南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (03): 342-345.doi: 10.12122/j.issn.1673-4254.2020.03.06

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血液标本灭活处理对液相串联质谱法伏立康唑治疗药物监测的 影响及其在COVID-19疫情期间的应用

赵博欣,刘思佳,刘 媛,李国锋,张 庆   

  • 出版日期:2020-04-08 发布日期:2020-03-20
  • 基金资助:

Liquid chromatography tandem mass spectrometry for therapeutic drug monitoring of voriconazole in heat-inactivated blood samples: its application during COVID-19 pandemic

  

  • Online:2020-04-08 Published:2020-03-20

摘要: 目的 研究新型冠状病毒56 ℃ 30 min灭活方法引起的改变对TDM液质联用优化检测伏立康唑的影响并探讨该方法在疫情防控期间的应用。方法 将临床送检抗凝采血管以75%乙醇表面消毒后,混匀全血,分为非灭活分离血浆组,全血灭活分离血浆组,分离血浆后灭活组。灭活方法采用56 ℃ 30 min水浴,再以1∶3比例的乙腈或乙醇沉淀血浆蛋白处理样品。血浆标准曲线样品及质控样品分别采用同等条件灭活与非灭活处理。结果 应用优化的串联质谱检测方法,伏立康唑在不同浓度下灭活样品平均准确率为97.37%,日间精密度为3.59%,日内精密度为2.81%。以乙腈或乙醇为沉淀蛋白提取溶剂均能获得较高的提取回收率,均值分别为100.56%及95.90%,并且基质效应影响较小,均值分别为102.85%及93.62%。临床标本中,全血及血浆灭活的伏立康唑浓度与非灭活检测结果均呈现良好的线性相关性关系,各组间相关系统均大于0.99。结论 血液标本以采血管内56 ℃ 30 min灭活结合乙醇处理血浆样品对串联质谱法伏立康唑血浆浓度检测影响较小,可用于疫情防控期间伏立康唑液相串联质谱法治疗药物监测的开展。

Abstract: Objective To investigate the effect of heat inactivation (56 ℃ for 30 min) of SARS-CoV-2 on the results of therapeutic drug monitoring (TDM) of voriconazole by liquid chromatography tandem mass spectrometry (LC-MS/MS). Methods We collected clinical blood samples from voriconazole-treated patients in heparinized tubes and sterilized the surface of the tubes with 75% ethanol. The whole blood samples were centrifuged to separate the plasma with or without prior heat inactivation, or only the separated plasma was heat inactivated. Heat inactivation of the samples was carried out at 56 ℃ for 30 min followed by protein precipitation with acetonitrile or ethanol. The plasma standard and quality control samples were inactivated in an identical manner and tested with LC-MS/MS along with the treated samples. Results The optimized method showed a high imprecision (with mean intra- and inter-day imprecisions of 3.59% and 2.81%, respectively) and a high accuracy (mean 97.37%) for detecting voriconazole in the inactivated samples at different concentration levels. Sample preparation with acetonitrile or ethanol resulted in a high mean recovery (100.56% or 95.90% ) with minimal mean matrix effect (102.85% or 93.62% ). The measured voriconazole concentrations in inactivated whole blood, inactivated plasma and the samples without inactivation all showed good linear correlations with correlation coefficients all greater than 0.99. Conclusion Heat inactivation at 56 ℃ for 30 min combined with ethanol sample preparation only has limited effects to affect LC-MS-based voriconazole concentration measurement in whole blood samples collected in heparinized tubes, and can be used for therapeutic drug monitoring of voriconazole during the ongoing COVID-19 pandemic.