背景:高血压(HT)是分泌儿茶酚胺的神经内分泌肿瘤患者最常见的表现之一。尽管已经描述了这些肿瘤的心血管表现,目前尚未对嗜铬细胞瘤和副神经节瘤(PPGL)患者的HT概况以及心脏结构和功能的变化进行大规模研究.
方法:在本研究中,我们调查了2001年1月至2022年4月在我们中心接受PPGL手术的598例患者中HT和左心室重构(LVR)的患病率.人口统计信息,住院的原因,病史,生化参数,超声心动图发现,并记录肿瘤特征。根据是否有HT病史比较LVR指数。
结果:平均年龄为47.07±15.07岁,其中277例(46.32%)患者为男性。598例患者中有423例(70.74%)有HT病史。副神经节瘤在HT组中明显更常见(26.00%vs.17.71%,P=0.030),并且在该组的健康检查中偶然发现的可能性显着降低(22.93%vs.59.43%,P<0.001)。在365名具有完整超声心动图数据的患者中,左心室质量指数(86.58±26.70vs.75.80±17.26,P<0.001)和相对壁厚(0.43±0。08vs.0.41±0.06,P=0.012)在PPGL和HT病史的患者中明显更高。左心室肥厚(LVH)的比例(19.40%vs.8.25%,P=0.011)和LVR(53.73%vs.39.18%,有HT病史时,P=0.014)也更高。在调整了年龄之后,性别,身体质量指数,酒精消费,吸烟状况,糖尿病,中风,肌酐水平,肿瘤位置,和肿瘤大小,HT病史与LVH(比值比2.71,95%置信区间1.18-6.19;P=0.018)和LVR(比值比1.83,95%置信区间1.11-3.03;P=0.018)显著相关.
结论:HT在PPGL患者中很常见(在该队列中为70.74%)。没有HT病史的PPGL更有可能偶然发现(我们队列中的59.43%)。在具有完整超声心动图数据的PPGL患者中,HT与LVR有关。应仔细观察这些患者的心脏损害,尤其是那些有HT历史的人。
BACKGROUND: Hypertension (HT) is one of the most common manifestations in patients with catecholamine-secreting neuroendocrine tumors. Although the cardiovascular manifestations of these tumors have been described, there have been no large-scale investigations of the profile of HT and changes in cardiac structure and function that occur in patients with
pheochromocytomas and paragangliomas (PPGL).
METHODS: In this study, we investigated the prevalence of HT and left ventricular remodeling (LVR) in a cohort of 598 patients who underwent surgery for PPGL at our center between January 2001 and April 2022. Information on demographics, reason for hospitalization, medical history, biochemical parameters, findings on echocardiography, and tumor characteristics were recorded. The LVR index was compared according to whether or not there was a history of HT.
RESULTS: The average age was 47.07 ± 15.07 years, and 277 (46.32%) of the patients were male. A history of HT was found in 423 (70.74%) of the 598 patients. Paraganglioma was significantly more common in the group with HT (26.00% vs. 17.71%, P = 0.030) and significantly less likely to be found incidentally during a health check-up in this group (22.93% vs. 59.43%, P < 0.001). Among 365 patients with complete echocardiography data, left ventricular mass index (86.58 ± 26.70 vs. 75.80 ± 17.26, P < 0.001) and relative wall thickness (0.43 ± 0. 08 vs. 0.41 ± 0.06, P = 0.012) were significantly higher in patients with PPGL and a history of HT. The proportions with left ventricular hypertrophy (LVH) (19.40% vs. 8.25%, P = 0.011) and LVR (53.73% vs. 39.18%, P = 0.014) were also higher when there was a history of HT. After adjusting for age, gender, body mass index, alcohol consumption, smoking status, diabetes, stroke, creatinine level, tumor location, and tumor size, a history of HT was significantly correlated with LVH (odds ratio 2.71, 95% confidence interval 1.18-6.19; P = 0.018) and LVR (odds ratio 1.83, 95% confidence interval 1.11-3.03; P = 0.018).
CONCLUSIONS: HT is common in patients with PPGL (70.74% in this cohort). PPGL without a history of HT is more likely to be found incidentally (59.43% in our cohort). HT is associated with LVR in PPGL patients with complete echocardiography data. These patients should be observed carefully for cardiac damage, especially those with a history of HT.