Although the problem of abuse of immunoassay items is not a pure test problem, this problem seems to be more closely related to clinicians, but once the abuse of test items occurs, the responsibility of the laboratory can not be shirk, at least we have not done well The publicity and interpretation of the clinical application value of inspection projects, the rapid development of contemporary laboratory medicine, has made new inspection projects continue to enter our clinical laboratories. As the first contact of these new projects, clinical inspection personnel, especially the person in charge, are also responsible The clinical application value of these projects must be fully understood and communicated to each relevant clinician in lectures or other suitable ways. In addition, we should consciously avoid abuse caused by pure pursuit of economic benefits.
The abuse of immune test items is mainly manifested in the following aspects. One is the abuse of serological markers of infectious pathogen infection. For example, some clinical laboratories have carried out quantitative measurement of HBsAg, HBeAg and even anti-HCV and syphilis antibodies to judge the therapeutic effect of clinical patients. Due to the lack of understanding of the relationship.
At present, there are two main types of anti-pathogen drug treatment for infectious diseases: one is to kill antibiotics such as syphilis and tuberculosis; the other is to suppress antiviral treatments such as hepatitis B and C. When the treatment is effective, the former shows the disappearance of pathogens, the latter shows a dynamic decrease in the number of pathogens. Therefore, what is closely related to the therapeutic effect is the existence or the number of pathogens. Antibodies, because they are the product of the body ’s specific immune response to specific antigen components of the pathogen, even if the pathogen has disappeared or greatly reduced due to the application of antibacterial or antiviral drugs, it may exist in the body for a long period of time or continue to exist , Which has no positive correlation with the presence or quantity of pathogens.
Maybe there is a question to ask, what about pathogen antigens? Are they not part of the pathogens? It should be said that their content is positively correlated with the pathogens. This requires specific analysis of the specific situation. As mentioned above, HBsAg and HBeAg will not work, because HBsAg exists in three forms in the blood circulation of hepatitis B patients, namely round particles, tubular particles and Dan particles, of which only hepatitis B virus exists in Dan particles, but it only accounts for all 0.2% of HBsAg, the other is mostly empty round particles and tube-shaped particles, so there is naturally a lack of positive correlation between HBsAg and hepatitis B virus.
HBeAg usually has a good positive correlation with the presence of hepatitis B virus, and it is also a major serological indicator of the strength of infectivity in hepatitis B patients. It should be reasonable to be used as an observation indicator of anti-viral efficacy of hepatitis B patients. Do, but because the pre-C region of the hepatitis B virus genome is often prone to point mutations, resulting in the loss of HBeAg expression, serum HB, Ag test is negative at this time, but a large number of pathogens still exist. Therefore, HBeAg can not be used as an index for the observation of antiviral efficacy of hepatitis B patients.
The second serious problem is the abuse of tumor markers. At present, there are many tumor marker projects carried out in clinical laboratories, and there are nearly a dozen kinds of commonly used ones. Usually, when a patient comes, he will check it for five or six items, and some even check a dozen or twenty items. It is known that most of the commonly used tumor markers are not used for the diagnosis of patients with unknown tumors, because these tumor markers such as the CA series do not have good organ specificity, but only in certain or certain The probability and concentration of its appearance in tumor-like tumors are relatively higher. Therefore, it should be a monitoring marker for the treatment and recurrence of known tumor patients, not a diagnostic marker. Of course, some people have proposed whether tumor markers can be used in combination for diagnosis, but there is no ideal combination application model that is specific and sensitive to a certain tumor.
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