原醛症六例临床分析及两种分型预测评分系统的应用

Clinical analysis of 6 patients with primary aldosteronism and application of two subtyping predictive scoring systems

目的:分析6例原发性醛固酮增多症(PA)患者的临床特征、肾上腺静脉采血(AVS)结果及两种PA分型预测评分系统的应用价值,以期提高临床医师对该病的认识和诊治水平。方法:收集2022年3月至2023年4月在南京市溧水区人民医院诊断为PA并行AVS的6例患者的一般临床资料及诊治情况进行回顾性分析,并结合已发表文献评价SPACE及CLR评分系统的应用价值。结果:6例患者平均年龄50岁,均表现为高血压,4例合并低血钾。所有患者立位血浆醛固酮与肾素比值(ARR)均高于常用切点,确诊试验均为阳性,双侧AVS成功率50%。与既往5年国内发表的10篇个案汇总分析,SPACE评分系统诊断UPA的阳性预测值100%,阴性预测值50%,可使41.6%的患者避免行AVS,CLR与SPACE评分系统预测PA分型的一致率为75%。结论:对于PA患者,如无法进行AVS或AVS仅单侧成功,可结合SPACE或CLR评分系统,以使部分患者在免于进行初次或再次AVS的情况下得到正确的治疗。

Objective:To analyze the clinical features of 6 patients with primary aldosteronism(PA),the results of adrenal venous sampling(AVS),and the application value of two PA subtyping predictive scoring systems in order to improve the understanding,diagnosis and treatment of the disease among clinicians.Methods:The general clinical data,diagnosis and treatment of 6 patients diagnosed with PA and underwent AVS in Nanjing Lishui People s Hospital from March 2022 to April 2023 were retrospectively analyzed,and the application value of SPACE and CLR scoring systems were evaluated combined with published papers.Results:All the 6 patients with an average age of 50 years presented with hypertension,and 4 of the 6 with hypokalemia.The upright plasma aldosterone-to-renin ratio(ARR)in all patients exceeded the usual cut-off point,the confirmatory tests were positive,and the success rate of bilateral AVS was 50%.Along with 10 cases published in China in the past 5 years,the SPACE scoring system displayed a positive/negative predictive value of 100%/50%,avoiding AVS in 41.6%of patients.The agreement rate of CLR and SPACE scoring system in predicting PA subtyping was 75%.Conclusion:For patients with PA,if AVS is unavailable or of unilateral success,the SPACE or CLR scoring systems can be integrated in clinical practice to enable some patients to be properly treated in the cases of avoiding initial or repetitive AVS.