乾燥濾紙血液を用いたサイロキシン測定法の検討, 並びにその先天性甲状腺機能低下症早期発見応用に関する研究
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We examined the method of radioimmunoassay of the Disc T<SUB>4</SUB> (dried blood spot T<SUB>4</SUB>) for the purpose of mass screening of neonatal hypothyroidism and tried the parallel assay of T<SUB>4</SUB> and TSH in dried blood spotted on filter paper at the fifth day of life, and we compared the results.<BR>By changing the volumes of T<SUB>4</SUB> antibody and T<SUB>4</SUB> antigen solutions, it is possible to measure thyroxine using two discs 3mm in diameter. Disc T<SUB>4</SUB> values obtained in 45 unknown samples by this method were in good correlation with serum T<SUB>4</SUB> values of the same subjects (Y = 0.97X + 0.06). The coefficients of variation were 5.6 to 18.9% in the range of 5.3 to 10.7 μg/100ml of Disc T<SUB>4</SUB> (within assay), and 7.9 to 20.8% in the range of 2.4 to 10.3 μg/ 100ml of Disc T<SUB>4</SUB> (between assay).<BR>We measured both Disc T<SUB>4</SUB> and Disc TSH of 26,067 newborn infants born between June 1978 and May 1979. Out of 26,067 measurements, four cases of primary hypothyroidism, fourteen cases of TBG deficiency and two cases of transient hypothyroidism were dis-covered. Out of the four cases of primary hypothyroidism, three showed low Disc T<SUB>4</SUB> (1.3 to 4.0 μg/100ml) and high Disc TSH (200 to 240 pu/ml), one showed normal Disc T<SUB>4</SUB> (7.1 μg/100ml) and high Disc TSH (30 pu/ml). It was thought the last case might be mild hypothyroidism. In 14 cases of TBG deficiency, Disc T<SUB>4</SUB> was not detectable to 3.4 μg/100ml while Disc TSH was within the normal range. In two cases of transient hypothyroidism, Disc T<SUB>4</SUB> measurements showed normal range (6.5, 10.6 μg/100ml), and Disc TSH showed high values (41,120 pu/ml). Therefore, Disc TSH was more sensitive and showed less false positive cases than did Disc T<SUB>4</SUB> for screening hypothyroidism. Although no secondary hypothyroidism existed in the 26,067 measurements, it continues to be important to measure Disc T<SUB>4</SUB> for the discovery of secondary or tertiary hypothyroidism.
- 日本内分泌学会の論文
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