无高血压性嗜铬细胞瘤的临床病理特点

Clinical and Pathological Features of Pheochromocytoma without Hypertension

目的研究无高血压性嗜铬细胞瘤临床病理特点,为其防治提供理论依据。方法随机选取132例散发性单侧肾上腺嗜铬细胞瘤(PHEO),分为2组A组即嗜铬细胞瘤合并高血压(HPs)90例,B组即无高血压性嗜铬细胞瘤(NPs)42例,原发性高血压(PH)98例作为参照组即C组。比较分析A、B及C组3组患者临床表现及病理特点。结果 A、B、C 3组在性别、年龄及身高上差异均无统计学意义(P>0.05);SBP和DBP3组相比,C组最高,A组第二,B组最低。B组的三联征发生率明显低于A组,差异有统计学意义(P=0.021);A组眩晕、持续高血压及阵发性高血压发生率均比B组高,差异均有统计学意义(P=0.002,P=0.001,P=0.002)。A、B两组CT特征比较差异无统计学意义(P>0.05)。根据苯乙醇胺-N-甲级转移酶(PNMT)免疫组化染色定性结果分为2个亚组,B组亚组肿瘤直径与PNMT表现呈负相关,而A组亚组则没有此情况。A、B两组在细胞低密度、儿茶酚胺肾上腺素型及儿茶酚胺去甲肾上腺素型方面差异有统计学意义(P=0.014,P=0.003,P=0.003),其它均无统计学意义(P>0.05)。除VMAT1外,其它基因表达水平A组均高于B组,差异有统计学意义(P=0.039,P=0.041,P=0.035)。结论 NPs和HPs的临床病理特点不同,主要与肿瘤发生及发展进程中儿茶酚胺途径的相关产物及催化酶的基因转录水平紧密关联。

Objective To study the clinicopathological characteristics of non-hypertensive pheochromocytoma ,and pro-vide the theoretical basis for its prevention and treatment .Methods 132 sporadic pheochromocytoma of the adrenal gland （PHEO） were randomly selected and divided into 2 groups：group A（HPs） with hypertension 90 cases,group B without hyperten-sion（NPs） 42 cases,group C with primary hypertension（PH） 98 cases as the control group.The clinical manifestations and path-ological features of group A ,B and C were analyzed .Results There was no significant difference in gender ,age and height among the 3 groups（P〉0.05）.The SBP and DBP were the highest in group C and lowest in group A and B respectively .The incidence of triad syndrome in group B was significantly lower than that of group A （P=0.021）.The incidence of vertigo,persistent hyper-tension and paroxysmal hypertension in group A was higher than that of group B ,the difference was statistically significant （ P=0.002,P=0.001,P=0.002）.There was no significant difference in CT features between group A and group B （P〉0.05）. There were 2 subgroups according to the immunohistochemical staining of phenylethanolamine -N-methyltransferase （ PNMT ） . There was a negative correlation between tumor diameter and PNMT in group B , but not in group A .There was no significant difference between the 2 groups（P=0.014,P=0.003,P=0.003）,but there was no statistical significance between the 2 groups （P〉0.05）.In addition to VMAT1,the expression of other genes in group A was significantly higher than that of group B （P=0.039,P=0.041,P=0.035）.Conclusion NPs and HPs have different clinicopathological features ,which are closely related to the level of catecholamine pathway and the level of catalytic enzyme gene transcription in tumorigenesis and progression .