血浆甲氧基肾上腺素和甲氧基去甲肾上腺素诊断嗜铬组织来源肿瘤的意义

目的探讨血浆甲氧基肾上腺素（MN）和甲氧基去甲肾上腺素（NMN）诊断嗜铬组织来源肿瘤（嗜铬细胞瘤）的意义。方法选择2003年5月—2008年12月上海交通大学医学院附属瑞金医院具有嗜铬细胞瘤筛查指征的患者,高效液相色谱分析法检测并比较嗜铬细胞瘤和非嗜铬细胞瘤患者以及嗜铬细胞患者手术前后血浆NMN和MN水平,受试者工作特征（ROC）曲线评价血浆NMN和MN诊断嗜铬细胞瘤的敏感度和特异性。结果 259例嗜铬细胞瘤患者和4387例非嗜铬细胞瘤患者入选本研究。NMN和MN的ROC曲线下面积分别为0.989±0.005和0.783±0.019;嗜铬细胞瘤与非嗜铬细胞瘤患者血浆NMN[（2930.56±4166.56）pg/mL和（70.48±25.07）pg/mL]和MN[（585.68±1368.75）pg/mL和（45.61±42.63）pg/mL]比较,差异均具有统计学意义（P=0.00）;血浆NMN在130pg/mL时诊断嗜铬细胞瘤的敏感性和特异性分别为95.4%和90.0%,血浆MN在83pg/mL时诊断敏感性和特异性分别为51.4%和90.0%。69例嗜铬细胞患者手术前后NMN[（3145.8±3651.86）pg/mL和（233.1±934.92）pg/mL]和MN[（653.7±1053.12）pg/mL和（47.56±25.82）pg/mL]比较,差异均具有统计学意义（P=0.00）。结论血浆NMN和MN水平可作为嗜铬细胞瘤的一线筛查指标,术后血浆NMN和MN水平可反映手术效果和早期发现肿瘤转移或复发。

Roles of plasma metanephrine and normetanephrine in diagnosis of chromaffin cell tumors

Objective To explore the roles of plasma metanephrine (MN) and normetanephrine (NMN) in diagnosis of chromaffin cell tumors. Methods From May 2003 to December 2008, patients with indications for chromaffin cell tumor screening in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected. Plasma NMN and MN levels were detected by high performance liquid chromatogram, and were compared between patients with chromaffin cell tumors and those without. Besides, plasma NMN and MN levels before operation were compared with those after operation in patients with chromaffin cell tumors. Receiver operating characteristic (ROC) curves were employed to determine the sensitivity and specificity of plasma NMN and MN in diagnosis of chromaffin cell tumors. Results Two hundred and fifty-nine patients with chromaffin cell tumors and 4 387 patients without were enrolled. The area under ROC curve of NMN was 0.989±0.005, and that of MN was 0.783±0.019. There were significant differences in NMN and MN levels between patients with chromaffin cell tumors and those without, (2930.56±4166.56) pg/mL vs (70.48±25.07) pg/mL and (585.68±1368.75) pg/mL vs (45.61±42.63) pg/mL, respectively (P=0.00 for both).The sensitivity and specificity were 95.4% and 90.0% respectively for plasma NMN of 130 pg/mL, and those were 51.4% and 90.0% respectively for plasma MN of 83 pg/mL. Besides, there were significant differences between NMN and MN levels before operation and those after operation in 69 patients with chromaffin cell tumors, (3 145.8±3651.86) pg/mL vs (233.1±934.92) pg/mL and (653.7±1053.12) pg/mL vs (47.56±25.82) pg/mL, respectively (P=0.00 for both). Conclusion Plasma NMN and MN levels can be adopted as optimal parameters in screening chromaffin cell tumors, and plasma NMN and MN levels after operation may indicate the outcomes and help to detect early recurrence or metastasis of the tumors.