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目的 :探讨嗜铬细胞瘤患者血浆间甲肾上腺素类物质(metanephrines,MNs)水平与其血压及糖脂代谢情况间的相关性。方法:纳入2005年6月至2013年9月我院内分泌科经病理证实的193例嗜铬细胞瘤患者,所有患者均接受血浆MNs及代谢指标检测。采用Pearson相关分析、多元线性回归和多元logistic回归分析MNs与血压、血糖及血脂等代谢指标间的相关性。结果:嗜铬细胞瘤患者中合并高血压者占83.4%;伴有明显的糖脂代谢异常,合并糖尿病及血脂异常者分别占35.8%和23.8%。Pearson相关分析显示,间甲肾上腺素(metanephrine,MN)与空腹血糖及糖负荷2 h血糖呈显著正相关(P<0.05);去甲变肾上腺素(normetanephrine,NMN)与收缩压、舒张压、空腹血糖、糖负荷2 h血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及游离脂肪酸呈显著正相关(P<0.05)。多元线性回归分析表明,在校正年龄、性别、体质量指数、吸烟史及饮酒史后,MN与空腹血糖及游离脂肪酸仍显著正相关(P<0.05),NMN与收缩压、舒张压、空腹血糖、糖负荷2 h血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及游离脂肪酸显著正相关(P<0.05)。多元logistic回归分析证实,MN和NMN水平升高的患者糖尿病患病风险增加,且NMN水平升高患者的高血压患病风险增加。结论:嗜铬细胞瘤患者血浆MN、NMN水平与血压及糖脂代谢调控密切相关,且NMN对代谢的影响更为显著。
Objective: To investigate the correlation between plasma metanephrines (MNs) levels and blood pressure and glucose and lipid metabolism in patients with pheochromocytoma. Methods: Totally 193 cases of pheochromocytoma confirmed by pathology in our hospital from June 2005 to September 2013 were enrolled in this study. All patients received plasma MNs and metabolic indices. Pearson correlation analysis, multivariate linear regression and multivariate logistic regression analysis of MNs and blood pressure, blood glucose and lipid and other metabolic indicators between the correlation. Results: Pheochromocytoma patients with hypertension accounted for 83.4%; accompanied by significant abnormal glucose and lipid metabolism, diabetes and dyslipidemia accounted for 35.8% and 23.8%. Pearson correlation analysis showed that metanephrine (MN) was positively correlated with fasting plasma glucose and glucose load for 2 h (P <0.05); normetanephrine (NMN) was associated with systolic blood pressure, diastolic blood pressure, Fasting blood glucose, glucose load 2 h blood glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and free fatty acid were significantly correlated (P <0.05). Multivariate linear regression analysis showed that there was still a significant positive correlation between MN and fasting blood glucose and free fatty acid (P <0.05) after adjusting for age, gender, body mass index, smoking history and drinking history. NMN was positively correlated with systolic blood pressure, diastolic blood pressure, fasting blood glucose (P <0.05). There was a significant positive correlation between the blood sugar, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and free fatty acid. Multivariate logistic regression analysis confirmed an increased risk of diabetes mellitus in patients with elevated MN and NMN levels and an increased risk of hypertension in patients with elevated NMN levels. Conclusion: The levels of plasma MN and NMN in patients with pheochromocytoma are closely related to the regulation of blood pressure and glucose and lipid metabolism, and the effect of NMN on the metabolism is more significant.