【作者】 丁文蕴；

【导师】 李汉忠；

【作者基本信息】 中国协和医科大学 ， 临床医学， 2008， 博士

【摘要】 目的:观察间甲肾上腺素类物质(MNs)在嗜铬细胞瘤组织及血浆中的表达,评价MNs能否在不同临床类型嗜铬细胞瘤诊断中作为常规检测指标。方法:以免疫组织化学法了解嗜铬细胞瘤组织中MN表达情况;以ELISA检测血浆游离MNs含量,并与临床资料进行比较分析。结果:MN在嗜铬细胞瘤组中阳性表达率为75.86%,肾上腺皮质肿瘤组全无表达;嗜铬细胞瘤组血浆MNs诊断敏感性为100%,特异性＞93.18%;其AUC＞0.995,而尿总E及尿总NE的AUC仅有0.842和0.829;非静止型组和静止型组,统计学无显著差异;静止型组的MNs阳性检出率皆为100%。结论:血浆游离MNs检测应用于嗜铬细胞瘤诊断的敏感性100%;其综合诊断评价明显优于尿肾上腺素和尿去甲肾上腺素;其基本不受临床功能影响,静止型组阳性检出率为100%;因此,血浆游离MNs浓度检测应可以作为诊断嗜铬细胞瘤的理想手段之一。更多还原

【Abstract】 Aim:To investigate the expression of metanephrine(MN) in the tissue and the plasma free metanephrines(MNs) levels of pheochromocytoma patients for the diagnosis.Method:Immunohistochemistry was used to detect metanephrine in the tissue samples. Enzyme-linked immunosorbent assay(ELISA) was used to analyse the level of plasma free metanephrine and plasma free normetanephrine(NMN) in these patients’ samples.The result was compared with the test data from 24-hour urinary epinephrine(E) and norepinephrine(NE) tests of these patients.Results:The results of immunochemistry tests on the pheochromocytoma group revealed a positive rate of 75.86%(22/29),however,the adrenocortical disease group did not display any positive result(0/8).ELISA results:The plasma free MNs tests revealed the sensitivity and specificity results of 100%and greater than 93.18%.The area under the receiver operating characteristic(ROC) curve(AUC) of plasma free MNs were greater than 0.995,but the AUC of urinary epinephrine(E) and norepinephrine (NE) were only 0.842 and 0.829.There was no significant statistical difference between the MNs levels of silent pheochromocytoma and non-silent pheochromocytoma groups,two of the pheochromocytoma subgroups(P=0.503, 0.148).The positive detection rate of the silent group was 100%,but the positive detection rates of the 24-hour urinary E and NE tests were 50%and 25%.Conclusion:(1) The sensitivity and specificity results of plasma free MNs were 100% and greater than 93.18%.(2) Plasma free MNs gave a much better overall evaluation of the diagnosis of pheochromocytoma than the urinary E and NE test did.(3) Plasma free MNs were not affected by different clinical function gradation and the silent pheochromocytoma group revealed a positive detection rate of 100%.更多还原