Hernandez F C, Sánchez M, Alvarez A, Díaz J, Pascual R, Pérez M, Tovar I, Martínez P
Department of Clinical Chemistry, University Hospital Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain.
Clin Biochem. 2000 Nov;33(8):649-55. doi: 10.1016/s0009-9120(00)00172-7.
The purpose of the study is to identify biochemical tests that are good predictors for the diagnosis of pheochromocytoma in patients at hypertension.
Review of data from of 3826 patients studied over a 5-year period, between 1994 and 1998, at the University Hospital Virgen de la Arrixaca, Murcia, Spain.
A retrospective study for the diagnosis of pheochromocytoma of 24-h urinary free catecholamines (norepinephrine, epinephrine, and dopamine) measured by high-performance liquid chromatography (HPLC)-electrochemical detector (ECD), total metanephrines (MNt), and vanillylmandelic acid measured by spectrophotometric methods.
During this period, 57 patients were found to have pheochromocytoma, being 47 sporadic, 9 with multiple endocrine neoplasia type 2A, and 1 with neurofibromatosis. In all patients multiple endocrine neoplasia type 2A the tumor were bilateral but only in four of the sporadic tumor group (p < 0.0001, Fisher's exact test). MNt was determined to be the best discriminator of hypertension and pheochromocytoma. It scored a sensitivity of 94.7% (95% confidence interval, 88.3-99.9%), a specificity of 95.3% (89.5-99.9%), and thus had the best negative predictive value of 99.9% (99.8-99.9%), and this biochemical test also had the best positive predictive value of 23.3% (10.8-59.9%). When combining both MNt and norephinephrine, the positive predictive value to increases to 85.6% (65.3-95.6%).
Urinary 24-h MNt excretion level is the best single biochemical test for screening and, in combination with norephinephrine, is diagnostic of the presence of pheochromocytoma.
本研究旨在确定对高血压患者嗜铬细胞瘤诊断具有良好预测价值的生化检测指标。
回顾1994年至1998年期间在西班牙穆尔西亚的比贞德拉阿里克萨卡大学医院对3826例患者进行研究的数据。
采用回顾性研究方法，通过高效液相色谱（HPLC）-电化学检测器（ECD）检测24小时尿游离儿茶酚胺（去甲肾上腺素、肾上腺素和多巴胺），采用分光光度法检测总甲氧基肾上腺素（MNt）和香草扁桃酸，以诊断嗜铬细胞瘤。
在此期间，发现57例患者患有嗜铬细胞瘤，其中47例为散发性，9例为2A型多发性内分泌腺瘤病，1例患有神经纤维瘤病。在所有2A型多发性内分泌腺瘤病患者中，肿瘤均为双侧性，但散发性肿瘤组中只有4例（p<0.0001，Fisher精确检验）。MNt被确定为高血压和嗜铬细胞瘤的最佳鉴别指标。其敏感性为94.7%（95%置信区间，88.3-99.9%），特异性为95.3%（89.5-99.9%），因此具有最佳的阴性预测值99.9%（99.8-99.9%），该生化检测指标的阳性预测值也最佳，为23.3%（10.8-59.9%）。当同时检测MNt和去甲肾上腺素时，阳性预测值提高到85.6%（65.3-95.6%）。
24小时尿MNt排泄水平是筛查嗜铬细胞瘤的最佳单一生化检测指标，与去甲肾上腺素联合检测可诊断嗜铬细胞瘤的存在。
