心肌酶谱、动态心电图及冠状动脉CT血管造影诊断嗜铬细胞瘤儿茶酚胺性心脏损害价值研究

摘要 目的：探讨心肌酶谱、动态心电图及冠状动脉CT血管造影诊断嗜铬细胞瘤儿茶酚胺性心脏损害的临床价值。方法：收集2013年1月-2020年4月在我院诊断为嗜铬细胞瘤患者114例，其中嗜铬细胞瘤儿茶酚胺性心脏损害的患者27例。所有患者均完善术前常规检查（血常规、胸片、动态心电图）、心肌酶谱、心脏超声、冠状动脉CTA等临床资料，并收集患者一般临床资料，如血压、临床症状等。结果：114例嗜铬细胞瘤患者中，27例患者存在嗜铬细胞瘤儿茶酚胺性心脏损害。嗜铬细胞瘤儿茶酚胺性心脏损害患者一般临床资料与嗜铬细胞瘤无儿茶酚胺性心脏损害的患者差异无统计学意义（P＞0.05）。嗜铬细胞瘤儿茶酚胺性心脏损害以高血压为主要表现，临床症状表现多样，可伴有头痛、心悸、多汗三联征表现。114例患者中，26例患者出现心肌酶谱升高，36例患者存在不同程度的心电图异常、24例患者冠状动脉CTA异常，嗜铬细胞瘤儿茶酚胺性心脏损害患者在心肌酶谱、动态心电图及冠状动脉CTA异常例数与嗜铬细胞瘤无儿茶酚胺性心脏损害患者中差异均有统计学意义（P＜0.05）。114例患者中心肌酶谱或心电图或冠状动脉CTA异常的患者总共56例，其中嗜铬细胞瘤儿茶酚胺性心脏损害患者23例，嗜铬细胞瘤无儿茶酚胺性心脏损害患者有33例，差异有统计学意义（P＜0.05）。嗜铬细胞瘤儿茶酚胺性心脏损害患者中，心律失常最为常见。结论：嗜铬细胞瘤儿茶酚胺性心脏损害患者心肌酶谱、动态心电图及冠状动脉CTA均可存在异常表现，但特异性、敏感性不高，三者同时综合分析可以提高临床诊断。

The Value of Myocardial Enzyme, Dynamic Electrocardiogram and Coronary Artery CTA Angiography in the Diagnosis of Pheochromocytoma with Catecholamine Heart Damage

ABSTRACT Objective: To explore the clinical value of myocardial enzyme, dynamic electrocardiogram and coronary artery CTA angiography in the diagnosis of pheochromocytoma with catecholamine heart damage. Methods: From January 2013 to April 2020, 114 patients with pheochromocytoma were diagnosed in our hospital, including 27 pheochromocytoma with catecholamine heart damage. All patients completed the preoperative routine examination (blood routine, chest film, dynamic electrocardiogram), myocardial enzyme, cardiac ultrasound, coronary artery CTA and other clinical data, and collected general clinical data of patients, such as blood pressure, clinical symptoms and so on. Results: Among 114 patients with pheochromocytoma, 27 had catecholamine heart damage. There was no significant difference between the general clinical data of pheochromocytoma with catecholamine heart damage and pheochromocytoma without catecholamine heart damage(P>0.05). The main manifestation of pheochromocytoma with catecholamine heart damage was hypertension,and the clinical symptoms are various,with headache, palpitation and hyperhidrosis. In 114 patients, 26 patients had elevated myocardial enzyme spectrum, 36 patients had different degrees of electrocardiogram abnormalities, 24 patients had abnormal coronary artery CTA. There were significant differences in the number of abnormal cases of myocardial enzyme spectrum, dynamic electrocardiogram and coronary artery CTA between pheochromocytoma with catecholamine heart damage and pheochromocytoma without catecholamine heart damage (P<0.05). There were 56 patients with abnormal myocardial enzyme spectrum or electrocardiogram or coronary artery CTA in 114 patients, including 23 pheochromocytoma with catecholamine heart damage and 33 pheochromocytoma without catecholamine heart damage, the difference was statistically significant (P<0.05). Arrhythmia was the most common in pheochromocytoma with catecholamine heart damage. Conclusion: The abnormal manifestations of myocardial zymogram, dynamic electrocardiogram and coronary artery CTA were found in pheochromocytoma with catecholamine heart damage, but their specificity and sensitivity are not high. Simultaneous comprehensive analysis of the three factors can improve clinical diagnosis.