尿17-OH、17-KS、VMA与血浆ALD、COR联合检测在肾上腺肿瘤中的诊断价值

The value of combined detection of 24 h urine 17-OH,17-KS,VMA,and plasma ALD,COR in the diagnosis of adrenal neoplasms

目的探讨17-羟皮质类固醇(17-hydroxycorticosteroids,17-OH)、17-酮皮质类固醇(17-ketosteroids,17-KS)、香草扁桃酸(vanilmandelic acid,VMA)、醛固酮(aldosterone,ALD)和皮质醇(Cortisol,COR)在肾上腺肿瘤中的诊断价值。方法采用微柱比色法和电化学发光技术,对笔者所在医院400例不同病理类型的肾上腺肿瘤患者进行24小时尿17-OH、17-KS、VMA及血浆ALD、COR检测。对照组30名,均为排除肾上腺、内分泌、心血管、肿瘤等疾病的健康人。结果与对照组比较,17-OH水平在肾上腺肿瘤(除肾上腺增生组)均显著增高(P<0.05);17-KS水平除腹膜后肿瘤组外,其他各组均显著增高(P<0.05);VMA水平在肾上腺增生组、肾上腺恶性肿瘤组和嗜铬细胞瘤组显著增高(P<0.05);ALD在肾上腺囊肿组、肾上腺良性肿瘤组、肾上腺恶性肿瘤组和腹膜后肿瘤组均显著增高(P<0.05);COR在肾上腺良性肿瘤组、肾上腺恶性肿瘤组、嗜铬细胞瘤组和腹膜后肿瘤组显著增高(P<0.05)。嗜铬细胞瘤组的VMA水平明显高于其他组,差异有统计学意义(P<0.05)。以超出正常值范围为阳性,不同肿瘤组均有不同程度的增高,17-OH以肾上腺恶性肿瘤组(31%)为最高;17-KS以肾上腺囊肿组(60%)和嗜铬细胞瘤组(44%)为最高;VMA以嗜铬细胞瘤组(88%)为最高;ALD和COR以肾上腺增生组为最高,分别是31%和38%。相关分析显示,血浆ALD与17-OH、17-KS之间呈正相关(r=0.502,0.796,P<0.01);COR与17-OH、17-KS之间亦呈正相关(r=0.648,0.584,P<0.01);ALD、COR与VMA之间无相关性(r=0.090,0.010,P>0.05)。结论应用24小时尿17-OH、17-KS、VMA和血浆ALD、COR的联合检测,对良、恶性肾上腺肿瘤的鉴别诊断以及肿瘤功能性的判断,为临床手术的实施方案和预后具有重要的指导意义。

Objective To study the value of combined detection of 17-hydroxycorticosteroids （17-OH）, 17- ketone corticosteroids （17-KS）,vanillylmandelic acid （VMA）,aldosterone （ALD） and cortisol （COR） in adrenal nepplasms diagnosis. Methords The 400 hospitalized patients in author＇s hospital from 2010-01 to 2013-08, according to CT,nuclear magnetic resonance and pathology were divided into：26 cases of adrenal hyperplasia;30 cases of adrenal cyst;benign adrenal tumors in 89 cases;16 cases of adrenal malignant tumor;pheochromocytoma in 34 cases;5 cases of retroperitoneal tumors. A control group had 30,all health people excluded adrenal, endocrine,cardiovascular,cancer and other diseases. By using microcolumn chromatography 24h urine 17-KS,VMA and 17-OH levels were detected and by electrochemical luminescence technology for plasma ALD,COR levels. Results Compared with control group,17-OH in other groups were significantly increased except drenal hyperplasia group （P〈0.05）;17-KS in the other groups were significantly increased except retroperitoneal tumor group （P〈0.05）. VMA increased significantly in the adrenal hyperplasia group,adrenal malignant tumor group and pheochromocytoma group （P〈0.05）. ALD increased significantly in adrenal cyst group,benign adrenal tumor group, adrenal malignant tumor group and retroperitoneal tumor group （P〈0.05）. COR increased significantly in adrenal benign tumor group,adrenal malignant tumor group,and retroperitoneal pheochromocytoma group （P〈0.05）. Pheochromocytoma group VMA had significant differences with the rest of the group （P〈0.05）,and to adrenal cyst group,benign adrenal tumor group,retroperitoneal tumor group VMA value （P〈0.01）,tbe rest of the targets in the cases of no statistical significance between the two groups （P〉0.05）. With more than the normal value waspositive,different disease groups had different degrees of positive rate increased,the positive rate of 17-OH in adrenal malignant tumor group（31%） was the highest;the positive rate of 17-KS in adrenal cyst group（60%） and pheochromocytoma group （44%） was the highest;the positive rate of VMA in pheochromocytoma group （88%） was the highest;the positive rate of ALD in adrenal hyperplasia group（31%） was the highest;the positive rate of COR in adrenal hyperplasia group was the highest （38%）. Correlation analysis showed that there was a positive correlation between plasma ALD,17-OH,17- and KS （r=O.502,0.796,P〈O.O1） ;also a positive correlation between COR and 17-OH,17-KS （r=O.648,0.584,P〈O.O1）;there was no correlation between the ALD,COR and VMA （r= 0.090,0.010,P〉0.05）. Conclusion The combined detection of 17-OH,17-KS,VMA and plasma ALD,COR has the value of diagnosis and differential diagnosis in benign ,malignant adrenal tumors,and whether it has function.