Nobin A, Karp W, Lunderquist A, Rosengren E, Sandén G, Sundler F
Brain Res Bull. 1982 Jul-Dec;9(1-6):781-97. doi: 10.1016/0361-9230(82)90186-1.
Selective catheterization of hepatic, intestinal and adrenal veins with blood sampling for serotonin and catecholamine determination was evaluated regarding its use in the diagnosis, location and characterization of carcinoids and pheochromocytomas. Catheterization of intestinal veins via the transhepatic route and of the adrenal veins via the femoral and caval veins was performed in 49 patients without major complications. High pressure liquid chromatography with electrochemical detection was used to quantitate norepinephrine and epinephrine in plasma and serotonin in plasma and whole blood. Serotonin in plasma was also determined by an enzymatic procedure. In 30 patients with suspected or verified carcinoid tumors concentration of serotonin in tumor-draining veins was clearly elevated in all patients but one. In this patient, who previously had been treated with temporary liver dearterialization, the serotonin concentration in the hepatic vein was within the normal range in spite of the existence of liver metastases. Hyperserotoninemia was registered in one patient without detectable carcinoid tumor cells. In three patients determination of norepinephrine and epinephrine in adrenal venous blood diagnosed a hyperplasia and tumors in the adrenal medulla. In these cases angiography and computed tomography were negative. Microscopic analyses revealed serotonin in all carcinoids and substance P-like immunoreactivity in a large percentage of these tumors. PP-like and glucagon-like immunoreactivity were observed in two endocrine pancreatic tumors. In normal adrenal medulla and in adrenal medullary tumor tissue catecholamine fluorescence and enkephalin-like immunoreactivity were demonstrated. In the two pheochromocytomas ACTH-like, somatostatin-like and calcitonin-like immunoreactivities were identified. The technique with determinations of plasma serotonin and catecholamines in combination with selective catheterization is a useful investigation for the diagnosis, location and follow-up of patients with carcinoids and pheochromocytomas.
对通过肝、肠和肾上腺静脉选择性插管采血以测定血清素和儿茶酚胺在类癌和嗜铬细胞瘤诊断、定位及特征描述中的应用进行了评估。对49例患者经肝途径进行肠静脉插管以及经股静脉和腔静脉进行肾上腺静脉插管，未出现重大并发症。采用带电化学检测的高压液相色谱法定量测定血浆中的去甲肾上腺素和肾上腺素以及血浆和全血中的血清素。血浆中的血清素也通过酶促方法测定。在30例疑似或确诊类癌肿瘤的患者中，除1例患者外，所有患者引流肿瘤的静脉中血清素浓度均明显升高。该患者此前曾接受过暂时性肝动脉阻断治疗，尽管存在肝转移，但肝静脉中的血清素浓度仍在正常范围内。1例无可检测到的类癌细胞的患者出现了高血清素血症。3例患者肾上腺静脉血中去甲肾上腺素和肾上腺素的测定诊断出肾上腺髓质增生和肿瘤。在这些病例中，血管造影和计算机断层扫描均为阴性。显微镜分析显示所有类癌中均有血清素，且这些肿瘤中有很大比例存在P物质样免疫反应性。在两个内分泌胰腺肿瘤中观察到PP样和胰高血糖素样免疫反应性。在正常肾上腺髓质和肾上腺髓质肿瘤组织中证实有儿茶酚胺荧光和脑啡肽样免疫反应性。在两个嗜铬细胞瘤中鉴定出促肾上腺皮质激素样、生长抑素样和降钙素样免疫反应性。结合选择性插管测定血浆血清素和儿茶酚胺的技术对类癌和嗜铬细胞瘤患者的诊断、定位及随访是一项有用的检查。
