嗜铬细胞瘤/副节瘤患者心血管表现的临床分析

目的探究嗜铬细胞瘤/副节瘤(PH/PGL)患者中心血管异常的发生率、表现形式、临床转归与其发生机制。方法入选2010年10月至2013年4月期间就诊于北京协和医院的78例PH/PGL患者,记录患者临床症状、血压、心率、心肌酶、心力衰竭标记物、心电图、超声心动图表现及24 h尿儿茶酚胺水平,并进行分析。结果 (1)78例患者中,66例(84.6%)有高血压,3例(3.8%)病程中有低血压病史。45例(57.7%)存在心脏损害,包括急性左心功能不全3例(3.8%),心肌酶与心电图ST-T段动态变化6例(7.7%),左心室射血分数下降6例(7.7%),其中5例随访恢复正常,心律失常30例(38.5%),左心室肥厚25例(32.1%)。(2)以有无左心室肥厚将高血压PH/PGL患者分为两组,两组高血压病程、表现为持续与阵发性血压升高比例、血压水平差异无统计学意义,肥厚组24 h尿去甲肾上腺素[435(61⁷66)μg/24 h比110(35766)μg/24 h比110(35²42)μg/24 h,U=320,P<0.01]、肾上腺素[3.51(3.01242)μg/24 h,U=320,P<0.01]、肾上腺素[3.51(3.01⁴.53)μg/24 h比2.88(2.324.53)μg/24 h比2.88(2.32³.89)μg/24 h,U=337,P=0.02]显著高于无肥厚组。结论PH/PGL可引起多种心血管损害,少数出现左心室射血分数下降,大多可逆。

A clinical study of cardiovascular manifestations of 78 pheochromocytoma/paraganglioma patients

Objective To explore the prevalence,manifestations,clinical outcomes and etiology of cardiovascular abnormalities among pheochromocytoma /paraganglioma（ PH /PGL） patients. Methods Seventy-eight PH /PGL patients receiving medical attention at Peking Union Medical College Hospital from October 2010 to April 2013 were included in the study. Clinical symptoms,blood pressure,heart rate,biomarkers of myocardial injury and heart failure,electrocardiogram,echocardiography,and levels of 24-hour urinary catecholamine of the patients were recorded and analyzed. Results（ 1） Of the 78 patients,66（ 84.6%） were hypertensive,3（ 3.8%） experienced hypotensive episodes,45（ 57.7%） had histories indicative of cardiac injuries,including 3（ 3. 8%） with acute left-sided heart failure episodes,6（ 7. 7%）with concurrent evolving cardiac enzyme elevation and alteration of ECG ST-T segment,6（ 7. 7%） with decreased left ventricular ejection fraction（ LVEF）,5 of which restored during follow-up,30（ 38. 5%） with arrhythmias,25（ 32. 1%） with left ventricular hypertrophy.（ 2） Among hypertensive PH /PGL patients,levels of 24-hour urinary norepinephrine [435（ 61-766） μg /24 h vs. 110（ 35-242） μg /24 h,U = 320,P〈0. 01]and epinephrine[3. 51（ 3. 01-4. 53） μg /24 h vs. 2. 88（ 2. 32-3. 89） μg /24 h,U = 337,P = 0. 02]were significantly higher in LV hypertrophy group than in normal geometry group, while the duration,manifestation（ sustained vs. paroxysmal） and degree of blood pressure elevation did not differ between the two groups. Conclusions PH /PGL can cause multiple cardiovascular alterations. Decreased LVEF,often reversible,occurs occasionally.