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昇圧された血管作動性腸管ペプチド濃度はVIPomaをほとんど予測しない

Jack Korleski1, Luis E Ospina Velasquez2, Joshua Bornhorst3

  • 1Department of Internal Medicine, Mayo Clinic, Rochester MN United States.

Endocrine-related cancer
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PubMed
まとめ

VIPoma、まれな神経内分泌腫瘍の診断は困難です。この研究では、血管作動性腸管ペプチド（VIP）レベルの上昇が発生する可能性がある一方で、VIPomaを予測するための最適な閾値は442 pg/mLであり、不要な検査を回避できることがわかりました。

キーワード:
診断精度慢性下痢

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科学分野:

  • 内分泌学;腫瘍学;消化器病学

背景:

  • VIPomaは、診断上の課題を伴うまれな神経内分泌腫瘍（NET）です。
  • 血管作動性腸管ペプチド（VIP）レベルの上昇は特徴的ですが、定義された診断閾値がありません。
  • VIPomaの診断には、VIPレベルの正確な解釈が重要です。

研究 の 目的:

  • VIPoma診断における血漿VIP濃度の最適な閾値を決定すること。
  • VIPoma患者と非VIPoma患者のVIPレベルを比較すること。
  • 単一施設集団におけるVIP検査の診断ユーティリティを評価すること。

主な方法:

  • VIPレベルが75 pg/mLを超える患者のVIP検査結果（2011-2023）の遡及的レビュー。
  • 確認されたVIPomaコホートと非VIPomaコホート間の血漿VIP濃度比較。
  • 最適なVIP閾値とその予測値の決定のための統計分析。

主要な成果:

  • 9例のVIPomaが76例の適格患者で診断され、すべて慢性下痢を呈していました。; VIPoma患者（508 pg/mL）対非VIPoma患者（223 pg/mL）で平均VIP濃度は高かったですが、統計的に有意ではありませんでした（p=0.31）。; 最適なVIP閾値442 pg/mL（OR：11.96、p=0.01）が特定され、有意なオッズ比は200 pg/mLから開始されました。75 pg/mLでの陽性的中率はわずか12％でした。

結論:

  • 上昇したVIP濃度のみでは、VIPomaを強く予測するものではありません。
  • VIPレベルが高い患者のほとんどはVIPomaではありません。
  • 不要な検査を防ぐために、特定の臨床シナリオでのVIP検査の賢明な使用を推奨します。