基于CYP11B2免疫组化病理诊断的肾上腺瘤患者回顾性分析

Retrospective analysis of patients with adrenal tumors based on immunohistochemical pathological diagnosis of CYP11B2

目的:比较CYP11B2免疫组化为基础的病理与临床生化检测在诊断醛固酮瘤(APA)中的一致性,以及不同诊断类型患者的随访。方法:回顾性研究了既往39例原发性醛固酮增多症(PA)和32例无功能腺瘤(NFA)患者,采用CYP11B2免疫组化为基础进行病理诊断,并比较了病理诊断与临床生化诊断APA的一致性,最后按照免疫组化分类进行了随访。结果:按照CYP11B2免疫组化为基础的病理分型与临床生化检查具有极高的一致性(两种诊断的一致性系数Kappa值为0.89,P<0.01)。PA的严重程度与病理分型相关,APA依次强于分泌醛固酮的结节(APN)和分泌醛固酮的微结节(APM),相比APN患者,APA患者醛固酮水平[(934.75±719.15)pg/ml vs(315.26±138.77)pg/ml;P<0.05]、醛固酮/肾素活性比值明显偏高[6569.50(2275.00,87274.00)vs 1346.10(453.20,5381.50);P<0.05],钾离子水平则明显偏低[(2.95±0.55)mmol/Lvs(3.59±0.30)mmol/L;P<0.05]。相比APM患者,APN患者肾素活性抑制更加明显[0.232(0.072,0.511)ng/ml·h vs 0.75(0.299,1.402)ng/ml·h;P<0.05],醛固酮/肾素活性比值明显偏高[1346.10(453.20,5381.50)vs 281.04(210.01,370.99)]。患者术后半年的血压改变及口服降压药数量上无明显差异。通过CYP11B2免疫组化的病理检测中也发现,部分肾上腺标本可能是多种类型混合,例如APA合并APN、NFA合并APN和APM。结论:以CYP11B2免疫组化为基础的病理与临床生化检测在诊断PA时具有极高的一致性,可以弥补良性肾上腺病理诊断无法对临床诊断提供帮助的不足。不同病理分类反映了疾病的严重程度不同。

Objective:To compare the concordance between CYP11B2 immunohistochemical based pathology and biochemical testing in the diagnosis of aldosteronoma(APA)and follow-up of patients with different diagnostic categories.Methods:A previous series of 39 patients with primary aldosteronism(PA)and 32 non-function adeno⁃mas(NFA)were retrospectively studied,pathological diagnosis was made on the basis of CYP11B2 immunohisto⁃chemistry,and concordance between the pathological diagnosis and the biochemical diagnosis of APA was compared,finally patients were followed up according to the immunohistochemical classification.Results:Pathologic typing based on immunohistochemistry according to CYP11B2 had extremely high concordance with clinical biochemical testing(coefficient of agreement kappa value of 0.89 for both diagnoses,P<0.01).The severity of PA was correlat⁃ed with the pathological classification.APA is more severe than APN,whereas APN is more severe than APM.Compared to APN patients,the aldosterone level in APA patients[(934.75±719.15)pg/ml vs(315.26±138.77)pg/ml;P<0.05],and the aldosterone/renin activity ratio was significantly higher[6569.50(2275.00,87274.00)vs 1346.10(453.20,5381.50);P<0.05],potassium levels were also significantly lower[((2.95±0.55)mmol/L vs(3.59±0.30)mmol/L;P<0.05)].Compared with APM,APN showed more marked sup⁃pression of renin activity[0.232(0.072,0.511)ng/ml·h vs 0.75(0.299,1.402)ng/ml·h;P<0.05]and high⁃er aldosterone/renin activity ratio[1346.10(453.20,5381.50)vs 281.04(210.01,370.99)].Patients showed no apparent differences in blood pressure changes and number of antihypertensive medications change.It is also found in the pathological detection by CYP11B2 immunohistochemistry that some of the adrenal samples may be mixed types,such as APA combined with APN,NFA combined with APN and APM.Conclusions:The pathologic based on CYP11B2 immunohistochemistry and biochemical tests in diagnosing PA showed the excellent concordance.This may compensate for benign adrenal pathology cannot help in PA.The different pathological classifications reflect the different severity of the disease.