Gardet V, Gatta B, Simonnet G, Tabarin A, Chêne G, Ducassou D, Corcuff J B
Department of Nuclear Medicine, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
J Hypertens. 2001 Jun;19(6):1029-35. doi: 10.1097/00004872-200106000-00006.
To audit the performances of the analytes used in the diagnosis of pheochromocytoma and to present a graphical guideline to help the diagnosis.
A 5 year retrospective study.
Laboratory and departments of a university hospital.
In-patients, suspected of bearing a pheochromocytoma, were investigated for urinary metanephrines and catecholamines (photometric method) and vanillylmandelic acid, fractionated catecholamines and metanephrines [high pressure liquid chromatography (HPLC) coupled to electrochemical detection (ED)] urinary excretion.
Patients with a pheochromocytoma (24 out of 2003 patients) were diagnosed by the combination of normetanephrine and metanephrine determination.
All analytes but dopamine were significantly elevated in patients with a pheochromocytoma. The area under the receiver operating characteristics (ROC) curves were the highest for total metanephrines, normetanephrine and metanephrine determinations. Because of analytical interferences in the metanephrines determination, the normetanephrine and metanephrine performed better. It is noteworthy that all pheochromocytomas had either normetanephrine or metanephrine levels above their respective optimal threshold (sensitivity 100%). The best optimal threshold performance was reached by the mean of three daily samples. Total or fractionated catecholamines or vanillylmandelic acid were less accurate tools.
Amongst urinary tests, the combined use of HPLC/ED determination of normetanephrine and metanephrine seems the most effective screening strategy for the diagnosis of pheochromocytoma. The older total metanephrine photometric assay is grieved by analytical interferences.
审核用于嗜铬细胞瘤诊断的分析物的性能,并提供一份图形指南以辅助诊断。
一项为期5年的回顾性研究。
一所大学医院的实验室及各科室。
怀疑患有嗜铬细胞瘤的住院患者接受了尿间甲肾上腺素和儿茶酚胺(光度法)以及香草扁桃酸、儿茶酚胺和间甲肾上腺素的分级测定[高压液相色谱法(HPLC)结合电化学检测(ED)]的尿排泄量检测。
通过去甲变肾上腺素和变肾上腺素测定相结合的方法诊断出嗜铬细胞瘤患者(2003例患者中有24例)。
除多巴胺外,嗜铬细胞瘤患者的所有分析物均显著升高。总变肾上腺素、去甲变肾上腺素和变肾上腺素测定的受试者工作特征(ROC)曲线下面积最高。由于变肾上腺素测定存在分析干扰,去甲变肾上腺素和变肾上腺素表现更佳。值得注意的是,所有嗜铬细胞瘤患者的去甲变肾上腺素或变肾上腺素水平均高于各自的最佳阈值(敏感性100%)。通过每日三个样本的均值可达到最佳的最佳阈值性能。总儿茶酚胺或分级儿茶酚胺或香草扁桃酸是准确性较低的检测工具。
在尿液检测中,联合使用HPLC/ED法测定去甲变肾上腺素和变肾上腺素似乎是诊断嗜铬细胞瘤最有效的筛查策略。较老的总变肾上腺素光度测定法受到分析干扰的困扰。