Bílek R, Zelinka T, Vlček P, Dušková J, Michalský D, Novák K, Václavíková E, Widimský J
Institute of Endocrinology, Prague, Czech Republic.
Physiol Res. 2017 Sep 26;66(Suppl 3):S397-S408. doi: 10.33549/physiolres.933719.
This work discusses the clinical performance of chromogranin A, free metanephrine and normetanephrine determination in plasma using a radioimmunoanalytical methods for the diagnosis of pheochromocytoma and paraganglioma. Blood samples were collected from 55 patients (46 pheochromocytomas, 9 paragangliomas). A sampling of biological materials was performed preoperatively and about one week, six months and one year after adrenal gland surgery. The comparative group without a diagnosis of pheochromocytoma/paraganglioma consisted of 36 pheochromocytoma/paraganglioma patients more than 4 months after adrenal gland surgery, and of 87 patients, 16 of them with multiple endocrine neoplasia, 9 with medullary and 5 with parafolicullar carcinoma of the thyroid gland. The rest were patients with various adrenal gland disorders. Chromogranin A, metanephrine and normetanephrine were determined in the EDTA-plasma using a radioimmunoassay kits Cisbio Bioassays, France and IBL International GmbH, Germany. Clinical sensitivity was 96 % for the combination of metanephrine and normetanephrine, and 93 % for chromogranin A. Clinical specificity was 100 % for the combination metanephrine and normetanephrine, and 96 % for chromogranin A. Falsely elevated levels of chromogranin A were observed in 1 patient with chronic renal insufficiency and 9 analyses were influenced by the administration of proton pump inhibitors. These results were excluded of CGA specificity. Both the combination of plasma free metanephrine, normetanephrine and chromogranin A as determined by radioimmunoassays, which are simple without the necessity of special laboratory material, are effective markers of pheochromocytoma or paraganglioma. Chromogranin A exerts association to malignity and all markers are associated with tumor mass.
本研究探讨了采用放射免疫分析方法测定血浆中嗜铬粒蛋白A、游离甲氧基肾上腺素和甲氧基去甲肾上腺素在嗜铬细胞瘤和副神经节瘤诊断中的临床应用价值。收集了55例患者的血样（46例嗜铬细胞瘤，9例副神经节瘤）。在术前以及肾上腺手术后约1周、6个月和1年采集生物样本。未诊断为嗜铬细胞瘤/副神经节瘤的对照组包括肾上腺手术后4个月以上的36例嗜铬细胞瘤/副神经节瘤患者，以及87例患者，其中16例患有多发性内分泌腺瘤，9例患有甲状腺髓样癌，5例患有甲状腺滤泡旁癌。其余为患有各种肾上腺疾病的患者。使用法国Cisbio Bioassays公司和德国IBL International GmbH公司的放射免疫分析试剂盒测定EDTA血浆中的嗜铬粒蛋白A、甲氧基肾上腺素和甲氧基去甲肾上腺素。甲氧基肾上腺素和甲氧基去甲肾上腺素联合检测的临床敏感性为96%，嗜铬粒蛋白A为93%。甲氧基肾上腺素和甲氧基去甲肾上腺素联合检测的临床特异性为100%，嗜铬粒蛋白A为96%。1例慢性肾功能不全患者观察到嗜铬粒蛋白A水平假性升高，9次分析受到质子泵抑制剂给药的影响。这些结果被排除在嗜铬粒蛋白A特异性之外。通过放射免疫分析测定的血浆游离甲氧基肾上腺素、甲氧基去甲肾上腺素和嗜铬粒蛋白A联合检测方法简单，无需特殊实验室材料，是嗜铬细胞瘤或副神经节瘤的有效标志物。嗜铬粒蛋白A与恶性程度相关，所有标志物均与肿瘤大小相关。
