当前位置:主页 > 医学论文 > 肿瘤论文 >

嗜铬细胞瘤危象临床特征分析

发布时间:2018-06-13 22:24

  本文选题:嗜铬细胞瘤危象 + 甲氧基肾上腺素类物质 ; 参考:《重庆医科大学》2017年硕士论文


【摘要】:目的:分析分泌儿茶酚胺的嗜铬细胞瘤和副神经节瘤(PPGL)危象(PCC)的临床特征,以提高临床医生对本病的认识及诊断水平。方法:收集2011年4月至2017年2月就诊于重庆医科大学附属第一医院的123例PPGL患者的临床资料,根据有无血流动力学紊乱和终末器官损伤或功能障碍分为危象组和非危象组。比较两组间人口学特点、临床表现、实验室检查、影像学表现、围术期情况及病理资料等的差异。结果:1)危象组16例,其中误诊率31.2%(5例)。非危象组107例。2)与非危象组相比,危象组头痛、心悸、多汗、经典三联征及其它表现更多见,重度高血压、低血压发生率更高,且以阵发性高血压居多、PPGL发作性症状就诊者更多,差异均具有统计学意义(均P0.05)。3)血白细胞、空腹血糖、转氨酶、肌钙蛋白、D-二聚体更高,而估算肾小球滤过率(eGFR)更低,更多肿瘤位于肾上腺左侧(均P0.05)。4)血甲氧基肾上腺素类物质(MNs)水平、肿瘤最大直径、CT扫描各期CT值、良性肿瘤比例、瘤内出血或坏死情况均高于非危象组,但差异均无统计学意义。5)危象组更多进行择期手术,但术前准备时间、手术方式、术中及术后并发症、死亡率两组间无显著差异。结论:PCC是一种少见的内分泌急症,其临床表现复杂多样,往往伴有典型三联征,血流动力学更不稳定和终末器官更易受累。虽然依靠生化检查和影像学诊断PCC较为有效,但仍有较高误诊率。一旦明确诊断,应及时启动药物准备,手术切除肿瘤是治疗PCC的关键。
[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.
【学位授予单位】:重庆医科大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R736.6

【参考文献】

相关期刊论文 前2条

1 曹万里;黄宝星;成康;宿恒川;黄欣;戴军;周文龙;祝宇;沈周俊;费晓春;宁光;孙福康;;血浆游离甲氧肾上腺素和甲氧基去甲肾上腺素正常的嗜铬细胞瘤/副神经节瘤患者的临床特点[J];中华临床医师杂志(电子版);2015年02期

2 刘力生;;中国高血压防治指南2010[J];中华高血压杂志;2011年08期



本文编号:2015706

资料下载
论文发表

本文链接:https://www.wllwen.com/yixuelunwen/zlx/2015706.html


Copyright(c)文论论文网All Rights Reserved | 网站地图 |

版权申明:资料由用户efa4e***提供,本站仅收录摘要或目录,作者需要删除请E-mail邮箱bigeng88@qq.com