【摘要】 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VMA/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。更多还原

【Abstract】 Aim To analyze the value of detection of 24-hour urine vanillylmandelic acid(VMA),5-hour urine VMA/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 VMA/Cr,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 VMA/Cr 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(x2=9.091,P=0.003).(3)The areas under the ROC curve of 24-hour urine VMA,5-hour urine VMA/Cr,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.更多还原