the present invention is commented figure.
Below in conjunction with Fig. 1, a kind of Chromosomal Abnormal Karyotype chamber interstitial that the present invention is proposed comments figure and preparation method to be explained in detail.
As shown in Figure 1, its karyotype not shows as the normal male caryogram of normal female or 46, the XY of 46, XX, but is 46, X, t (Y; 5) (q12; Q12) rare, easy mistaken diagnosis abnormal karyotype, No. 5 karyomit(e)s [der (5)] that occur after pathology transposition resemble karyomit(e) No. 9 very much; And there is the Y chromosome [t (Y after pathology transposition; 5)] resemble very much karyomit(e) No. 14, have two chromosome abnormalties in this karyogram simultaneously, very easy mistaken diagnosis is 46, X ,+9 ,+14, and-Y ,-5.Specific embodiment of the invention method is as follows:
1, collection of specimens and cultivation: application 5ml asepsis injector and (the 5u/ml anticoagulant heparin agent of sterile blood sampling pipe, can add 5-10ml peripheral blood), with No. 8 or No. 9 syringe needles, with aseptic technique, get and need to get the venous blood 5ml that blood is done the patient of chromosomal disorder laboratory diagnosis because of clinical diagnosis and treatment, mix gently, with No. 8 syringe needles, add 20 venous blood in 4ml1640 lymphocytes culture medium, put in 37 ℃ of incubators and cultivate 72h.
2, karyomit(e) preparation: (1) stops cultivating front 2～3h, and adding concentration is the colchicine of 20 μ g/ml, in every 5ml substratum, with No. 7 syringe needles, adding 3～4, to make ultimate density be 0.1 μ g/ml.After shaking up gently, then put into thermostat container, continue to cultivate 2～3h, to accumulate the more mitotic figure that stops at mid-term.(2) harvested cell: by thermostat container, take out culturing bottle, with suction pipe, fully blow and beat culturing bottle bottle wall, make cell all depart from a bottle wall, then enchylema is moved in taper centrifuge tube, 1500 turn/min, centrifugal 10min, removes supernatant liquor.(3) hypotonic processing: add the 0.075mol/L KCl8ml of 37 ℃ of pre-temperature, repeatedly, after piping and druming (approximately 100 times), put hypotonic processing 25min left and right in 37 ℃ of water baths.(4) pre-fix: add the fresh stationary liquid 1ml (methyl alcohol: Glacial acetic acid=3: 1), mix gently of preparing.(5) centrifugal: 2000 turn/min, centrifugal 10min, inhales and abandon supernatant liquor.(6) fixing: along centrifugal tube wall, slowly to add stationary liquid 8ml, mix gently, fixedly 10min.(7) centrifugal: the same, suck supernatant liquor.(8) fixing again: to be fixed liquid 8ml, to mix, fixedly 10min.(9) centrifugal: the same, suck supernatant liquor.(10) cell suspension processed: how many according to cell concentration, add appropriate stationary liquid, fully mix, make cell suspension, save backup.
3, film-making and aobvious band: (1) drips sheet: take out the slide glass soaking through frozen water in advance, draw the cell suspension mixing dripping sheet from the about 30cm distance of borneol with suction pipe, every agreement that contracts a film or TV play to an actor or actress is dripped 2～3 cell suspensions, and cell is better disperseed.General each culturing bottle can be made 3～5 sample slices.(2) dyeing: after sample airing, i.e. available dye liquor (1 part of Giemsa liquid stoste, 9 parts of the phosphoric acid buffers of pH6.8) dyeing 15min, after tap water rinses, (from backside rinse) dries standby.
4, chromosome karyotype analysis: photograph good division with Automated Cytogenetics Platform Cytovision (Leica Microsystems) and do mutually chromosome structure analysis, make and making a definite diagnosis.Except automatic analysis, chromosome karyotype analysis can also be counted 30 karyotypes under opticmicroscope, to find that whether chromosome number is abnormal, if any Special Circumstances such as mosaics, counts up to 100 karyotypes; Under oily mirror, analyze 3-5 karyotype, to find that there is all kinds of textural anomalies such as the transposition of dye-free body, disappearance, inversion, ring-type.
5, at-20 ℃, retain the unnecessary cell suspension of difficult, rare easy missed case, and after sending diagnosis report, discard the sample of normal and the abnormal case of ordinary stain body.
6, get in batch the cell suspension of the difficulty retained, rare, easy missed case, in 1 routine cell suspension, mix with 1: 1,1: 2,1: 3,1: 4,1: 5,1: 6,1: 7,1: 1～20 different suspension volumes or cell count ratio from other 1 example, 2 examples, 3 examples, 4 examples, 5 examples, 6 examples, 7 examples, 8 examples, 9 examples, 10 examples, 11 examples, 12 examples, 14 examples, 15 examples, 1～50 routine cell suspension respectively, mixed cell suspension contains dissimilar and chromosome abnormalty cell ratio, but comments figure as the inferior preparation of specimen's chamber interstitial of same example.
7, the cell suspension of mixing is carried out to conventional film-making and aobvious band, picked-up high-quality karyotype, after 2 experts do karyotype diagnosis, audit, writes down Standard karyotype, comprise the situations such as numerical abnormalities of chromosomes, textural anomaly and mosaic, store together with corresponding karyogram.The chamber interstitial of sample (mixed cell suspension) made that same like this example is inferior comments figure to contain easy mistaken diagnosis Chromosomal Abnormal Karyotype dissimilar, different ratios.The present invention comments figure to comprise the Chromosomal Abnormal Karyotype image of direct picked-up with the chromosome abnormalty chamber interstitial of this program making, Chromosomal Abnormal Karyotype image before making No. 1 karyomit(e) to 22 karyomit(e) and sex chromosome and pressing ordinal number and arrange after conventional processing, make No. 1 karyomit(e) to 22 karyomit(e) and sex chromosome and press the Chromosomal Abnormal Karyotype image after ordinal number is arranged, directly take from and make the difficulty made a definite diagnosis after the sick laboratory diagnosis of routine chromosome, rare Chromosomal Abnormal Karyotype figure, chromosome abnormalty cell suspension mixes several chromosome abnormalties that form the mosaic caryogram of depositing with chromosome abnormalty cell suspension, chromosome abnormalty cell suspension mixes the mosaic caryogram that a kind of forming or several chromosome abnormalties and karyomit(e) are normal and deposit with karyomit(e) normal cell suspension.
8, application: chamber interstitial is commented application: comment and transfer matter at random or targetedly figure and comment figure from the chamber interstitial of storage as required, with E-mail, mass-send to each laboratory or professional, make each chamber or personnel on time, complete independently chromosome abnormalty diagnosis in accordance with regulations, equally with E-mail feedback diagnostic result, organizer or examination person evaluate accuracy, the Misdiagnosis of the diagnostic result that each study subject gathers, analyze reason, regularly discuss, correct existing problems, to increase technician's experience and experience, improve quality of diagnosis; Examination examination application: get matter and comment figure to deliver by examination person, with written, oral, examine the diagnostic level by examination person then and there; Teaching application: with face to face or long-range mode to student, graduate student, explain orally matter and comment the abnormal karyotype shown in figure, be allowed to condition at understanding in the short as far as possible time, grasp diagnostic method, the diagnostic skill of more abnormal karyotype.
9, chamber interstitial is commented result and the effect of application: we are on the basis of self-control chromosome abnormalty lymphocyte strain, made 6 routine Chromosomal Abnormal Karyotype chamber interstitials and commented figure, set up the Chromosomal Abnormal Karyotype matter of 1 composite unit and commented figure, its caryogram is respectively 46, X, t (Y; 5) (q12; Q21), 46, XY, 15P
+, 46, XX, t (13; 18) (q12; Q21), 46, X, r (Xp), 46, X, t (Y; Y) and 46, XX, t (9; 20) (P13; P13), all belong to comparatively difficult, rare abnormal karyotype, and the chamber interstitial of having made cytogenetic diagnosis is commented test.We have respectively provided the chromosome abnormalty chamber interstitial of 1 composite unit and have commented figure to 35 laboratories, amount to 35 composite units, contain 210 parts of abnormal karyotypes, wherein have 19 parts of chamber interstitials to comment not Result of figure; Result have 191 parts, total return rate is 90.95%.Respectively the participate in evaluation and electing result of laboratory return, corresponds to 46, X, t (Y; 5) (q12; Q21), 46, XY, 15P
+, 46, XX, t (13; 18) (q12; Q21), 46, X, r (Xp), 46, X, t (Y; Y) and 46, XX, t (9; 20) (P13; The result of 6 Chromosomal Abnormal Karyotype sequences p13), its entirely true rate is respectively 81.82%, 78.13%, 86.67%, 78.79%, 78.13%, 90.32%, error rate is respectively 15.15%, 21.88%, 10.00%, 18.18%, 21.88%, 6.45% completely, and total entirely true rate, part accuracy, part error rate and complete error rate are respectively 82.20%, 0.52%, 1.57% and 15.71%.There is higher misdiagnosis rate in the cytogenetic diagnosis result in laboratory of showing respectively to participate in evaluation and electing, if 19 parts of Quality Control figure are made a definite diagnosis to the result of not returning because of being not sure, counts, and its misdiagnosis rate can be higher.This may be because: 1, with Chromosomal Abnormal Karyotype figure, make chamber interstitial and comment, difficult especially, rare abnormal karyotype are difficult to do further evaluation; 2, selecteed chamber interstitial comments object to be partial to grass-roots unit; 3, chromosome karyotype analysis is just generally carried out in recent years, and technician lacks the laboratory diagnosis experience to the rare karyomit(e) case of difficulty; 4, participate in for the first time chamber interstitial and comment, lack relevant chamber interstitial and comment experience; 5, the structure of karyotype is not described by unified standard standardization ground; 6, it is higher that this chamber interstitial is commented the determined matter assessment of bids of method standard.The Misdiagnosis of the chamber interstitial that we find in commenting is wherein to have 5 examples 46, X, t (Y; 5) (q12; Q21) be misdiagnosed as 46, X, t (5; 15), the former may have impact except reproductive function, and clinical Signs is generally normal, but the latter shows as the sexual abnormality of primary amenorrhea; There are 7 examples 46, XY, 15P
+be misdiagnosed as 46, XY, t (15; 21), the former is generally the normal polymorphism caryogram of clinical Signs, but the caryogram that the latter is mongolism; There are 2 examples 46, XX, t (13; 18) (q12; Q21) by wrong diagnosis, be 46, XX ,-18 ,+mar, 1 example are misdiagnosed as 46, XX, del (18) [1], the former easily miscarries when fertility filial generation, the clinical Signs of he or she is generally normal, but the latter shows as the symptom of chromosome deletion, the birth of generally can not living; There are 3 examples 46, X, r (Xp) is misdiagnosed as 46, X, and+mar, 2 examples are misdiagnosed as 45, X, are misdiagnosed as 46, XY and 46, X, and each 1 example of Xp, is particularly misdiagnosed as after 46, XY, will take surgical resection " cryptorchidism " in case cancerate; There are 4 examples 46, X, t (Y; Y) be misdiagnosed as 46, X ,-Y+11,3 examples are misdiagnosed as 46, X ,-Y, and+del (11), former caryogram is many 1 Y chromosome, has not but had Y chromosome after mistaken diagnosis; 46, XX, t (9; 20) be misdiagnosed as 46, XX,-20 ,+17 and 46, XX, each 1 example of del (9), former caryogram belongs to chromosome translocation, when fertility filial generation, spontaneous abortion easily occurs, and my clinical Signs is generally normal, but 46 after mistaken diagnosis, XX is that normal karyotype, other 2 kinds of caryogram generally can not survive birth.
As can be seen here, the comparatively serious consequence that existing problem and mistaken diagnosis thereof produce in the cytogenetic diagnosis of difficulty, rare caryogram.The Necessity and feasibility that the Chromosomal Abnormal Karyotype chamber interstitial of using the present invention to make comments figure to comment for carrying out cytogenetic diagnosis chamber interstitial is described, to pinpointing the problems, correct in time, improve diagnostic level, has great importance.
Claims (6)
1. a Chromosomal Abnormal Karyotype chamber interstitial is commented figure and preparation method, its principal character be take from because of clinical diagnosis and treatment need to do the sick laboratory diagnosis of routine chromosome after and be diagnosed as difficulty, the unnecessary cell suspension that retains of rare chromosome abnormalty, according to chamber interstitial to be produced, comment the requirement of figure, extract 1 example or numerical example cell suspension mixes in needed ratio, make to only have in original every part of cell suspension a kind of Chromosomal Abnormal Karyotype to change into contain in every part of cell suspension different ratios, be easy to the multiple Chromosomal Abnormal Karyotype of mistaken diagnosis, through routine chromosome, prepare, the prepared chamber interstitial of picked-up karyotype image is commented figure, original, just easily on the basis of mistaken diagnosis, more increased differential diagnosis, difficulty and the complicacy of chromosomal chimaera diagnosis, sample is easy to get and is the teaching teaching that can be used for chromosome karyotype analysis by discarded unnecessary cell transformation, technical examination, chamber interstitial is commented and the useful materials of resource sharing, after application to improving diagnostic level, the tool that tightens quality control has an unexpected effect.
2. a kind of Chromosomal Abnormal Karyotype according to claim 1 chamber interstitial is commented figure and preparation method, it is characterized in that retaining in batch, difficulty to be discarded, rare, the cell suspension of easy missed case, by 1 routine cell suspension respectively with other 1 example, 2 examples, 3 examples, 4 examples, 5 examples, 6 examples, 7 examples, 8 examples, 9 examples, 10 examples, 11 examples, 12 examples, 14 examples, 15 examples, 1～50 routine cell suspension was with 1: 1, 1: 2, 1: 3, 1: 4, 1: 5, 1: 6, 1: 7, 1: 1～20 different suspension volumes or cell count ratio are mixed, mixed cell suspension contains dissimilar and chromosome abnormalty cell ratio, but comment figure as preparation of specimen's chamber interstitial that same example is inferior.
3. a kind of Chromosomal Abnormal Karyotype according to claim 1 chamber interstitial is commented figure and preparation method, it is characterized in that Chromosomal Abnormal Karyotype chamber interstitial comment figure comprise direct picked-up Chromosomal Abnormal Karyotype image, make No. 1 karyomit(e) to 22 karyomit(e) and sex chromosome and arrange by ordinal number before Chromosomal Abnormal Karyotype image after conventional processing, the Chromosomal Abnormal Karyotype image after making No. 1 karyomit(e) to 22 karyomit(e) and sex chromosome and arranging by ordinal number.
4. according to a kind of Chromosomal Abnormal Karyotype chamber interstitial described in claim 1,3, comment figure and preparation method, it is characterized in that Chromosomal Abnormal Karyotype chamber interstitial is commented figure to comprise directly to take to make the difficulty, the rare Chromosomal Abnormal Karyotype figure that make a definite diagnosis after the sick laboratory diagnosis of routine chromosome.
5. a kind of Chromosomal Abnormal Karyotype according to claim 1 chamber interstitial is commented figure and preparation method, it is characterized in that extracting 1 example or numerical example cell suspension and mixes and comprise that chromosome abnormalty cell suspension mixes several chromosome abnormalties that form the mosaic caryogram of depositing with chromosome abnormalty cell suspension in needed ratio.
6. a kind of Chromosomal Abnormal Karyotype according to claim 1 chamber interstitial is commented figure and preparation method, it is characterized in that extracting 1 example or numerical example cell suspension and mixes and comprise that chromosome abnormalty cell suspension mixes a kind of formation or several chromosome abnormalties and karyomit(e) normally and the mosaic caryogram of depositing with karyomit(e) normal cell suspension in needed ratio.
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| CN110265087A (en) * | 2018-10-05 | 2019-09-20 | 中国医药大学附设医院 | Chromosome abnormality detection model, its detection system and chromosome abnormality detection method |
| CN112036237A (en) * | 2020-07-22 | 2020-12-04 | 江苏医像信息技术有限公司 | Chromosome chimera identification and judgment method and system and chromosome karyotype analysis method |
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Effective date of registration: 20200914 Address after: 310006 No. 1, bachelor Road, Zhejiang, Hangzhou Patentee after: WOMEN'S HOSPITAL, SCHOOL OF MEDICINE, ZHEJIANG University Address before: 317300. Zhejiang Taizhou Xianju County Chengguan the Bund flood Road hospital nurse building Patentee before: Weng Binghuan |