本文選題：嗜鉻細胞瘤危象 + 甲氧基腎上腺素類物質(zhì)　； 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的:分析分泌兒茶酚胺的嗜鉻細胞瘤和副神經(jīng)節(jié)瘤(PPGL)危象(PCC)的臨床特征,以提高臨床醫(yī)生對本病的認識及診斷水平。方法:收集2011年4月至2017年2月就診于重慶醫(yī)科大學附屬第一醫(yī)院的123例PPGL患者的臨床資料,根據(jù)有無血流動力學紊亂和終末器官損傷或功能障礙分為危象組和非危象組。比較兩組間人口學特點、臨床表現(xiàn)、實驗室檢查、影像學表現(xiàn)、圍術期情況及病理資料等的差異。結果:1)危象組16例,其中誤診率31.2%(5例)。非危象組107例。2)與非危象組相比,危象組頭痛、心悸、多汗、經(jīng)典三聯(lián)征及其它表現(xiàn)更多見,重度高血壓、低血壓發(fā)生率更高,且以陣發(fā)性高血壓居多、PPGL發(fā)作性癥狀就診者更多,差異均具有統(tǒng)計學意義(均P0.05)。3)血白細胞、空腹血糖、轉氨酶、肌鈣蛋白、D-二聚體更高,而估算腎小球濾過率(eGFR)更低,更多腫瘤位于腎上腺左側(均P0.05)。4)血甲氧基腎上腺素類物質(zhì)(MNs)水平、腫瘤最大直徑、CT掃描各期CT值、良性腫瘤比例、瘤內(nèi)出血或壞死情況均高于非危象組,但差異均無統(tǒng)計學意義。5)危象組更多進行擇期手術,但術前準備時間、手術方式、術中及術后并發(fā)癥、死亡率兩組間無顯著差異。結論:PCC是一種少見的內(nèi)分泌急癥,其臨床表現(xiàn)復雜多樣,往往伴有典型三聯(lián)征,血流動力學更不穩(wěn)定和終末器官更易受累。雖然依靠生化檢查和影像學診斷PCC較為有效,但仍有較高誤診率。一旦明確診斷,應及時啟動藥物準備,手術切除腫瘤是治療PCC的關鍵。
[Abstract]:Objective: to analyze the clinical features of PCC- (pheochromocytoma and PPGLG) secreting catecholamine in order to improve the understanding and diagnosis of the disease. Methods: the clinical data of 123 patients with PPGL from April 2011 to February 2017 in the first affiliated Hospital of Chongqing Medical University were collected and divided into crisis group and non-crisis group according to hemodynamic disorder and end-organ injury or dysfunction. The demographic characteristics, clinical manifestations, laboratory findings, imaging findings, perioperative conditions and pathological data were compared between the two groups. Results of the 16 cases in the crisis group, the misdiagnosis rate was 31. 2%. Compared with the non-crisis group, headache, palpitation, hyperhidrosis, classic triple sign and other manifestations were more common in the crisis group than in the non-crisis group, and the incidence of severe hypertension and hypotension was higher than that in the non-crisis group. There were more paroxysmal hypertension patients with PPGL paroxysmal symptoms, and the difference was statistically significant (P 0.05). The levels of blood leukocytes, fasting blood glucose, aminotransferase, troponin D dimer and estimated glomerular filtration rate (GFR) were lower. More tumors were located on the left side of adrenal gland (P 0.05. 4). The CT value of each stage, the proportion of benign tumors, the rate of hemorrhage or necrosis in the tumor were higher than those in the non-crisis group, and the maximum diameter of the tumor was higher than that in the non-crisis group. But there was no significant difference between the two groups, but there was no significant difference in preoperative preparation time, operative method, intraoperative and postoperative complications and mortality between the two groups. Conclusion: PCC is a rare endocrine emergency, its clinical manifestations are complex and diverse, often accompanied by typical triple sign, hemodynamics is more unstable and terminal organs are more susceptible to involvement. Although it is effective to rely on biochemical examination and imaging to diagnose PCC, there is still a high misdiagnosis rate. Once the diagnosis is clear, drug preparation should be initiated in time. Surgical resection of tumors is the key to the treatment of PCC.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.6

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相關期刊論文 前2條

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本文編號：2015706