CN115436506A - 一种先天性肾上腺皮质增生症筛查试剂盒及其应用 - Google Patents

一种先天性肾上腺皮质增生症筛查试剂盒及其应用 Download PDF

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CN115436506A
CN115436506A CN202210957106.5A CN202210957106A CN115436506A CN 115436506 A CN115436506 A CN 115436506A CN 202210957106 A CN202210957106 A CN 202210957106A CN 115436506 A CN115436506 A CN 115436506A
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陈建起
李海明
鲍冬芹
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Guangzhou Fenghua Bioengineering Co ltd
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Abstract

本发明公开了一种先天性肾上腺皮质增生症筛查试剂盒及其应用,涉及血液检测技术领域。本发明的一种先天性肾上腺皮质增生症筛查试剂盒,其特征在于,所述试剂盒包括校准品、质控品、同位素内标准品、提取液、萃取液和流动相。本发明提供的先天性肾上腺皮质增生症筛查试剂盒采用液相色谱串联质谱技术,检测通量高,能够同时检测17α‑OHP、睾酮、雄烯二酮、11‑脱氧皮质醇、21‑脱氧皮质醇和皮质醇标志物,且检测灵敏度高、特异性强、准确性高;本发明的试剂盒所检测的样品为干血片,干血片样品收集方便,成本低,降低采血需求;本发明的试剂盒检测过程较简单,45min内可完成多种标志物的检测。

Description

一种先天性肾上腺皮质增生症筛查试剂盒及其应用
技术领域
本发明涉及血液检测技术领域,具体涉及一种先天性肾上腺皮质增生症筛查试剂盒及其应用。
背景技术
先天性肾上腺皮质增生症(congenital adrenal hyperplasia,CAH)是一组常染色体隐性遗传病。由于肾上腺皮质激素合成酶的缺陷,皮质醇的合成部分或完全受阻,反馈抑制减弱,使促肾上腺皮质激素释放激素(conicotropin releasing homlone,CRH)、促肾上腺皮质激素(adrenoconicotropic honnone,ACTH)分泌增加,从而使肾上腺皮质增生。不同的酶缺陷引起不同的类固醇激素水平改变,临床上以2l-羟化酶缺乏(2l-hydroxylasedeficiency,21-0HD)最常见,占所有CAH病人的90%~95%。2l-OHD分为经典型(classical)及非经典型(non classical,NC)(迟发型或轻型)两种,前者又分单纯男性化型(simple virilizing,SV)和失盐型(salt-wasting,SW)。失盐型(salt wasting,SW):该型患儿21-羟化酶完全缺乏,约占75%。患儿出生后2周左右可出现肾上腺皮质醇及醛固酮合成障碍,出现糖、盐皮质激素缺乏所致的肾上腺皮质功能减低的表现,如呕吐、腹泻、体重不增、脱水、皮肤色素沉着;难以纠正的低血钠、高血钾、代谢性酸中毒、低血糖,甚至休克、死亡,病死率为4.0%~11.3%。4岁后机体对失盐耐受性有所增加,失盐逐渐改善。此外,表现为雄激素增高体征(见单纯男性化型)。单纯男性化型:21-羟化酶部分缺乏,酶活性1%~11%,约占25%。该型患儿血醛固酮和皮质醇合成部分受阻,虽无临床失盐症状,但体内存在失盐,部分患儿皮肤色素沉着,主要见于乳晕、手指关节伸面及阴囊或阴唇;另表现为雄激素增高的体征:男婴出生时外生殖器多正常,少数阴茎增大,睾丸大小正常;女婴出生时多伴有外生殖器不同程度男性化(阴蒂肥大、阴唇融合)。随着年龄增大,生长加速、骨龄超前而最终矮小。非经典型21-羟化酶活性达20%~50%中国少见。儿童后期或青春期出现雄激素增多的体征。21-OHD患儿父母为疾病携带者(杂合子),杂合子发生率约1:60。每生育一个孩子,患病概率为25%。21-OHD在活婴儿中发病率为1:23044~1:9800。新生儿疾病筛查统计,世界范围内21-HD发病率为1:13000,北美1:15000,欧洲国家为1:14000~1:10000,日本为1:15000。亚裔人群中的发病率约为1:43764;而在阿拉斯加的爱斯基摩人和法国的LaReunion地区中发生率分别高达1:282和1:2141。在国内,据上海交通大学医学院附属新华医院新生儿筛查中心统计,2008-2014年共筛查了84万名新生儿,得出CAH(21-OHD)患病率约为1/17700。
为了预防危及生命的肾上腺皮质危象以及由此导致的脑损伤或死亡;预防女性患儿由于外生殖器男性化造成性别判断错误;预防过多雄激素造成的成年后身材矮小、心理、生理发育等障碍,使患儿在临床症状出现之前及早得到诊治。新生儿CAH筛查能检出70%经典型21-OHD(主要为失盐型和大部分单纯男性化型)患儿,而非经典型21-OHD难以通过筛查发现。
国际上新生儿CAH筛查(即21-OHD筛查)起始于1977年,至今约30多个国家开展了新生儿CAH筛查。我国CAH筛查起步于20世纪90年代初,上海2007年增加新生儿CAH筛查项目,全国有近百家新生儿筛查中心开展了CAH筛查。目前,国内外多数实验室采用免疫学方法检测17羟孕酮(17α-OHP)单项指标进行CAH初筛,但由于新生儿17α-OHP易受诸如胎龄、性别、体质量等多种因素影响,再加上其他结构类似的甾体激素交叉抗原干扰,假阳性率高达99%。因此,亟待改进当前新生儿CAH筛查方法。近年来,由于液相色谱串联质谱(LC-MS/MS)技术具有卓越的灵敏度、准确性以及高通量等特性,已被广泛运用于新生儿多种代谢性疾病筛查,且取得了很好的社会价值,为了更好服务于临床,一种新型先天性肾上腺皮质增生筛查试剂盒开发迫在眉睫。
发明内容
本发明的目的在于克服现有技术的不足,提供一种先天性肾上腺皮质增生症筛查试剂盒及其应用。
为实现上述目的,本发明采取的技术方案为:一种先天性肾上腺皮质增生症筛查试剂盒,所述试剂盒包括校准品、质控品、同位素内标准品、提取液、萃取液和流动相;所述校准品由17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇、皮质醇和全血混合制备而成;所述质控品由17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇、皮质醇和全血混合制备而成;所述同位素内标准品含有17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇;所述提取液为甲醇、乙腈、异丙醇、水中的至少两种;所述萃取液为乙酸乙酯、叔丁基甲醚中的至少一种;所述流动相由流动相A和流动相B组成;所述流动相A为氢氧化铵的水溶液;所述流动相B为甲醇。
研究表明,采用免疫学方法检测17羟孕酮(17α-OHP)单项指标进行CAH初筛,但由于新生儿17α-OHP易受诸如胎龄、性别、体质量等多种因素影响,再加上其他结构类似的甾体激素交叉抗原干扰,假阳性率高达99%,且盖操作时间长,一般至少需要240分钟之后才能出检测结果,这样给检测者和被检测者都带来的诸多不便。本发明采用液相色谱-串联质谱技术能够同时检测17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇标志物,同时应用于新生儿疾病筛查,不仅检测结果准确、操作方便、通量高,每次只需采一滴血,不仅为操作者提供方便,而且给特殊的采血者减少痛苦,具有很好的应用前景。
作为本发明所述的试剂盒的优选实施方式,所述校准品包括7个浓度呈梯度的校准品;所述校准品中17α-OHP的浓度为100~20000pg/mL,睾酮的浓度为80~16000pg/mL,雄烯二酮的浓度为50~10000pg/mL,11-脱氧皮质醇的浓度为80~16000pg/mL,21-脱氧皮质醇的浓度为80~16000pg/mL,皮质醇的浓度为100~20000pg/mL。
作为本发明所述的试剂盒的优选实施方式,所述质控品包括质控品C1和质控品C2;所述质控品C1包括500pg/mL17α-OHP,400pg/mL睾酮,250pg/mL雄烯二酮,400pg/mL11-脱氧皮质醇,400pg/mL21-脱氧皮质醇和500pg/mL皮质醇;所述质控品C2包括10000pg/mL17α-OHP,8000pg/mL睾酮,5000pg/mL雄烯二酮,8000pg/mL11-脱氧皮质醇,8000pg/mL21-脱氧皮质醇和10000pg/mL皮质醇。
作为本发明所述的试剂盒的优选实施方式,所述提取液由甲醇、乙腈、异丙醇和水组成。
作为本发明所述的试剂盒的优选实施方式,所述萃取液由乙酸乙酯和叔丁基甲醚组成。
作为本发明所述的试剂盒的优选实施方式,所述流动相A的氢氧化铵的水溶液的浓度为0.02~0.1%。
本发明还提供所述试剂盒的使用方法,包括以下步骤:
(1)按比例向同位素内标准品中加入提取液,制备得到日常提取工作液;
(2)向校准品、质控品和待测样品分别加入日常提取工作液,进行孵育;
(3)孵育后加入萃取液,孵育后取上清液,上清液用氮气吹干;
(4)将吹干后的残渣用复溶剂复溶,取上清液进行液相色谱串联质谱技术进行检测;
(5)以校准品17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇或皮质醇的浓度为横坐标,以校准品的峰面积与内标峰面积的比值为纵坐标,绘制标准曲线并计算曲线的回归方程,计算出滤纸干血片中17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇的浓度值。
作为本发明所述的试剂盒的使用方法的优选实施方式,所述步骤(4)中的色谱条件为:色谱柱为Thermo AccucoreTM RP-MS;柱温为40℃;流动相流速为0.5mL/min;梯度洗脱条件:0~1min:85%流动相A-15%流动相B,1~1.5min:85%→60%流动相A-15%→40%流动相B,1.5~3.5min:60%→20%流动相A-40%→80%流动相B,3.5~4min:20%→10%流动相A-80%→90%流动相B,4~4.5min:10%→85%流动相A-90%→15%流动相B,4.5~5min:85%流动相A-15%流动相B;进样体积为10uL。
作为本发明所述的试剂盒的使用方法的优选实施方式,所述步骤(4)中的质谱条件为:采用电喷雾离子源,正离子扫描模式,选择反应检测扫描方式。
本发明还提供所述的试剂盒在利用液相色谱串联质谱技术同时检测滤纸干血片中17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇中的应用。
本发明的有益效果:本发明提供的先天性肾上腺皮质增生症筛查试剂盒采用液相色谱串联质谱技术,检测通量高,能够同时检测17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇标志物,且检测灵敏度高、特异性强、准确性高;本发明的试剂盒所检测的样品为干血片,干血片样品收集方便,成本低,降低采血需求;本发明的试剂盒检测过程较简单,45min内可完成多种标志物的检测。
附图说明
图1为检测17α-OHP目标物的色谱图。
图2为检测睾酮目标物的色谱图。
图3为检测雄烯二酮目标物的色谱图。
图4为检测11-脱氧皮质醇目标物的色谱图。
图5为检测21-脱氧皮质醇目标物的色谱图。
图6为检测皮质醇目标物的色谱图。
图7为17α-OHP的线性结果图。
图8为睾酮的线性结果。
图9为雄烯二酮的线性结果图。
图10为11-脱氧皮质醇的线性结果图。
图11为21-脱氧皮质醇的线性结果图。
图12为皮质醇的线性结果图。
具体实施方式
以下通过实施例形式的具体实施方式,对本发明的上述内容再作进一步的详细说明。但不应将此理解为本发明上述主题的范围仅限于以下的实例。凡基于本发明上述内容所实现的技术均属于本发明的范围。
实施例1
本发明实施例的一种先天性肾上腺皮质增生症筛查试剂盒,该试剂盒的组成及主要成分如表1所示。
其中校准品和质控品配制方法为:收集乙型肝炎病毒HBsAg、抗-HCV、抗-TP、抗-HIV全阴的全血经过离心处理分离得到上层血浆和下层血球,取上层血浆备用,将血球用生理盐水与血球比例1:1混合洗涤3次,将17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇标准品配制成混合标准品,最后与处理后的全血混合配制成需要浓度,取50uL滴注于Whatma 903号滤纸干血片上,让其自然扩散晾干,真空保存于密封薄膜袋中。
内标准品的配置方法为:精密称量17羟孕酮-d8、睾酮-13C3、雄烯二酮-13C3、11-脱氧皮质醇-d5、21-脱氧皮质醇-d5和皮质醇-d4 1mg,分别采用1mL乙醇溶解,配置成浓度为1mg/mL的溶剂,然后再用内标准品稀释液配置成17羟孕酮-d8 0.5ug/mL、睾酮-13C3、雄烯二酮-13C3 1.0ug/mL、11-脱氧皮质醇-d52.0ug/mL、21-脱氧皮质醇-d5 2.0ug/mL和皮质醇-d4 1.0ug/mL混合内标准品,混匀,分装1.0mL/瓶冻干。
表1试剂盒组成及主要成分
Figure BDA0003791799580000061
实施例2
本实施例提供实施例1的试剂盒的使用方法。
(1)该试剂盒的具体操作步骤如表2所示。
表2试剂盒的操作方法
Figure BDA0003791799580000071
Figure BDA0003791799580000081
(2)该试剂盒检测的色谱条件如表3和表4所示。
表3色谱条件
Figure BDA0003791799580000082
表4梯度洗脱条件
Figure BDA0003791799580000083
(3)该试剂盒检测的质谱条件
1)质谱检测采用电喷雾离子源(ESI),正离子扫描模式,扫描方式SRM,具体离子源参数如表5所示。
表5离子源参数
Figure BDA0003791799580000084
2)化合物质谱参数如表6所示。
表6离子对信息参数
Figure BDA0003791799580000091
(4)检测结果计算
17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇的目标物的色谱图如图1~6所示。
以7个校准品的标示浓度为横坐标(X),以7个校准品的实际检测峰面积与各自的内标峰面积的比值为纵坐标(Y),绘制标准曲线并计算曲线的回归方程,即可计算出滤纸干血片中17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇的浓度值,并同时可以观测不同项目间浓度值比值。检测17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇的线性结果如图7~12所示。
(5)方法验证
1)线性及相关系数:取至少6个浓度的校准品,每个重复至少2次,按照说明书操作处理,考察标准曲线的线性相关系数。
数据接受标准:标准曲线上最低浓度样本中每个化合物的相对偏差(RE)和相对标准偏差(RSD)均在20%以内,其它浓度的样本中每个化合物的相对偏差(RE)和相对标准偏差(RSD)均在15%以内,相关系数r在0.9900以上。
2)重复性:取低、高质控品(QC1、QC2)各10孔,按照说明书操作处理,利用标准曲线计算该批次的低、高质控品的浓度,得到每个样本的相对偏差(RE)和相对标准偏差(RSD)。
数据接受标准:低、高质控品(QC1、QC2)的每个化合物的相对偏差(RE)和相对标准偏差(RSD)均在15%以内。
3)准确性:取低、高质控品(QC1、QC2)各10孔,按照说明书操作处理,利用标准曲线计算该批次的低、高质控品的浓度,得到每个样本的相对偏差(RE)和相对标准偏差(RSD)。
数据接受标准:低、高质控品(QC1、QC2)的每个化合物的相对偏差(RE)和相对标准偏差(RSD)均在15%以内。
4)携带污染:通过进样标准曲线上最高浓度样本(G点)后运行1个标准曲线上最低浓度样本(B点),来进行评估携带污染率。
数据接受标准:紧接着标准曲线上最高浓度样本后进样标准曲线上最低浓度样本的实测浓度-曲线第一次进样的标准曲线上最低浓度样本的实测浓度/曲线第一次进样的标准曲线上最低浓度样本的实测浓度*100%≤20%。
验证结果如表7所示。
表7
Figure BDA0003791799580000111
实施例3
本实施例对该试剂盒中提取液组成成分进行优选,与实施例1相比,将提取液替换成表8和表9所示的提取液。表8和表9的实验数据表明提取液成分以甲醇+乙腈+异丙醇+水混合提取效果较好。
表8
Figure BDA0003791799580000112
Figure BDA0003791799580000121
表9
Figure BDA0003791799580000122
实施例4
本实施例对该试剂盒中萃取液组成成分进行优选,与实施例1相比,将提取液替换成表10和表11所示的提取液。表10和表11的实验数据表明萃取液成分以乙酸乙酯+叔丁基甲醚混合提取效果较好。
表10
Figure BDA0003791799580000123
表11
Figure BDA0003791799580000131
实施例5
本实施例对该试剂盒中流动相组成成分进行优选,与实施例1相比,将提取液替换成表12和表13所示的提取液。表12和表13的实验数据表明流动相A选择以含有NH4OH的水溶液,流动相B选择甲醇效果较好,其中NH4OH最佳浓度为0.05%。
表12
Figure BDA0003791799580000132
表13
Figure BDA0003791799580000133
最后应当说明的是,以上实施例仅用以说明本发明的技术方案而非对本发明保护范围的限制,尽管参照较佳实施例对本发明作了详细说明,本领域的普通技术人员应当理解,可以对本发明的技术方案进行修改或者等同替换,而不脱离本发明技术方案的实质和范围。

Claims (10)

1.一种先天性肾上腺皮质增生症筛查试剂盒,其特征在于,所述试剂盒包括校准品、质控品、同位素内标准品、提取液、萃取液和流动相;所述校准品由17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇、皮质醇和全血混合制备而成;所述质控品由17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇、皮质醇和全血混合制备而成;所述同位素内标准品含有17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇;所述提取液为甲醇、乙腈、异丙醇、水中的至少两种;所述萃取液为乙酸乙酯、叔丁基甲醚中的至少一种;所述流动相由流动相A和流动相B组成;所述流动相A为氢氧化铵的水溶液;所述流动相B为甲醇。
2.根据权利要求1所述的试剂盒,其特征在于,所述校准品包括7个浓度呈梯度的校准品;所述校准品中17α-OHP的浓度为100~20000pg/mL,睾酮的浓度为80~16000pg/mL,雄烯二酮的浓度为50~10000pg/mL,11-脱氧皮质醇的浓度为80~16000pg/mL,21-脱氧皮质醇的浓度为80~16000pg/mL,皮质醇的浓度为100~20000pg/mL。
3.根据权利要求1所述的试剂盒,其特征在于,所述质控品包括质控品C1和质控品C2;所述质控品C1包括500pg/mL17α-OHP,400pg/mL睾酮,250pg/mL雄烯二酮,400pg/mL11-脱氧皮质醇,400pg/mL21-脱氧皮质醇和500pg/mL皮质醇;所述质控品C2包括10000pg/mL17α-OHP,8000pg/mL睾酮,5000pg/mL雄烯二酮,8000pg/mL11-脱氧皮质醇,8000pg/mL21-脱氧皮质醇和10000pg/mL皮质醇。
4.根据权利要求1所述的试剂盒,其特征在于,所述提取液由甲醇、乙腈、异丙醇和水组成。
5.根据权利要求1所述的试剂盒,其特征在于,所述萃取液由乙酸乙酯和叔丁基甲醚组成。
6.根据权利要求1所述的试剂盒,其特征在于,所述流动相A的氢氧化铵的水溶液的浓度为0.02~0.1%。
7.根据权利要求1~6任一项所述的试剂盒的使用方法,其特征在于,包括以下步骤:
(1)按比例向同位素内标准品中加入提取液,制备得到日常提取工作液;
(2)向校准品、质控品和待测样品分别加入日常提取工作液,进行孵育;
(3)孵育后加入萃取液,孵育后取上清液,上清液用氮气吹干;
(4)将吹干后的残渣用复溶剂复溶,取上清液进行液相色谱串联质谱技术进行检测;
(5)以校准品17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇或皮质醇的浓度为横坐标,以校准品的峰面积与内标峰面积的比值为纵坐标,绘制标准曲线并计算曲线的回归方程,计算出滤纸干血片中17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇的浓度值。
8.根据权利要求7所述的试剂盒的使用方法,其特征在于,所述步骤(4)中的色谱条件为:色谱柱为Thermo AccucoreTM RP-MS;柱温为40℃;流动相流速为0.5mL/min;梯度洗脱条件:0~1min:85%流动相A-15%流动相B,1~1.5min:85%→60%流动相A-15%→40%流动相B,1.5~3.5min:60%→20%流动相A-40%→80%流动相B,3.5~4min:20%→10%流动相A-80%→90%流动相B,4~4.5min:10%→85%流动相A-90%→15%流动相B,4.5~5min:85%流动相A-15%流动相B;进样体积为10uL。
9.根据权利要求7所述的试剂盒的使用方法,其特征在于,所述步骤(4)中的质谱条件为:采用电喷雾离子源,正离子扫描模式,选择反应检测扫描方式。
10.根据权利要求1~6任一项所述的试剂盒在利用液相色谱串联质谱技术同时检测滤纸干血片中17α-OHP、睾酮、雄烯二酮、11-脱氧皮质醇、21-脱氧皮质醇和皮质醇中的应用。
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