LABORATORY DIAGNOSIS OF PHEOCHROMOCYTOMA - WHICH ANALYTES SHOULD WE MEASURE
LABORATORY DIAGNOSIS OF PHEOCHROMOCYTOMA - WHICH ANALYTES SHOULD WE MEASURE
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DOI：
10.1177/000456329303000203
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发表时间：
1993-03-01
影响因子：
2.2
通讯作者：
LAZARUS, L
中科院分区：
文献类型：
--
作者：
GRAHAM, PE;SMYTHE, GA;LAZARUS, L
关于哪种生化分析最适合调查疑似嗜铬细胞瘤患者，文献中有各种各样的建议。临床实验室面临的挑战是选择那些既能检测到所有嗜铬细胞瘤，同时又具有最低假阳性诊断发生率的检测方法。我们比较了目前用于嗜铬细胞瘤生化诊断的多种检测方法的敏感性和特异性，分别采用特异气相色谱-质谱仪(GC/MS)和高效液相色谱-电化学检测(HPLC/ED)技术。对20例经组织学证实的嗜铬细胞瘤患者和一大批后来发现没有嗜铬细胞瘤的患者的24小时尿样进行去甲肾上腺素(NA)、肾上腺素(ADR)、多巴胺(DA)、3，4-二羟基苯甘醇(DHPG)、羟甲氧基扁桃酸(HMMA)、去甲肾上腺素(NMET)和甲肾上腺素(MET)的检测。由于嗜铬细胞瘤是一组异质性的激素分泌肿瘤，没有单一的分析方法可以达到100%的敏感性；只有当NA和ADR或NMET和MET联合使用时，才能达到100%的敏感性。DA、DHPG和HMMA的敏感性均较低。以非肿瘤患者的高95%可信水平(48mumol/24 h)为界值，HMMA的敏感性为70%。以35mumol/24 h为界值，灵敏度可达100%，但特异度从98%降至92%。在这项研究的基础上，我们建议将NA和ADR或NMET和MET作为检测嗜铬细胞瘤最合适的分析方法，此外，由于其较差的特异性，HMMA不应作为合适的分析方法。
There is a diversity of advice in the literature as to which biochemical assays are best suited to the investigation of patients with a suspected phaeochromocytoma. The challenge for the clinical laboratory is to select those assays which detect all phaeochromocytomas, whilst having the lowest incidence of false positive diagnoses. We compared the sensitivity and specificity of a wide range of assays currently used for the biochemical diagnosis of phaeochromocytoma using either specific gas chromatographic-mass spectrometric (GC/MS) or high performance liquid chromatography-electrochemical detection (HPLC/ED) techniques.Noradrenaline (NA), adrenaline (ADR), dopamine (DA), 3,4-dihydroxyphenylglycol (DHPG), hydroxymethoxymandelic acid (HMMA), normetanephrine (NMET) and metanephrine (MET) were measured in 24 h urine specimens from 20 patients with histologically proven phaeochromocytoma and a large group of patients referred for investigation but subsequently found not to have a phaeochromocytoma. Because phaeochromocytomas are a heterogeneous group of hormone secreting tumours, no single analyte could achieve 100% sensitivity; 100% sensitivity was achieved only when the combination of both NA and ADR or NMET and MET was used. DA, DHPG and HMMA all had poor sensitivities. HMMA had a sensitivity of 70% when using the upper 95% confidence level (48 mumol/24 h) of the non-tumour patients as the cut-off. By lowering the cut-off to 35 mumol/24 h the sensitivity could be increased to 100% but at the expense of the specificity which was decreased from 98 to 92%. On the basis of this study we recommend the specific measurement of either NA and ADR or NMET and MET as the most suitable analytes for the detection of phaeochromocytoma, and further that, due to its poor specificity, HMMA be abandoned as a suitable analyte.