健康成人肾上腺CT测量值的建立及意义

CT measurement of adrenal glands in healthy adults

目的建立健康成人肾上腺测量参数参考值,分析肾上腺体积(AGV)与人体测量参数的关系,建立AGV预测公式。分析健康成人AGV与肾上腺激素水平、血压、空腹血糖(FBG)、血脂、尿酸(UA)的关系。方法本研究纳入成都地区于2018年~2019年随机招募的105名健康志愿者(HVs),收集年龄、性别、身高、体重、腰围、体重指数(BMI)、体表面积(BSA)、血压等信息,于四川大学华西医院检验科检测FBG、血脂、UA及肾上腺激素水平,并行肾上腺CT平扫,基于医学数字成像与通信(DICOM)图像,人工描绘肾上腺轮廓,半自动体积测量法计算AGV。结果左侧肾上腺平均肢体宽度(ALW)、右侧ALW的95%参考值范围分别为0.27~0.57 cm、0.22~0.49 cm;左侧AGV(L-AGV)、右侧AGV(R-AGV)、总AGV(T-AGV)的95%参考值范围分别为1.86~5.08 cm^(3)、1.21~4.36 cm^(3)、3.30~9.21 cm^(3);左右侧ALW比值(L/Rw)、左右肾上腺体积比(L/Rv)的95%参考值范围分别为0.76~1.66,0.73~1.91。男性T-AGV大于女性(P<0.0001)。纳入人口学参数及肾上腺测量参数,利用多元线性逐步回归分析建立AGV预测公式,L-AGV(cm^(3))=0.199×长(cm)+0.495×高(cm)+3.359×ALW(cm)+0.037×体重(kg)-2.128,调整后R2为0.663;R-AGV(cm^(3))=0.414×长(cm)+0.552×高(cm)+3.595×ALW(cm)+0.024×体重(kg)-2.857,调整后R2为0.579。T-AGV与8点皮质醇(PTC)、促肾上腺皮质激素(ACTH)、24小时尿游离皮质醇(24hUFC)、去甲肾上腺素、收缩压(SBP)、舒张压(DBP)、UA正相关,矫正体重后,T-AGV与肾上腺激素水平及各生化指标均无相关性。与肾素活性(PRA)、醛固酮(ALD)、FBG、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-L)、高密度脂蛋白胆固醇(HDL-C)、血钾水平无明显相关性。结论本研究建立了肾上腺测量参数参考值范围,为后续探索肾上腺测量在肾上腺疾病诊治中的应用提供基线数据。T-AGV与体重密切相关,在对肾上腺测量值进行分析时,需考虑体重影响因素。

Objective To provide the reference values of adrenal measurement parameters in healthy adults,explore the relationship between adrenal volume(AGV)and anthropometric parameters,and establish an AGV prediction model.To analyze the relationship between AGV and adrenal hormones,blood pressure,fasting blood glucose(FBG),blood lipid and uric acid(UA)in healthy adults.Methods 105 healthy volunteers(HVs)randomly recruited in Chengdu from 2018 to 2019 were included.Age,sex,height,weight,waistline,body mass index(BMI),body surface area(BSA),blood pressure and other information of them were collected.FBG,blood lipids,UA and adrenal hormones were measured in the laboratory department of West China Hospital of Sichuan University,and adrenal CT scan was performed.Based on medical digital imaging and communication(DICOM)images,the contour of adrenal gland was depicted manually,and the AGV was calculated by semi-automatic volumetric method.SPSS 23 statistical software was used for statistical analysis.Results The 95%reference range of left adrenal mean limb width(ALW)and right ALW were 0.27-0.57cm and 0.22-0.49cm,respectively.The 95%reference ranges of left AGV(L-AGV),right AGV(R-AGV)and total AGV(T-AGV)were 1.86-5.08 cm^(3),1.21-4.36 cm^(3)and 3.30-9.21 cm^(3),respectively.95%reference values of left and right ALW ratio(L/Rw)and left and right adrenal volume ratio(L/Rv)were 0.76-1.66 and 0.73-1.91,respectively.Male T-AGV was greater than female(P<0.0001).Including demographic parameters and adrenal measurement parameters,the prediction model of AGV was established by multiple linear stepwise regression analysis,L-AGV(cm^(3))=0.199*length(cm)+0.495*height(cm)+3.359*ALW(cm)+0.037*body weight(kg)-2.128,adjusted R 2 was 0.663;R-AGV(cm^(3))=0.414*length(cm)+0.552*height(cm)+3.595*ALW(cm)+0.024*body weight(kg)-2.857,adjusted R 2 was 0.579.T-AGV was positively correlated with 8 a.m.cortisol(PTC),adrenocorticotropin(ACTH),24-hour urinary free cortisol(24hUFC),norepinephrine,systolic blood pressure(SBP),diastolic blood pressure(DBP)and UA.After weight correction,the correlation between T-AGV and those biochemical indexes was disappeared.There was no significant correlation with renin activity(PRA),aldosterone(ALD),FBG,triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and serum potassium.Conclusion This study established the reference range of adrenal measurement parameters,providing baseline data for the follow-up exploration of the application of adrenal measurement in the diagnosis and treatment of adrenal diseases.T-AGV was closely related to body weight,and the influencing factors of body weight should be considered in the analysis of adrenal measurement values.