M蛋白干扰临床实验室检测项目的研究进展

doi:10.16150/j.1671-2870.2023.04.013

摘要/Abstract

摘要：

M蛋白是一种特殊的免疫球蛋白，其存在可能影响一些临床血液检验项目的实验室检测结果。M蛋白的干扰存在于检验前、检验中和检验后，严重影响其他检测项目的准确性。在血清肌酐、尿酸、脂蛋白、总蛋白、胆红素、血糖、血磷、血红蛋白、糖化白蛋白检测中,高浓度的M蛋白可造成结果出现假性高值或假性低值；在25-OH维生素D、促甲状腺素、C反应蛋白、万古霉素、庆大霉素、丙戊酸钠药物浓度的检测中，M蛋白的异常存在干扰了实际检测结果。针对以上问题，解决方案包括如检验前稀释血清或去除蛋白、检验中使用蛋白稳定剂或优化反应条件等。临床上，还可以发现隐匿性的M蛋白，能够在疾病发生前有效检出M蛋白，对于疾病的治疗和预后发展都将出现新的转机。

关键词: M蛋白, 干扰, 实验室检测

Abstract:

M protein is a unique immunoglobulin type that often affects the laboratory results of certain blood tests. The M protein interference exits in the pre-analytical, analytical and post-analytical process, seriously affecting the accuracy of tests. For example, high concentrations of M protein in serum creatinine, uric acid, lipoprotein, total protein, bilirubin, blood glucose, phosphorus, hemoglobin, glycosylated albumin can cause false high or false low results. The abnormal presence of M protein in 25-OH vitamin D, thyroid-stimulating hormone, c-reactive protein, vancomycin, gentamicin and sodium valproate concentrations interferes with the actual detection results. Solutions to the above problems include diluting serum or removing protein before testing, using protein stabilizers during testing or optimizing reaction conditions. Furthermore, in clinical practice, hidden M protein can be uncovered, and effective detection prior to the onset of disease can open new avenues for disease management and prognosis.

Key words: M protein, Interference, Laboratory test

中图分类号:

潘晓园, 石慧, 曹季军, 施新明, 史册. M蛋白干扰临床实验室检测项目的研究进展[J]. 诊断学理论与实践, 2023, 22(04): 407-411.

PAN Xiaoyuan, SHI Hui, CAO Jijun, SHI Xinming, SHI Ce. Advancements in M protein interference in the clinical laboratory detection[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(04): 407-411.

图/表 1

参考文献 30

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类别	可能出现M蛋白干扰的检测方法	去除M蛋白或更换检测方法
肌酐	酶法（日本Sekisui 医疗试剂）	高氯酸或超滤去除M蛋白同位素稀释质谱法
尿酸	尿酸酶法（奥林巴斯AU800）	生理盐水稀释，TCA去除M蛋白
胆红素	重氮法（贝克曼库尔特试剂）	水稀释，超滤去除M蛋白钒酸盐氧化法
脂蛋白	均相直接法（贝克曼Synchron CX-5）	脂蛋白电泳法
总蛋白	双缩脲法（贝克曼库尔特试剂）	双缩脲法（不同厂家试剂）
血磷	磷钼酸盐紫外法（罗氏cobas 8000分析仪）	20%磺基水杨酸稀释或沉淀M蛋白
血糖	己糖激酶法（罗氏试剂）	葡萄糖氧化酶法
糖化白蛋白	酶法（日本旭化成试剂）	稀释或聚乙二醇沉淀M蛋白
血红蛋白	比色法（STK-S分析仪）	稀释剂1∶1稀释，更换分析仪
25-OH维生素D	化学发光微粒免疫测定（雅培）	液相色谱串联质谱法
促甲状腺素	酶免疫分析法（雅培AxSYM TSH检测）	时间分辨免疫荧光测定，电化学发光法）
C反应蛋白	免疫比浊法(罗氏模块化体统)	特定抗体去除M蛋白
万古霉素	免疫分析法(荧光偏振免疫分析，比浊法，酶联免疫分析法）	液相色谱串联质谱