Biochemistry Department, Crosshouse Hospital, Kilmarnock KA2 0BE, UK.
Ann Clin Biochem. 2011 Jul;48(Pt 4):358-66. doi: 10.1258/acb.2011.011023. Epub 2011 Jun 13.
Neuroblastoma is the most common extracranial solid tumour in childhood (8% of all childhood cancers), the most frequently diagnosed in infancy, and has one of the highest death rates, while chromaffin tumours rarely present in childhood. Both tumour types produce catecholamines and their metabolites. It is difficult to produce reference ranges for tests in children, and currently, no age-related medical decision limits for free metadrenalines (free metanephrines) in random urine specimens exist in the paediatric literature.
Results of vanillylmandelic acid (VMA), 5-hydroxyindoleacetic acid, homovanillic acid (HVA), noradrenaline (NA), adrenaline, dopamine (DA), free normetadrenaline (fNMA), free metadrenaline and free 3-methoxytyramine (f3MT) in 1658 random urines obtained from infants, children and young adults were measured by high performance liquid chromatography with electrochemical detection. Specimens were excluded from consideration if obtained from the following categories, i.e. (a) harbouring neuroblastic, chromaffin, carcinoid or other tumours or malignancies; (b) medical conditions having known association with excess catecholamine excretion; (c) patients administered catecholamine or paracetamol; (d) overly dilute urine; and (e) manifesting outlying values following visual inspection.
There remained 872 specimens that were grouped into seven age ranges (<1; 1 or 2; 3 or 4; 5-7; 8-10; 11-13; 14-19 y) for which medical decision limits were determined for each analyte. There was no significant difference between the results for boys or girls. In 55 patients harbouring neuroblastic tumours, HVA (54/55), f3MT (14/16), VMA (45/53) and DA (43/53) were the most frequently elevated analytes at time of diagnosis. In 11 patients presenting in childhood with chromaffin tumours, fNMA (11/11) followed by NA (10/11) were the most frequently elevated. Discussion The likely reasons for outlying or missing values, together with the reasons for variation in the distinctive biochemical patterns of analytes exhibited in individuals harbouring either neuroblastic or chromaffin tumours are discussed.
神经母细胞瘤是儿童期最常见的颅外实体瘤（占儿童期所有癌症的 8%），在婴儿期最常被诊断出，死亡率最高，而嗜铬细胞瘤在儿童期很少见。这两种肿瘤类型都会产生儿茶酚胺及其代谢物。儿童检测的参考范围较难确定，目前，儿科文献中也没有针对随机尿样中游离代谢肾上腺素（游离甲氧基肾上腺素）的年龄相关医学决策限值。
采用高效液相色谱电化学检测法检测了 1658 例婴儿、儿童和年轻成人的香草扁桃酸（VMA）、5-羟色氨酸、高香草酸（HVA）、去甲肾上腺素（NA）、肾上腺素、多巴胺（DA）、游离正甲氧基肾上腺素（fNMA）、游离代谢肾上腺素和游离 3-甲氧基酪胺（f3MT）的含量。如果尿液样本符合以下类别，则不纳入研究范围，即（a）含有神经母细胞瘤、嗜铬细胞瘤、类癌或其他肿瘤或恶性肿瘤；（b）已知与儿茶酚胺过量排泄有关的医疗条件；（c）患者服用儿茶酚胺或对乙酰氨基酚；（d）尿液过度稀释；（e）经目视检查后显示异常值。
872 例尿液样本符合研究要求，这些样本被分为七个年龄组（<1；1 或 2；3 或 4；5-7；8-10；11-13；14-19 岁），并确定了每个分析物的医学决策限值。男孩和女孩的检测结果没有显著差异。在 55 例患有神经母细胞瘤的患者中，HVA（54/55）、f3MT（14/16）、VMA（45/53）和 DA（43/53）是诊断时最常升高的分析物。在 11 例儿童期嗜铬细胞瘤患者中，fNMA（11/11）紧随其后的是 NA（10/11）。讨论：讨论了出现异常值或缺失值的可能原因，以及导致神经母细胞瘤或嗜铬细胞瘤患者表现出独特生化模式的分析物发生变化的原因。
