儿茶酚胺代谢产物检测对嗜铬细胞瘤诊断价值的比较

目的比较24h尿3-甲氧基-4-羟基苦杏仁酸（VMA），5h尿VMA／Cr，血、尿3甲氧基去甲肾上腺素（NMN）和3甲氧基肾上腺素（MN）在嗜铬细胞瘤诊断中的准确性。方法对45例嗜铬细胞瘤患者、111例肾上腺皮质腺瘤患者、145例原发性高血压患者和39例健康体检者的24h尿VMA，5h尿VMA／Cr，血、尿NMN和MN的检测结果进行比较。结果24h尿VMA检测的敏感性仅为73．3％，低于血NMN＋MN的95．6％（P〈0．05）、尿NMN＋MN的97．8％（P〈0．05）和血、尿NMN＋MN联合检测的100％（P〈0．01）。5h尿VMA／Cr检测的特异性为84．1％，低于24h尿VMA的92．2％、血NMN＋MN的93．6％、尿NMN＋MN的93．9％和血、尿NMN＋MN的联合检测99．7％（P均〈0．01）：24h尿VMA、5h尿VM～Cr、血NMN＋MN和尿NMN＋MN的ROC曲线下面积分别为0．884、0．923、0．972和0．985。结论血、尿NMN＋MN检测的敏感性和特异性高，是临床诊断嗜铬细胞瘤较为理想的检测方法。如果两者联合检测将进一步提高诊断的准确性。

Value of detection of catecholamine metabolite in diagnosis of pheochromocytoma

Aim To analyze the value of detection of 24-hour urine vanillylmandelic acid（VMA）, 5-hour urine VMM Cr,normetanephrine （NMN） and metanephrine （MN） in blood and urine in diagnosis of pheochromocytoma. Methods There 45 pheochromocytoma cases, 111 adrenal cortical adenoma cases, 145 essential hypertension cases and 39 healthy individuals were chosen for detection of 24-hour urine VMA,5-hour urine VMMCr, NMN＋MN in blood and urine. Results The sensitivity of 24-hour urine VMA was only 73.3%,which was lower than that of the blood NMN＋MN （95.6%,P〈0.05）, urinary NMN＋MN （97.8%,P〈0.05） and the joint detection of blood and urine NMN＋MN （100%,P〈0.01）. The specificity of 5 hours urine VMMCr was 84.1%, which was lower than that of the 24-hour urine VMA（92.2%）, blood NMN＋MN （93.6%）, urinary NMN＋MN （93.9%） and the joint detection of blood and urine NMN＋MN （99.7%,P〈0.01）. Paired Chi-square tests showed that the positive rate of urinary NMN ＋MN was higher than that of the 24-hour urine VMA in diagnosing pheochromocytoma（x^2=9.091, P=0.003）. （3） The areas under the ROC curve of 24-hour urine VMA,5-hour urine VMMCr, blood NMN ＋MN and urine NMN ＋MN were 0.884,0.923,0.972 and 0.985,respectively. Conclusion Both of the sensitivity and specificity of blood NMN＋MN and urine NMN＋MN are high in diagnosing pheochromocytoma. Joint detection can enhance the diagnostic accuracy.