摘要
目的:原发性醛固酮增多症(PA)的分侧诊断是决定治疗策略的关键。本研究旨在比较肾上腺CT和分侧肾上腺静脉取血(AVS)对PA分侧诊断的符合率。方法:连续入选2015年6月至2018年6月期间在阜外医院确诊为PA的155例住院患者,平均年龄(48.0±11.3)岁,男性90例(58.1%)。所有患者均接受了肾上腺CT和成功AVS检查。比较肾上腺CT和AVS对PA分侧诊断的符合率。结果:155例患者的肾上腺CT和AVS的符合率为54.2%(84/155),其中肾上腺CT示单侧病变、单侧腺瘤、双侧病变和双侧正常患者,肾上腺CT和AVS的符合率分别为57.0%(45/79)、61.1%(33/54)、33.3%(4/12)和54.7%(35/64)。如以AVS作为PA分侧诊断的标准,仅根据肾上腺CT来制定治疗方案,可能导致45.8%(71/155)的患者治疗不当,具体为14.2%(22/155)被选择行不必要的肾上腺手术,23.9%(37/155)本应选择手术却推荐非手术治疗,7.7%(12/155)手术侧选择错误。对于2016年美国内分泌学会推荐仅凭CT就可选择单侧肾上腺手术治疗的7例(4.5%)患者,肾上腺CT与AVS的符合率为71.4%(5/7)。结论:肾上腺CT和AVS的符合率不高,所有愿意行肾上腺手术治疗的PA患者均应推荐行AVS,有利于正确分侧和作出正确治疗选择。
Objectives:Subtype diagnosis is crucial for the purpose of selecting the appropriate therapeutic strategies for patients with primary aldosteronism(PA).The purpose of this study was to assess the coincidence rate of adrenal computed tomography(CT)and adrenal venous sampling(AVS)in the subtype diagnosis of PA.Methods:A total of 155 consecutive PA patients underwent adrenal CT and successful AVS at our institution from 2015-06 to 2018-06 were studied.The coincidence rate of adrenal CT and AVS in the subtype diagnosis of PA was evaluated.Results:The mean age of the patients was(48.0±11.3)years and 90(58.1%)patients were male.The coincidence rate of adrenal CT and AVS was 54.2%(84/155).With regard to patients with unilateral lesions,unilateral adenoma,bilateral lesions and bilateral normal based on adrenal CT results,the coincidence rate of adrenal CT and AVS was 57.0%(45/79),61.1%(33/54),33.3%(4/12)and 54.7%(35/64),respectively.If only CT results were used to determine lateralization of an adrenal abnormality,inappropriate treatment would have occurred in 45.8%(71/155)patients,including inappropriate adrenalectomy,inappropriate exclusion from adrenalectomy,and adrenalectomy on the wrong side in 14.2%(22/155),23.9%(37/155)and 7.7%(12/155)patients,respectively.With regard to 7 patients who could proceed to unilateral adrenalectomy without prior AVS according to the recommendation of 2016 Endocrine Society,the coincidence rate of adrenal CT and AVS were 71.4%(5/7).Conclusions:Our study results show that the coincidence rate of adrenal CT and AVS in the subtype diagnosis of PA is low.All patients with PA,intended to receive adrenalectomy surgery,should undergo AVS examination to improve the subtype diagnosis and AVS is essential for the appropriate decision-making on surgery plan of PA patients.
作者
李艳珍
董徽
陈阳
车武强
熊洪亮
华倚虹
崔成
宋雷
钱俊
石治宇
邹玉宝
蒋雄京
LI Yanzhen;DONG Hui;CHEN Yang;CHE Wuqiang;XIONG Hongliang;HUA Yihong;CUI Cheng;SONG Lei;QIAN Jun;SHI Zhiyu;ZOU Yubao;JIANG Xiongjing(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2019年第7期698-702,共5页
Chinese Circulation Journal
基金
国家自然科学基金(81700440)