arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2023-29-1-68-78arthyper-2248Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСовременная диагностика феохромоцитомы и параганглиомы. Фокус на хромогранин АDiagnosis of pheochromocytoma and paraganglioma. Focus on chromogranin Ahttps://orcid.org/0000-0003-3124-1512КравчукЕ. Н.KravchukE. N.

Кравчук Екатерина Никодимовна — кандидат медицинских наук, старший научный сотрудник научно-исследовательской лаборатории нейроэндокринных опухолей 

Ekaterina N. Kravchuk, MD, PhD, Senior Researcher, Laboratory of Neuroendocrine Tumors, World-Class Research Centre for Personalized Medicine

kravchuke@gmail.comhttps://orcid.org/0000-0003-4013-4831ЦойУ. А.TsoyU. A.

Цой Ульяна Александровна — кандидат медицинских наук, руководитель научно-исследовательской лаборатории нейроэндокринных опухолей

Uliana A. Tsoy, MD, PhD, Head, Laboratory of Neuroendocrine Tumors, World-Class Research Centre for Personalized Medicine

utsoi@mail.ruhttps://orcid.org/0000-0002-1898-0743КрукА. С.KrukA. S.

Крук Анастасия Сергеевна — врач-эндокринолог

Anastasia S. Kruk, MD, Endocrinologist

ya.stasya-9428@yandex.ruhttps://orcid.org/0000-0002-2115-8873ВасильеваЕ. Ю.VasilyevaE. Yu.

Васильева Елена Юрьевна — заведующая центральной клинико-диагностической лабораторией

Elena Yu. Vasilyeva, MD, Head, Central Diagnostic Laboratory

vasil'eva_eyu@almazovcentre.ruhttps://orcid.org/0000-0003-0042-7680ГриневаЕ. Н.GrinevaE. N.

Гринева Елена Николаевна — доктор медицинских наук, профессор, член-корреспондент РАН, директор Института эндокринологии 

Elena N. Grineva, MD, PhD, DSc, Professor, Corresponding Member of the Russian Academy of Sciences, Director, Institute of Endocrinology

grineva_e@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian FederationФедеральная сеть многопрофильных клиник Клиника Фомина, ООО «КДФ-СПБ»РоссияFomin ClinicRussian Federation2023080920222916878Copyright © Кравчук Е.Н., Цой У.А., Крук А.С., Васильева Е.Ю., Гринева Е.Н., 20232023Кравчук Е.Н., Цой У.А., Крук А.С., Васильева Е.Ю., Гринева Е.Н.Kravchuk E.N., Tsoy U.A., Kruk A.S., Vasilyeva E.Y., Grineva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2248

Цель исследования — проанализировать результаты определения хромогранина А в крови, выполненного в лаборатории ФГБУ «НМИЦ им. В. А. Алмазова» Минздрава России, у пациентов с подтвержденным диагнозом феохромоцитомы/параганглиомы (ФПГЛ) и у пациентов с отсутствием данных о нейроэндокринной опухоли (НЭО) по результатам комплексного обследования и определить возможности данного метода в диагностике ФПГЛ. Материалы и методы. Проведено одноцентровое ретроспективное когортное исследование. Были изучены электронные истории болезни пациентов, которым в период с 2015 по 2021 год было выполнено исследование хромогранина А в крови. Пациенты, включенные в анализ, были разделены на 2 группы. В группу 1 (группа исследования) был включен 51 пациент с подтвержденным диагнозом ФПГЛ, в группу 2 (группа контроля) были включены 120 пациентов, которым проводилось обследование в связи с подозрением на наличие НЭО, но диагноз не был подтвержден. Пороговое значение хромогранина А определено с помощью ROC-анализа, в качестве зависимой переменной выбрано наличие ФПГЛ. Результаты. Медиана значений хромогранина А в исследуемой группе составила 495,93 мкг/л (0–100). По данным ROC-анализа, оптимальной точкой разделения значения хромогранина А для диагностики ФПГЛ с чувствительностью теста 82,4 %, специфичностью 94,2 % (площадь под кривой AUC — 0,939, стандартная ошибка — 0,024, 95 % доверительный интервал — 0,892–0,986, р < 0,001) оказалось значение 97,2 мкг/л. После разделения пациентов с ФПГЛ на 3 подгруппы в зависимости от размера образования надпочечника и распространенности поражения по данным компьютерной томографии (менее 5 см — подгруппа 1, 5 см и более — подгруппа 2, множественное поражение — подгруппа 3), чувствительность порогового значения хромогранина А 97 мкг/л в подгруппе 1 оказалась 70 %, в подгруппе 2 — 95 % и в подгруппе 3 — 82 %. Заключение. Выполнение анализа крови на хромогранин А может использоваться в качестве эффективного маркера ФПГЛ, дополняя стандартные методы лабораторной диагностики. Данный показатель может быть дополнительным тестом в диагностике ФПГЛ, особенно при наличии крупных образований надпочечников, однако отсутствие повышения хромогранина А не является основанием для исключения диагноза ФПГЛ.

Objective. To analyze the results of a laboratory examination for chromogranin A in the blood performed in the laboratory at Almazov National Medical Research Centre in patients with confirmed diagnosis of pheochromocytoma/paraganglioma (PPGL) and in patients with unconfirmed neuroendocrine tumor based on the results of a comprehensive examination and to determine the possibilities of this method in the diagnosis of PPGL. Design and methods. A single-center retrospective cohort study was conducted. Electronic medical histories of patients with valid chromogranin A blood test in the period from 2015 to 2021 were studied. The patients included in the study were divided into 2 groups. Group 1 (study group) included 51 patients with a confirmed diagnosis of PPGL, and Group 2 (control group) included 120 patients, who were examined for suspected neuroendocrine tumor, but the diagnosis was not confirmed. The threshold value of chromogranin A was determined using ROC-analysis, the presence of PPGL was selected as a dependent variable. Results. The median of chromogranin A in the study group was 495,93 µg/l (0–100). According to the ROC-analysis, the optimal point of separation of the chromogranin A value for the diagnosis of PPGL with a test sensitivity of 82,4 %, specificity of 94,2 % (area under curve AUC — 0,939, standard error — 0,024, 95 % confidence interval — 0,892–0,986, p < 0,001) was 97,2 µg/l. After dividing patients with PPGL into 3 subgroups, depending on the size of the adrenal gland formation and the prevalence of the lesion according to computer tomography (less than 5 cm — subgroup 1, 5 cm or more — subgroup 2, multiple lesion — subgroup 3), the sensitivity of the threshold value of chromogranin A 97 µg/l in subgroup 1 was 70 %, in subgroup 2 — 95 % and in subgroup 3 — 82 %. Conclusions. Performing a blood test for chromogranin A can be used as an effective marker of PPGL, complementing the standard methods of laboratory diagnostics. This indicator may be an additional factor in the diagnosis of PPGL, especially in the presence of large formations, but the absence of an increase in chromogranin A should not be used to exclude the diagnosis.

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The authors declare that there are no conflicts of interest present.