嗜铬细胞瘤/副神经节瘤患者血浆MNs与血脂、血糖、血压的相关性分析
|
摘要
目的探讨嗜铬细胞瘤(PCC)/副神经节瘤(PGL)(合称PPGL)患者血浆甲氧基肾上腺素(MN)及甲氧基去甲肾上腺素(NMN)(合称MNs)与血脂、血糖、血压的相关性。方法回顾性分析2017年1月-2018年6月在解放军总医院第一医学中心手术病理确诊的PPGL 64例临床资料。根据术前血浆MN三分位数将64例分为T1(n=21)、T2(n=21)、T3(n=22)组,再根据术前血浆NMN三分位数将其分为T'1(n=21)、T'2(n=21)、T'3(n=22)组。分析MNs与血脂、血糖、血压等指标的相关性。结果 PPGL患者中随血浆MNs的水平升高,体重指数(BMI)值明显下降;随血浆NMN的水平升高,高密度脂蛋白胆固醇(HDL-C)、收缩压(SBP)明显升高(P<0.05)。Pearson相关分析显示,血浆MN与BMI呈明显负相关(r=–0.319,P=0.010),与肿瘤直径呈明显正相关(r=0.268,P=0.032)。血浆NMN与BMI呈明显负相关(r=–0.353,P=0.004),与SBP、空腹血糖(FBG)、总胆固醇(TG)、HDL-C、肿瘤直径呈明显正相关(r分别为0.256、0.019、0.047、0.001、0.003,P<0.05)。多元线性回归分析结果显示,在校正年龄、性别、吸烟史、饮酒史后,血浆MN与BMI呈明显负相关(β=–0.09,P=0.004),与肿瘤直径呈明显正相关(β=0.04,P=0.016);血浆NMN与BMI呈明显负相关(β=–0.08,P=0.006),与SBP、FBG、TG、HDL-C、肿瘤直径呈明显正相关(β分别为0.01、0.13、0.18、0.50、0.06,P<0.05)。结论血浆MNs水平与血脂、血糖、血压的调控有关,术前血浆MNs水平较高的患者更需注意高血压、高FBG的发生。
Objective To investigate the correlations of plasma methoxyadrenaline(MN) and methoxynorepinephrine(NMN)(collectively called MNs) to blood lipid, blood glucose and blood pressure in patients with pheochromocytoma(PCC) and paraganglioma(PGL)(collectively called PPGL). Methods The clinical data were retrospectively analyzed of 64 patients with pathologically confirmed PPGL in Chinese PLA General Hospital during Jan. 2017 to Jun. 2018. According to the tertiles plasma MN before operation, the 64 cases were divided into T1(n=21), T2(n=21) and T3(n=22) group, and then were divided into T'1(n=21), T'2(n=21) and T'3(n=22) group according to the tertiles plasma NMN before operation. The correlations were analyzed of plasma level of MNs to the blood lipid, blood glucose and blood pressure. Results The body mass index(BMI) value decreased significantly with the increase of plasma MNs level in patients with PPGL. With the increase of plasma NMN level, high density lipoprotein cholesterol(HDL-C) and systolic blood pressure(SBP) increased significantly(P<0.05). Pearson correlation analysis showed that the plasma MN was negatively correlated with BMI(r=–0.319, P=0.010), and positively correlated with the tumor diameter(r=0.268, P=0.032). The plasma NMN was negatively correlated with BMI(r=–0.353, P=0.004), and positively correlated with SBP, fasting blood glucose(FBG), total cholesterol(TG), HDL-C, and tumor diameter(r=0.256, 0.019, 0.047, 0.001 and 0.003,respectively. P<0.05). The multivariate linear regression analysis showed that the plasma MN was negatively correlated with BMI(β=0.09, P=0.004) and positively correlated with tumor diameter(β=0.04, P=0.016). Plasma NMN was negatively correlated with BMI(β=0.08, P=0.006), and positively correlated with SBP, FBG, TG, HDL-C, tumor diameter(β=0.01, 0.13, 0.18, 0.50 and 0.06,respectively. P<0.05). Conclusions The plasma MNs level is related to the regulation of blood lipid, blood sugar and blood pressure.Patients with high plasma MNs level before operation should pay more attention to the occurrence of hypertension and high FBG.
Objective To investigate the correlations of plasma methoxyadrenaline(MN) and methoxynorepinephrine(NMN)(collectively called MNs) to blood lipid, blood glucose and blood pressure in patients with pheochromocytoma(PCC) and paraganglioma(PGL)(collectively called PPGL). Methods The clinical data were retrospectively analyzed of 64 patients with pathologically confirmed PPGL in Chinese PLA General Hospital during Jan. 2017 to Jun. 2018. According to the tertiles plasma MN before operation, the 64 cases were divided into T1(n=21), T2(n=21) and T3(n=22) group, and then were divided into T'1(n=21), T'2(n=21) and T'3(n=22) group according to the tertiles plasma NMN before operation. The correlations were analyzed of plasma level of MNs to the blood lipid, blood glucose and blood pressure. Results The body mass index(BMI) value decreased significantly with the increase of plasma MNs level in patients with PPGL. With the increase of plasma NMN level, high density lipoprotein cholesterol(HDL-C) and systolic blood pressure(SBP) increased significantly(P<0.05). Pearson correlation analysis showed that the plasma MN was negatively correlated with BMI(r=–0.319, P=0.010), and positively correlated with the tumor diameter(r=0.268, P=0.032). The plasma NMN was negatively correlated with BMI(r=–0.353, P=0.004), and positively correlated with SBP, fasting blood glucose(FBG), total cholesterol(TG), HDL-C, and tumor diameter(r=0.256, 0.019, 0.047, 0.001 and 0.003,respectively. P<0.05). The multivariate linear regression analysis showed that the plasma MN was negatively correlated with BMI(β=0.09, P=0.004) and positively correlated with tumor diameter(β=0.04, P=0.016). Plasma NMN was negatively correlated with BMI(β=0.08, P=0.006), and positively correlated with SBP, FBG, TG, HDL-C, tumor diameter(β=0.01, 0.13, 0.18, 0.50 and 0.06,respectively. P<0.05). Conclusions The plasma MNs level is related to the regulation of blood lipid, blood sugar and blood pressure.Patients with high plasma MNs level before operation should pay more attention to the occurrence of hypertension and high FBG.
引文
[1] The Adrenology Group of Chinese Society of Endocrinology.Exper t consensus document on pheochromocytoma and paraganglioma[J]. Chin J Endocrinol Metab, 2016, 32(3):181-187.[中华医学会内分泌学分会肾上腺学组.嗜铬细胞瘤和副神经节瘤诊断治疗的专家共识[J].中华内分泌代谢杂志,2016, 32(3):181-187.]
[2] Scholten A, Cisco RM, Vriens MR, et al. Pheochromocytoma crisis is not a surgical emergency[J]. J Clin Endocrinol Metab,2013, 98(2):581-591.
[3] Xu LS, He JT, Mang J, et al. Pheochromocytoma with headache as first symptom:A case report and literature review[J]. J Jilin Univ(Med Ed), 2015, 41(5):1027-1031, 1106.[徐丽斯,何金婷,莽靖,等.以头痛为首发症状的嗜铬细胞瘤1例报告并文献复习[J].吉林大学学报(医学版), 2015, 41(5):1027-1031,1106.]
[4] Li J,Tang L,Wei TJ,etal.Acaseofrightatrial pheochromocytoma misdiagnosed as myxoma[J]. J Zhengzhou Univ(Med Sci), 2015, 50(6):863-864.[李杰,唐丽,魏廷举,等.右心房嗜铬细胞瘤误诊为黏液瘤一例[J].郑州大学学报(医学版), 2015, 50(6):863-864.]
[5] Petrák O, HaluzíkováD, KaválkováP, et al. Changes in energy metabolism in pheochromocytoma[J]. J Clin Endocrinol Metab,2013, 98(4):1651-1658.
[6] Unger N, Pitt C, Schmidt IL, Schmidt IL, et al. Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass[J]. Eur J Endocrinol, 2006, 154(3):409-417.
[7] Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma:an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2014, 99(6):1915-1942.
[8] Jiang L, Wang WQ. Significance of meta-adrenalines in the diagnosis of pheochromocytoma[J]. Foreign Med Sci(Sect Endocrinol), 2004, 24(3):202-204.[姜蕾,王卫庆.间甲肾上腺素类物质对诊断嗜铬细胞瘤的意义[J].国外医学(内分泌学分册), 2004, 24(3):202-204.]
[9] Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma:which test is best?[J]. JAMA, 2002,287(11):1427-1434.
[10] An Y, Reimann M, Masjkur J, et al. Adrenomedullary function,obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours[J]. Int J Obes(Lond), 2019, 43(2):263-275.
[11] Mu LS, Su TW, Jiang L, et al. Study on the Relationship between plasma meta-adrenalines and blood pressure and glycolipid metabolism in patients with pheochromocytoma[J]. J Diagn Conc Pract, 2015, 14(4):318-323.[木良善,苏颋为,姜蕾,等.嗜铬细胞瘤患者血浆间甲肾上腺素类物质与血压及糖脂代谢的相关性研究[J].诊断学理论与实践, 2015, 14(4):318-323.]
[12] Dai XP, Liu ZQ, Xu LY, et al. Association of plasma epinephrine level with insulin sensitivity in metabolically healthy but obese individuals[J]. Auton Neurosci, 2012, 167(1/2):66-69.
[13] Wei H, Averill MM, McMillen TS, et al. Modulation of adipose tissue lipolysis and body weight by high-density lipoproteins in mice[J]. Nutr Diabetes, 2014, 4:e108.
[14] Okamura T, Nakajima Y, Satoh T, et al. Changes in visceral and subcutaneous fat mass in patients with pheochromocytoma[J].Metabolism, 2015, 64(6):706-712.
[15] Jocken JW, Blaak EE. Catecholamine-induced lipolysis in adipose tissue and skeletal muscle in obesity[J]. Physiol Behav, 2008,94(2):219-230.
[16] Ensinger H, Weichel T, Lindner KH, e t al. Effects of norepinephrine,epinephrine,and dopamine infusions on oxygen consumption in volunteers[J]. Crit Care Med, 1993, 21(10):1502-1508.
[17] Su TW, Wang WQ, Zhou WW, e t al. Roles of plasma metanephrine and normetanephrine in diagnosis of chromaffin cell tumors[J]. J Shanghai Jiaotong Univ(Med Sci), 2010,30(5):489-492.[苏颋为,王卫庆,周薇薇,等.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[J].上海交通大学学报(医学版), 2010, 30(5):489-492.]
[18] Zelinka T, Eisenhofer G, Pacak K. Pheochromocytoma as a catercholamine producing tumor:implications for clinical practice[J]. Stress, 2007, 10(2):195-203.
[2] Scholten A, Cisco RM, Vriens MR, et al. Pheochromocytoma crisis is not a surgical emergency[J]. J Clin Endocrinol Metab,2013, 98(2):581-591.
[3] Xu LS, He JT, Mang J, et al. Pheochromocytoma with headache as first symptom:A case report and literature review[J]. J Jilin Univ(Med Ed), 2015, 41(5):1027-1031, 1106.[徐丽斯,何金婷,莽靖,等.以头痛为首发症状的嗜铬细胞瘤1例报告并文献复习[J].吉林大学学报(医学版), 2015, 41(5):1027-1031,1106.]
[4] Li J,Tang L,Wei TJ,etal.Acaseofrightatrial pheochromocytoma misdiagnosed as myxoma[J]. J Zhengzhou Univ(Med Sci), 2015, 50(6):863-864.[李杰,唐丽,魏廷举,等.右心房嗜铬细胞瘤误诊为黏液瘤一例[J].郑州大学学报(医学版), 2015, 50(6):863-864.]
[5] Petrák O, HaluzíkováD, KaválkováP, et al. Changes in energy metabolism in pheochromocytoma[J]. J Clin Endocrinol Metab,2013, 98(4):1651-1658.
[6] Unger N, Pitt C, Schmidt IL, Schmidt IL, et al. Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass[J]. Eur J Endocrinol, 2006, 154(3):409-417.
[7] Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma:an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2014, 99(6):1915-1942.
[8] Jiang L, Wang WQ. Significance of meta-adrenalines in the diagnosis of pheochromocytoma[J]. Foreign Med Sci(Sect Endocrinol), 2004, 24(3):202-204.[姜蕾,王卫庆.间甲肾上腺素类物质对诊断嗜铬细胞瘤的意义[J].国外医学(内分泌学分册), 2004, 24(3):202-204.]
[9] Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma:which test is best?[J]. JAMA, 2002,287(11):1427-1434.
[10] An Y, Reimann M, Masjkur J, et al. Adrenomedullary function,obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours[J]. Int J Obes(Lond), 2019, 43(2):263-275.
[11] Mu LS, Su TW, Jiang L, et al. Study on the Relationship between plasma meta-adrenalines and blood pressure and glycolipid metabolism in patients with pheochromocytoma[J]. J Diagn Conc Pract, 2015, 14(4):318-323.[木良善,苏颋为,姜蕾,等.嗜铬细胞瘤患者血浆间甲肾上腺素类物质与血压及糖脂代谢的相关性研究[J].诊断学理论与实践, 2015, 14(4):318-323.]
[12] Dai XP, Liu ZQ, Xu LY, et al. Association of plasma epinephrine level with insulin sensitivity in metabolically healthy but obese individuals[J]. Auton Neurosci, 2012, 167(1/2):66-69.
[13] Wei H, Averill MM, McMillen TS, et al. Modulation of adipose tissue lipolysis and body weight by high-density lipoproteins in mice[J]. Nutr Diabetes, 2014, 4:e108.
[14] Okamura T, Nakajima Y, Satoh T, et al. Changes in visceral and subcutaneous fat mass in patients with pheochromocytoma[J].Metabolism, 2015, 64(6):706-712.
[15] Jocken JW, Blaak EE. Catecholamine-induced lipolysis in adipose tissue and skeletal muscle in obesity[J]. Physiol Behav, 2008,94(2):219-230.
[16] Ensinger H, Weichel T, Lindner KH, e t al. Effects of norepinephrine,epinephrine,and dopamine infusions on oxygen consumption in volunteers[J]. Crit Care Med, 1993, 21(10):1502-1508.
[17] Su TW, Wang WQ, Zhou WW, e t al. Roles of plasma metanephrine and normetanephrine in diagnosis of chromaffin cell tumors[J]. J Shanghai Jiaotong Univ(Med Sci), 2010,30(5):489-492.[苏颋为,王卫庆,周薇薇,等.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[J].上海交通大学学报(医学版), 2010, 30(5):489-492.]
[18] Zelinka T, Eisenhofer G, Pacak K. Pheochromocytoma as a catercholamine producing tumor:implications for clinical practice[J]. Stress, 2007, 10(2):195-203.