嗜铬细胞瘤患者血压与儿茶酚胺分泌的昼夜变化

Circadian changes of blood pressure and catecholamine excretion in patients with pheochromocytoma

目的 研究嗜铬细胞瘤患者手术前后血压及尿儿茶酚胺排泄量的昼夜变化及两者之间的关系。方法 2 7例嗜铬细胞瘤患者术前进行动态血压监测 ,其中 12例在术前及术后 10天进行动态血压监测并同日留取十段尿待测尿儿茶酚胺排泄量 ,应用Cosinor方法分析收缩压、舒张压、心率及去甲肾上腺素、肾上腺素和多巴胺排量的昼夜变化。结果 术前不同血压类型患者的血压昼夜变化有所不同 ,持续性高血压患者的血压昼夜变化消失 ,阵发性高血压及正常血压患者血压昼夜变化存在。去甲肾上腺素、肾上腺素和多巴胺分泌的昼夜变化存在 ,肾上腺素、多巴胺的分泌高峰相有所后延。手术切除肿瘤后 ,患者的尿儿茶酚胺排泄量与血压的昼夜变化均恢复正常。 12例嗜铬细胞瘤患者术前的 2 4h平均收缩压、舒张压与 2 4h尿平均去甲肾上腺素排泄量呈明显正相关 (r =0 .83、0 .91,P <0 .0 0 1)。结论 嗜铬细胞瘤患者的儿茶酚胺分泌的昼夜变化存在 ;持续性高血压患者血压的昼夜变化消失 ,阵发性高血压患者血压的昼夜变化存在。

Objective To study the circadian changes of blood pressure and urinary catecholamine excretion in patients with pheochromocytoma before and after tumor removal. Methods Twenty-seven patients with pheochromocytoma were examined by 24h ambulatory blood pressure monitoring before tumor removal, and 12 of them were examined by ambulatory blood pressure monitoring both before and after operation, meanwhile, their urinary norepinephrine (NE), epinephrine (E) and dopamine (DA) excretions of 10 time-segmental portions of urine at the same day were determined by HPLC method. The circadian changes were analyzed by Cosinor method. Results The circadian changes of catecholamine excretion were observed, and the peak excretion time of E and DA were shifted to 14:00-16:00. The circadian changes of systolic and diastolic blood pressure disappeared in patients with sustained hypertension and existed in patients with paroxysmal hypertension. The circadian changes of blood pressure and urinary catecholamine excretion were returned to normal after surgery. The circadian change of heart rate was observed both before and after operation. Analysis of data from 12 cases with pheochromocytoma showed strongly positive correlationsbetween24hmeansystolicanddiastolic blood pressure and mean urinary NE excretion (r=0.83, 0.91, P<0.001). Conclusion The circadian change of urinary catecholamine excretion exists, while that of systolic and diastolic blood pressure disappears in patients with sustained hypertension but exists in patients with paroxysmal hypertension.