equilibrium dialysis

平衡透析
  • 文章类型: Journal Article
    全氟烷基和多氟烷基物质(PFAS)是一类不同的氟化化合物,尚未对潜在的不利健康影响和生物累积特性进行全面研究。具有较长的半衰期和积累特性,PFAS在非临床物种如大鼠和小鼠以及人类中与几种毒性作用有关。尽管已经检查了PFAS的生物学影响和特异性蛋白质结合,没有研究集中在血浆中未结合的物种特异性部分(fu)和相关的毒物动力学。在这里,预饱和平衡透析法用于测量和验证14个单独的PFAS与含有4至12个全氟化碳原子的碳链和几个功能性头基与小鼠的白蛋白和血浆(C57BL/6和CD-1)的结合。rat,和人类。在比较血浆中的fu和与白蛋白的结合时,每种物种-基质组合之间的等效测试表明大鼠和人之间呈正相关。对于小鼠血浆和白蛋白也观察到类似的结合趋势。所有组合的相对较高的Spearman相关性表明PFAS结合的高度一致性,而与基质无关。PFAS的理化性质,如分子量,链长,发现亲脂性在PFAS的血浆蛋白结合中具有重要作用。
    Per- and polyfluoroalkyl substances (PFAS) are a diverse group of fluorinated compounds which have yet to undergo comprehensive investigation regarding potential adverse health effects and bioaccumulative properties. With long half-lives and accumulative properties, PFAS have been linked to several toxic effects in both non-clinical species such as rat and mouse as well as human. Although biological impacts and specific protein binding of PFAS have been examined, there is no study focusing on the species-specific fraction unbound (fu) in plasma and related toxicokinetics. Herein, a presaturation equilibrium dialysis method was used to measure and validate the binding of 14 individual PFAS with carbon chains containing 4 to 12 perfluorinated carbon atoms and several functional head-groups to albumin and plasma of mouse (C57BL/6 and CD-1), rat, and human. Equivalence testing between each species-matrix combination showed positive correlation between rat and human when comparing fu in plasma and binding to albumin. Similar trends in binding were also observed for mouse plasma and albumin. Relatively high Spearman correlations for all combinations indicate high concordance of PFAS binding regardless of matrix. Physiochemical properties of PFAS such as molecular weight, chain length, and lipophilicity were found to have important roles in plasma protein binding of PFAS.
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  • 文章类型: Journal Article
    Niraparib是聚(ADP-核糖)聚合酶(PARP)的有效口服生物可利用抑制剂,对同工型1和2具有高特异性。它已被美国食品和药物管理局批准用于卵巢癌维持治疗,目前正在开发用于各种癌症,包括胶质母细胞瘤.评估尼拉帕尼在胶质母细胞瘤患者中的中枢神经系统(CNS)穿透性,开发了一种新的生物分析方法来测量人脑肿瘤组织和脑脊液(CSF)中总的和未结合的尼拉帕尼水平。使用血浆作为替代基质在LC-MS/MS系统上1-10,000nM的浓度范围内验证该方法。MS/MS检测采用正电喷雾电离模式,同时使用Kinetex™PSC18柱进行色谱,总梯度洗脱运行时间为3.5分钟。日内和日间精度的最大变异系数为10.6%,所有矩阵的准确度范围为92.8%-118.5%。尼拉帕尼在室温(RT)下在人脑匀浆中稳定至少6小时,在-20°C下稳定32天,以及在原液和工作溶液中至少21小时(RT)和278天(4°C)。平衡透析实验显示,尼拉帕尼在人脑和血浆中的未结合分数分别为0.05和0.16,分别。验证的方法目前用于评估人类胶质母细胞瘤组织中的尼拉帕尼水平,CSF,在一项新诊断的胶质母细胞瘤和复发性IDH1/2(+)ATRX突变型胶质瘤患者(NCT05076513)的正在进行的试验中,血浆。计算总数(Kp)和未约束(Kp,uu)肿瘤-血浆分配系数表明尼拉帕尼在胶质母细胞瘤患者中具有显着的脑渗透能力。
    Niraparib is a potent and orally bioavailable inhibitor of poly (ADP-ribose) polymerase (PARP) with high specificity for isoforms 1 and 2. It has been approved by the U.S. Food and Drug Administration for ovarian cancer maintenance therapy and is currently under development for various cancers, including glioblastoma. To assess central nervous system (CNS) penetration of niraparib in glioblastoma patients, a novel bioanalytical method was developed to measure total and unbound niraparib levels in human brain tumor tissue and cerebrospinal fluid (CSF). The method was validated using plasma as a surrogate matrix over the concentration range of 1-10,000 nM on an LC-MS/MS system. The MS/MS detection was conducted in positive electrospray ionization mode, while chromatography was performed using a Kinetex™ PS C18 column with a total 3.5-minute gradient elution run time. The maximum coefficient of variation for both intra- and inter-day precision was 10.6%, with accuracy ranging from 92.8% - 118.5% across all matrices. Niraparib was stable in human brain homogenate for at least 6 hours at room temperature (RT) and 32 days at -20°C, as well as in stock and working solutions for at least 21 hours (RT) and 278 days (4°C). Equilibrium dialysis experiments revealed the fractions unbound of 0.05 and 0.16 for niraparib in human brain and plasma, respectively. The validated method is currently employed to assess niraparib levels in human glioblastoma tissue, CSF, and plasma in an ongoing trial on newly diagnosed glioblastoma and recurrent IDH1/2(+) ATRX mutant glioma patients (NCT05076513). Initial results of calculated total (Kp) and unbound (Kp,uu) tumor-to-plasma partition coefficients indicate significant brain penetration ability of niraparib in glioblastoma patients.
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  • 文章类型: Journal Article
    丁螺环酮是一种抗焦虑药物,在治疗焦虑症和缓解症状方面发挥着重要作用。在生理条件下,利用几种技术研究了丁螺环酮与人血清白蛋白之间的相互作用。包括紫外-可见吸收光谱,荧光发射光谱,圆二色性,傅里叶变换红外光谱(FT-IR),平衡透析,和分子对接。这项研究的结果表明,丁螺环酮通过混合机制猝灭人血清白蛋白的固有荧光。此外,结合常数(Kb),淬火常数(Ksv),和热力学参数在各种温度下计算。丁螺环酮与人血清白蛋白的结合过程呈协同结合模式,由Scatchard图和希尔系数证实。分子对接结果表明,丁螺环酮与IIA相互作用,IIIA,和人血清白蛋白的IIB亚结构域,其构象略有改变。还发现疏水性力在这种相互作用中起主要作用。该研究因此证明BSH作为药物可以通过血液白蛋白运输。此外,由于其在与生物靶标结合时的吸光度的比率响应,HSA可用作跟踪生物分子相互作用的分子探针。
    Buspirone is an anxiolytic drug that plays a significant role in managing anxiety disorders and alleviating their symptoms as well. Several techniques were utilized to study the interaction between buspirone and human serum albumin under physiological conditions, including UV-vis absorption spectroscopy, fluorescence emission spectroscopy, circular dichroism, Fourier transform infrared spectroscopy (FT-IR), equilibrium dialysis, and molecular docking. The results of this study demonstrated that buspirone quenched the intrinsic fluorescence of human serum albumin through a mixed mechanism. Moreover, the binding constants (Kb), the quenching constants (Ksv), and thermodynamic parameters were calculated at various temperatures. The binding process of buspirone to human serum albumin showed a cooperative binding pattern, confirmed by the Scatchard diagram and Hill coefficient. Molecular docking results showed that buspirone interacted with the IIA, IIIA, and IIB subdomains of human serum albumin and slightly changed its conformation. It was also found that hydrophobic forces played a major role in this interaction. This study consequently proves that BSH as a drug can be transported by blood albumin. Additionally, due to its ratiometric response in absorbance upon binding to a biological target, HSA can be used as a molecular probe to follow biomolecular interactions.
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  • 文章类型: Preprint
    底物结合亲和力(Kd)的确定对于理解酶功能至关重要。已经开发了大量的方法并用于研究配体/底物结合,但最好的方法在很大程度上取决于底物和酶。下面我们描述如何测量BesD的Kd,一种非血红素铁卤化酶,对于其天然底物赖氨酸,使用平衡透析,随后用高效液相色谱(HPLC)进行检测。这种方法可以在无氧手套袋设置中进行,需要随时可用的HPLC仪器进行后续检测,并且适用于满足各种底物亲和力测量的需要。
    Determination of substrate binding affinity (Kd) is critical to understanding enzyme function. An extensive number of methods have been developed and employed to study ligand/substrate binding, but the best approach depends greatly on the substrate and the enzyme in question. Below we describe how to measure the Kd of BesD, a non-heme iron halogenase, for its native substrate lysine using equilibrium dialysis with subsequent detection with High Performance Liquid Chromatography (HPLC). This method can be performed in anaerobic glove bag settings, requires readily available HPLC instrumentation for subsequent detection, and is adaptable to meet the needs of a variety of substrate affinity measurements.
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  • 文章类型: Journal Article
    准确测量候选药物与人肝微粒体(HLM)的非特异性结合对于准确确定关键酶动力学参数(如米氏-曼顿(Km))至关重要。可逆抑制(Ki),或失活(KI)常数。已经开发了几种方法来确定小分子与HLM的非特异性结合,如快速平衡透析(红色),超滤(UF),HLM与可磁化珠子(HLM珠子)结合,超速离心(UC),线性外推稳定性试验(LESA),和Transil™系统。尽管这些方法之间在方法上存在各种差异,通常假定相似的自由分数值(Fu,mic)应该生成。为了评估这个假设,选择了9种化合物的测试集,代表低(高福,mic值)和显著(低fu,micvalue)HLM绑定,分别,在本手稿中测试的HLM浓度。fu,使用单一化合物浓度(1.0µM)和三种HLM浓度(0.025、0.50和1.0mg/mL)确定mic值。当HLM非特异性结合事件不广泛导致高fu时,mic值,所有方法都产生了相似的FU,mic值。然而,fu,当与HLM发生高结合时,mic值在不同的分析形式之间明显不同,在那里,fu,根据使用的方法,MIC值的差异高达33倍。所采用的各种方法存在这种差异的潜在原因,与进行不同的检测相关的实际意义,并讨论了对临床药物-药物相互作用(DDI)预测的影响。
    Accurate measurement of non-specific binding of a drug candidate to human liver microsomes (HLM) can be critical for the accurate determination of key enzyme kinetic parameters such as Michaelis-Menton (Km), reversible inhibition (Ki), or inactivation (KI) constants. Several methods have been developed to determine non-specific binding of small molecules to HLM, such as rapid equilibrium dialysis (RED), ultrafiltration (UF), HLM bound to magnetizable beads (HLM-beads), ultracentrifugation (UC), the linear extrapolation stability assay (LESA), and the Transil™ system. Despite various differences in methodology between these methods, it is generally presumed that similar free fraction values (fu,mic) should be generated. To evaluate this hypothesis, a test set of 9 compounds were selected, representing low (high fu,mic value) and significant (low fu,mic value) HLM binding, respectively, across HLM concentrations tested in this manuscript. The fu,mic values were determined using a single compound concentration (1.0 µM) and three HLM concentrations (0.025, 0.50, and 1.0 mg/mL). When the HLM non-specific binding event is not extensive resulting in high fu,mic values, all methods generated similar fu,mic values. However, fu,mic values varied markedly across assay formats when high binding to HLM occurred, where fu,mic values differed by up to 33-fold depending on the method used. Potential causes for such discrepancies across the various methods employed, practical implications related to conduct the different assays, and implications to clinical drug-drug interaction (DDI) predictions are discussed.
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  • 文章类型: Journal Article
    特别是对于抗菌剂,血浆蛋白结合(PPB)在破译候选药物的关键特性中起着关键作用。动物模型通常用于新药的临床前开发中,以使用翻译药代动力学/药效学(PK/PD)预测其在人体中的作用。因此,我们比较了不同条件下头孢唑啉的蛋白质结合(PB)以及细菌在体外的生长。研究了头孢唑啉在人体中的PB水平,牛,使用超滤(UF)和平衡透析(ED),在缓冲液和含有20-70%血浆或纯血浆的培养基中使用不同抗生素浓度的大鼠血浆。此外,在含有各种血浆百分比的MuellerHinton肉汤(MHB)中进行细菌生长和时间杀伤测定。发现UF和ED的头孢唑啉与血浆蛋白结合的模式相似。与人血浆相比,头孢唑啉与牛血浆的结合显着降低,而大鼠血浆中的模式与人血浆中的模式更一致。我们的生长曲线分析显示,与70%人血浆或纯MHB相比,70%牛或大鼠血浆对大肠杆菌的生长具有相当大的抑制作用。不出所料,我们用低浓度的头孢唑啉进行的实验表明,与MHB相比,大肠杆菌在20%的人和大鼠血浆中的生长略好,很可能是由于头孢唑啉与血浆中的蛋白质结合。以头孢唑啉为例,我们的研究强调了PB的种间差异,对PK/PD有潜在影响。在将临床前PK/PD数据外推到人类患者之前,应考虑这些发现。
    For antimicrobial agents in particular, plasma protein binding (PPB) plays a pivotal role in deciphering key properties of drug candidates. Animal models are generally used in the preclinical development of new drugs to predict their effects in humans using translational pharmacokinetics/pharmacodynamics (PK/PD). Thus, we compared the protein binding (PB) of cefazolin as well as bacterial growth under various conditions in vitro. The PB extent of cefazolin was studied in human, bovine, and rat plasmas at different antibiotic concentrations in buffer and media containing 20-70% plasma or pure plasma using ultrafiltration (UF) and equilibrium dialysis (ED). Moreover, bacterial growth and time-kill assays were performed in Mueller Hinton Broth (MHB) containing various plasma percentages. The pattern for cefazolin binding to plasma proteins was found to be similar for both UF and ED. There was a significant decrease in cefazolin binding to bovine plasma compared to human plasma, whereas the pattern in rat plasma was more consistent with that in human plasma. Our growth curve analysis revealed considerable growth inhibition of Escherichia coli at 70% bovine or rat plasma compared with 70% human plasma or pure MHB. As expected, our experiments with cefazolin at low concentrations showed that E. coli grew slightly better in 20% human and rat plasma compared to MHB, most probably due to cefazolin binding to proteins in the plasma. Based on the example of cefazolin, our study highlights the interspecies differences of PB with potential impact on PK/PD. These findings should be considered before preclinical PK/PD data can be extrapolated to human patients.
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  • 文章类型: Journal Article
    莫昔克丁(MOX)是一种大环内酯,用于消除许多哺乳动物物种中的内和外寄生虫。它尤其是抗寄生虫药物Cydectin®的活性成分,由Virbac制造,并经常用于治疗澳大利亚野生动植物的沙眼。蛋白质结合在药物的功效中起着重要作用,因为血浆中的未结合/游离药物最终反映了药理学相关浓度。这项研究旨在调查将Moxyectin的游离药物百分比体外加标到四种对动物敏感的澳大利亚野生动植物物种的血清中;考拉(Phascolarctoscinereus),裸鼻袋熊(Vombatusursinus),东部灰袋鼠(Macropusgiganteus),和山草尾负鼠(Trichosuruscunninghami)。对每个个体测试MOX的三个浓度点:20pg/μL,100pg/μL和500pg/μL。对每个物种的五个个体的血清进行平衡透析,然后进行液相色谱串联质谱(LC-MS/MS)。结果显示所有物种之间的非典型浓度依赖性结合,其中游离药物百分比随着MOX浓度的增加而降低。此外,袋熊显示出明显较低的游离药物水平。这些发现要求进一步研究莫西丁蛋白结合的机制,以帮助理解有袋动物中MOX的药代动力学。
    Moxidectin (MOX) is a macrocyclic lactone used to eliminate endo and ectoparasites in many mammalian species. It is notably the active ingredient of the anti-parasitic drug Cydectin®, manufactured by Virbac, and is frequently used to treat sarcoptic mange in Australian wildlife. Protein binding plays a significant role in the efficacy of a drug, as the unbound/free drug in plasma ultimately reflects the pharmacologically relevant concentration. This study aimed to investigate the free drug percentage of Moxidectin after in vitro spiking into the sera of four sarcoptic mange-susceptible Australian wildlife species; the koala (Phascolarctos cinereus), the bare-nosed wombat (Vombatus ursinus), the eastern grey kangaroo (Macropus giganteus), and the mountain brushtail possum (Trichosurus cunninghami). Three concentration points of MOX were tested for each individual: 20 pg/μL, 100 pg/μL and 500 pg/μL. Serum from five individuals of each species underwent an equilibrium dialysis followed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The results showed an atypical concentration dependent binding across all species, where free drug percentage decreased as MOX concentration increased. In addition, wombats showed significantly lower free drug levels. These findings call for further research into the mechanisms of moxidectin protein binding to help understand MOX pharmacokinetics in marsupials.
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  • 文章类型: English Abstract
    中药复方制剂成分复杂。作为一种广泛使用的中药注射剂,舒肝宁注射液,其体内过程尚未完全了解。确定血浆蛋白结合率对于药代动力学和药效学研究具有重要意义。在这个实验中,采用平衡透析法结合UPLC-MS/MS技术测定10种组分的血浆蛋白结合率,包括对羟基苯乙酮,咖啡酸,黄芩素,奥木精A,栀子苷,黄芩苷,cynaroside,奥木精A-7-O-β-D-葡糖苷酸,scutellarin,和金丝桃苷,为进一步阐明舒肝宁注射液的体内过程和指导临床用药提供理论依据。结果表明,除了黄芩素和栀子苷,人血浆中其他八种成分的血浆蛋白结合率高于大鼠血浆,并且存在种间差异。在人类血浆中,除了栀子苷,咖啡酸,和黄芩苷,其余7种成分的血浆蛋白结合率均在80%以上,黄芩素和奥木精A超过90%。所有成分都表现出与血浆蛋白的高水平结合,除了栀子苷。
    Traditional Chinese medicine(TCM) compound preparations have complex compositions. As a widely used TCM injection, Shuganning Injection, its in vivo processes are not yet fully understood. Determining the plasma protein binding rate is of great significance for pharmacokinetic and pharmacodynamic studies. In this experiment, the equilibrium dialysis method combined with UPLC-MS/MS technology was used to determine the plasma protein binding rates of 10 components, including p-hydroxyacetophenone, caffeic acid, baicalein, oroxylin A, geniposide, baicalin, cynaroside, oroxylin A-7-O-β-D-glucuronide, scutellarin, and hyperoside, in Shuganning Injection in rat and human plasma to provide a theoretical basis for further elucidating the in vivo processes of Shuganning Injection and guiding clinical medication. The results showed that, except for baicalein and geniposide, the plasma protein binding rates of the other eight components were higher in human plasma than in rat plasma, and there were interspecies differences. In human plasma, except for geniposide, caffeic acid, and baicalin, the plasma protein binding rates of the remaining seven components were above 80%, with baicalein and oroxylin A exceeding 90%. All components exhibit a high level of binding to plasma proteins, with the exception of geniposide.
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  • 文章类型: Journal Article
    目的:开发基于平衡透析(ED)的程序,允许测量血浆中的游离药物浓度,从而在测量合理的情况下改善治疗药物监测(TDM)。然而,此程序需要特定的样品制备,并存在不同的陷阱,不是没有错误的。与临床实验室提供的任何结果一样,这一条应该尽可能准确,以便进行正确的临床解释。测量不确定度(MU)是一个参数,使结果的准确性是已知的,这是由ISO15189规定的。在这里,这项研究表明,当使用ED时,如何估计血清中游离药物浓度结果的MU.
    方法:根据ISO/TS20914:2019和JCGM100:2008指南,使用自上而下和自下而上的方法相结合来估算MU,包括血清中游离苯妥英的浓度,作为一个例子。考虑到或不考虑与ED的主要缺点相关的显著偏差,纳入了不同的方案:非特异性结合,音量偏移效应和吉布斯-唐南效应.
    结果:估计的扩展不确定度在13.0和30.9%之间。当存在与体积移位和吉布斯-唐南效应相关的显著偏差时,最高MU对应于血清结果中的游离药物浓度。
    结论:使用ED对游离药物浓度的MU进行了详细估算,考虑不同的场景。这项研究可以刺激临床实验室进行MU研究及其在TDM中的应用。
    OBJECTIVE: Developing procedures based on equilibrium dialysis (ED) that allow measuring the free drug concentration in plasma improves therapeutic drug monitoring (TDM) in those cases where its measurement is justified. However, this procedure requires specific sample preparation and presents different pitfalls, which are not error-free. As with any result provided by a clinical laboratory, this one should be as accurate as possible to allow a correct clinical interpretation. The measurement uncertainty (MU) is a parameter that enables the accuracy of results to be known, and that is mandated by ISO 15189. Herein, this study suggests how the MU for the results of the free drug concentrations in serum could be estimated when an ED is used.
    METHODS: A combination of the top-down and bottom-up approaches was used to estimate the MU based on the ISO/TS 20914:2019 and JCGM 100:2008 guidelines, including the concentration of free phenytoin in serum, as an example. Different scenarios were incorporated considering or not a significant bias related to the primary drawbacks of ED: the non-specific binding, the volume shift effect and the Gibbs-Donnan effect.
    RESULTS: The expanded uncertainties estimated ranged between 13.0 and 30.9 %. The highest MU corresponded to the free drug concentrations in serum results when significant biases related to the volume shift and Gibbs-Donnan effects exist.
    CONCLUSIONS: A detailed estimation of MU for free drug concentrations is presented using ED, considering different scenarios. This study could stimulate clinical laboratories to perform MU studies and its application in TDM.
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  • 文章类型: Journal Article
    背景:游离T4(FT4)测定是内分泌学中最常用的生化测试之一。根据症状的严重程度和生化测试结果调整甲状腺功能障碍的治疗。对于Graves\'甲状腺功能亢进,临床指南建议使用FT4作为抗甲状腺药物剂量的(粗略)指南,以及其他临床信息。众所周知,不同的平台和方法给出不同的FT4结果;然而,在高FT4浓度下的大的非线性方法差异被较少地认识到。目前的临床指南没有明确甲状腺功能亢进范围的方法差异会影响推荐。
    方法:使用AbbottAlinity分析了FT4和/或游离T3(FT3)浓度非常低(生化甲状腺功能减退)至非常高(甲状腺功能亢进)患者的血清样本,并与使用RocheCobas测量的浓度进行比较。SiemensADVIACentaur(仅FT4)和内部平衡透析液相色谱串联质谱(LC-MS/MS)方法。
    结果:Alinity测得的FT4和FT3浓度明显低于其他方法,特别是在高FT4浓度。回归分析表明,AlinityFT4与其他方法测得的FT4具有非线性(弯曲)关系。方法差异影响了指南推荐的甲状腺功能亢进治疗。
    结论:测得的游离甲状腺激素浓度高度依赖于方法,特别是在高FT4浓度。治疗甲状腺功能亢进患者的临床医生应该意识到,与Cobas或Centaur相比,使用Alinity进行的FT4测量显示患者的甲状腺功能亢进要少得多。基于FT4的指南推荐的抗甲状腺药物剂量(包括上限参考范围的倍数)必须根据所使用的FT4方法进行调整。来自不同方法的FT4结果应在医疗记录中明确区分(例如单独的行)。
    BACKGROUND: Free T4 (FT4) determination is one of the most commonly performed biochemical tests in endocrinology. Treatment of thyroid dysfunctions is adjusted based on the severity of symptoms and biochemical test results. For Graves\' hyperthyroidism, clinical guidelines recommend using FT4 as a (rough) guide to dose antithyroid drugs, together with other clinical information. It is well known that different platforms and methods give different FT4 results; however, large non-linear method differences at high FT4 concentrations are less well recognized. Current clinical guidelines do not make it clear that method differences in the hyperthyroid range can affect recommendations.
    METHODS: Serum samples from patients with very low (biochemically hypothyroid) to very high (hyperthyroid) concentrations of FT4 and/or free T3 (FT3) were analyzed using Abbott Alinity and compared to concentrations measured using Roche Cobas, Siemens ADVIA Centaur (FT4 only) and an in-house equilibrium dialysis liquid chromatography tandem mass spectrometry (LC-MS/MS) method.
    RESULTS: Alinity measured markedly lower FT4 and FT3 concentrations compared to the other methods, particularly at high FT4 concentrations. Regression analysis indicated that Alinity FT4 had a non-linear (curved) relationship to FT4 measured by the other methods. The method differences affected guideline-recommended treatments for hyperthyroidism.
    CONCLUSIONS: Measured free thyroid hormone concentrations are highly method-dependent, especially at high FT4 concentrations. Clinicians treating hyperthyroid patients should be aware that patients appear much less hyperthyroid from FT4-measurements performed using Alinity compared to Cobas or Centaur. Guideline-recommended antithyroid drug dosages based on FT4 (including multiples of the upper reference range) have to be adjusted to the FT4 method used. FT4 results from different methods should be clearly distinguished (e.g. separate lines) in medical records.
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