총콜레스테롤 및 중성지방 검사에서 비타민 C에 의한 음성간섭영향
The negative role of Vitamin C in total cholesterol and triglycerides tests
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배경: 저자들은 Trinder 반응에 기반한 총콜레스테롤 및 중성지방 측정 중에 음성간섭현상이 발생한 사례를 검토하여 그 원인을 규명하고자 하였다. 방법: 19개월간 총콜레스테롤이나 중성지방 검사결과가 비정상적으로 낮았던 63건의 검사를 특정하였으며, 한 명의 환자에서 여러건의 비정상 결과가 발생한 경우가 있었기에 연구대상 환자는 48명이었다. 해당 검체들에 대해 지질 프로필(총콜레스테롤, 중성지방, HDL-콜레스테롤, LDL-콜레스테롤) 검사가 이루어졌으며, 두 종류의 시약-Roche Diagnostics (독일) 및 Sekisui Medical (일본)-을 사용하여 Cobas c702 (Roche) 장비에서 측정하였다. 비타민 C 첨가량에 따라 9가지 농도로 제조한 혈청에 대해 두 회사 시약으로 지질 프로필 4종을 측정하였다. 결과: Ascorbate oxidase를 포함하지 않는 Roche의 총콜레스테롤 및 중성지방 시약 측정값(평균±표준편차)은 52.76±56.80 mg/dL, 10.46±1.67 mg/dL이었으며, ascorbate oxidase를 포함하는 Sekisui의 총콜레스테롤 및 중성지방 시약을 이용한 측정값은154.19±46.78 mg/dL, 106.16±63.27 mg/dL이었다. 반면 HDL-콜레스테롤과 LDL-콜레스테롤 측정값은 큰 차이를 보이지 않았다. 대상 환자의 83%는 악성종양을 진단받았는데 이들은 고용량 비타민 C 치료를 받았을 가능성이 있었고, 27%는 만성신장병을 진단 받았는데 이는 비타민 C 투여를 지속하고 있을 가능성이 있는 병력으로 생각되었다. 25.0 mg/dL의 비타민 C를 첨가한 후 Roche 시약으로 측정한 혈청에서 총콜레스테롤과 중성지방은 각각 27%, >95%의 농도가 감소되었지만, Sekisui 시약에서는 거의 감소되지 않았다. 결론: 특정 질환 환자에서는 비정상적으로 낮은 총콜레스테롤 및 중성지방 측정값이 발생할 수 있다. 지질검사에서 음성간섭현상이 의심되면 ascorbate oxidase가 포함된 시약을 사용한 재검이 필요하며, 환자 병력을 확인하여 비타민 C가 원인일 가능성을 검토해야 한다.
Abstract
Background: This study aimed to determine the cause of low total cholesterol and triglyceride levels based on the Trinder reaction by reviewing cases of negative interference. Methods: We analyzed the results of total cholesterol and triglyceride tests performed over 19 months. Sixty-three test results from 48 patients showing abnormally low total cholesterol or triglyceride levels were included. Lipid profile (total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol) was evaluated with Roche Diagnostics (Germany) and Sekisui Medical (Japan) reagents by using Cobas c702 analyzer (Roche). In vitro lipid profile tests were also determined using both above reagents for serum spiked with nine different concentrations of vitamin C. Results: Total cholesterol and triglyceride levels measured using Roche reagents (without ascorbate oxidase) were significantly lower than those using Sekisui reagents containing ascorbate oxidase respectively. HDL-cholesterol and LDL-cholesterol levels showed no significant difference between the two company reagents. Malignancy was diagnosed in 83% of the patients, and the patients have the possibility of receiving high-dose vitamin C therapy. In addition, 27% of the patients were diagnosed with chronic kidney disease. At the level of 25.0 mg/dL vitamin C to the serum, total cholesterol and triglyceride levels, measured using Roche reagents, reduced by 27% and 95%, respectively, but were rarely reduced when using Sekisui reagents. Conclusions: When negative interference is suspected in the total cholesterol or triglyceride of patients, the specimens need to be retested with the reagent containing ascorbate oxidase, and the patient’s medical record should be reviewed thoroughly.
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