嗜铬细胞瘤切除术后患者血浆中儿茶酚胺、总甲氧基肾上腺素和神经肽Y的消失率。

Disappearance rate of catecholamines, total metanephrines, and neuropeptide Y from the plasma of patients after resection of pheochromocytoma.

作者信息

Grouzmann E, Fathi M, Gillet M, de Torrenté A, Cavadas C, Brunner H, Buclin T

机构信息

Division d'Hypertension, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.

出版信息

Clin Chem. 2001 Jun;47(6):1075-82.

PMID:11375294

Abstract

BACKGROUND

Plasma free metanephrines are a more reliable analyte to measure than catecholamines for the biochemical diagnosis of pheochromocytomas. We hypothesized that the long persistence of total (sulfate-conjugated plus free) metanephrines in the blood might have a significant diagnostic value.

METHODS

We measured plasma concentrations of catecholamines and total metanephrines (sulfate-conjugated plus free forms) by HPLC with amperometric detection, and neuropeptide Y (NPY) by an amplified ELISA in seven patients before and after removal of their pheochromocytomas. The results for catecholamine, total metanephrines, and NPY in each patient were analyzed for up to 120 min, starting from the time of tumor vessel clamping. The persistence of analytes was quantified as the area under the concentration-time curve over 120 min.

RESULTS

On the basis of the upper reference limit for each variable, plasma free norepinephrine (NE) and epinephrine (E) concentrations were increased preoperatively in at least one sample in seven and six patients, respectively. Total normetanephrine (NMN) and metanephrine (MN) were increased in all samples in seven and six patients, respectively. NPY was increased 2- to 465-fold. After removal of the tumor, MN and NMN showed a higher average relative increase above the upper limit of the reference interval than NE and E (P = 0.05), whereas NPY was intermediate. The persistence of increased values was significantly shorter for catecholamines than for metanephrines. The half-life estimated by nonlinear regression was 12.3 +/- 7.8 min for NPY. Significant correlations were observed among NE, E, NMN, MN, and NPY concentrations, but parent markers (E and MN or NE and NMN) did not appear significantly intercorrelated.

CONCLUSIONS

A larger increase and a longer persistence of total metanephrines (reflecting predominantly sulfo-conjugated metanephrines) than catecholamines and NPY in plasma may contribute to their greater diagnostic accuracy in pheochromocytoma.

摘要

背景

对于嗜铬细胞瘤的生化诊断，血浆游离甲氧基肾上腺素是比儿茶酚胺更可靠的检测指标。我们推测血液中总（硫酸结合型加游离型）甲氧基肾上腺素的长时间持续存在可能具有重要的诊断价值。

方法

我们采用高效液相色谱-安培检测法测定了7例嗜铬细胞瘤患者肿瘤切除前后血浆中儿茶酚胺和总甲氧基肾上腺素（硫酸结合型加游离型）的浓度，并用放大酶联免疫吸附测定法测定了神经肽Y（NPY）的浓度。从肿瘤血管夹闭时开始，对每位患者的儿茶酚胺、总甲氧基肾上腺素和NPY的结果进行长达120分钟的分析。将分析物的持续时间量化为120分钟内浓度-时间曲线下的面积。

结果

根据每个变量的参考上限，在7例患者中，至少有一个样本的术前血浆游离去甲肾上腺素（NE）和肾上腺素（E）浓度分别升高；在7例和6例患者中，所有样本的总去甲变肾上腺素（NMN）和变肾上腺素（MN）均升高。NPY升高了2至465倍。肿瘤切除后，MN和NMN高于参考区间上限的平均相对升高幅度高于NE和E（P = 0.05），而NPY则介于两者之间。儿茶酚胺升高值的持续时间明显短于甲氧基肾上腺素。通过非线性回归估计，NPY的半衰期为12.3±7.8分钟。在NE、E、NMN、MN和NPY浓度之间观察到显著相关性，但母体标志物（E和MN或NE和NMN）之间未出现显著相关性。