嗜铬细胞瘤的生化检测：我们是否仍应检测尿中高香草酸？
Biochemical detection of phaeochromocytoma: should we still be measuring urinary HMMA?
作者信息
Peaston R T, Lai L C
机构信息
Department of Clinical Biochemistry, Freeman Hospital, Newcastle upon Tyne.
出版信息
J Clin Pathol. 1993 Aug;46(8):734-7. doi: 10.1136/jcp.46.8.734.
AIMS
To compare the diagnostic value of biochemical tests in the detection of phaeochromocytoma.
METHODS
Urinary catecholamines and metabolites were measured by high performance liquid chromatography in the initial 24 hour collections from 31 patients with histologically confirmed phaeochromocytoma. Results were compared with values from 50 patients investigated for the possible presence of a phaeochromocytoma but in whom an alternative diagnosis was later established.
RESULTS
The diagnostic sensitivity for the measurement of normetadrenaline (NMT) (97%) was greater than any other single factor. Use of a combined noradrenaline and adrenaline value in preference to individual values increased the sensitivity of free catecholamines to 97%. Urinary 4-hydroxy-3-methoxymandelic acid (HMMA) showed a much lower sensitivity for the detection of phaeochromocytoma (81%). An increased excretion of either noradrenaline, adrenaline, or combined catecholamines was found in all 31 patients.
CONCLUSIONS
A combination of biochemical tests improves the detection of phaeochromocytoma. The measurement of urinary free catecholamines or metadrenalines, or both, is better than HMMA estimation. It is recommended that the practice of using only HMMA measurements for the biochemical detection of phaeochromocytoma should be abandoned.
目的
比较生化检测在嗜铬细胞瘤检测中的诊断价值。
方法
采用高效液相色谱法测定31例经组织学确诊的嗜铬细胞瘤患者最初24小时尿液中的儿茶酚胺及其代谢产物。将结果与50例因可能存在嗜铬细胞瘤而接受检查但后来确诊为其他疾病的患者的检测值进行比较。
结果
去甲变肾上腺素（NMT）测定的诊断敏感性（97%）高于其他任何单一因素。优先使用去甲肾上腺素和肾上腺素的联合值而非单个值可将游离儿茶酚胺的敏感性提高至97%。尿4-羟基-3-甲氧基扁桃酸（HMMA）对嗜铬细胞瘤的检测敏感性低得多（81%）。在所有31例患者中均发现去甲肾上腺素、肾上腺素或儿茶酚胺联合排泄增加。
结论
联合生化检测可提高嗜铬细胞瘤的检出率。测定尿游离儿茶酚胺或变肾上腺素，或两者同时测定，优于HMMA测定。建议摒弃仅使用HMMA测定进行嗜铬细胞瘤生化检测的做法。
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