单侧原发性醛固酮增多症的病理类型分析及其临床特征

Pathological types and clinical features of unilateral primary aldosteronism

目的明确单侧原发性醛固酮增多症(原醛症)的病理类型分布,并探讨不同病理分型的单侧原醛症患者的临床特征及预后。方法连续纳入经肾上腺手术的单侧原醛症患者241例,搜集其临床及术后随访资料,并对其术后组织切片进行HE染色和醛固酮合酶染色。根据染色结果,对241例患者进行分型,比较不同病理分型的单侧原醛症患者的临床特征及手术预后。结果根据国际单侧原醛症病理共识,241例单侧原醛症患者中,有223例为经典型(92.5%),17例为非经典型(7.1%),另有1例为醛固酮癌(0.4%)。在经典型中,189例为醛固酮瘤,34例为醛固酮结节;非经典型中,8例为多发性醛固酮结节,9例为多发性醛固酮微结节。与经典型组相比,非经典型组中的高血压病程较长(9.0对5.0年,P=0.062),基线血浆醛固酮浓度较低(273对305 pg/mL,P=0.147),但差异不具有显著性。两组之间,术后获得完全生化缓解的患者比例无显著差异(98%对92.3%,P=0.281),但非经典组中获得完全临床缓解的患者比例显著更低(23.1%对52.9%,P=0.046)。结论单侧原醛症的病理分型以经典型为主,其中醛固酮瘤最多见。经典型和非经典型患者的临床特征及术后生化缓解率无显著差别,但后者临床预后劣于经典组。

Objective To investigate the distribution of pathological types of unilateral primary aldosteronism,and to explore the clinical characteristics and prognosis of patients with different pathological types.Methods A total of 241 patients with unilateral primary aldosteronism who underwent adrenal surgery were included in this study.The clinical data and postoperative follow-up data were collected,and the postoperative tissue sections were stained with HE and aldosterone synthase.According to the staining results,pathological types of 241 patients were classified,and the clinical characteristics and surgical prognosis of patients with unilateral primary aldosteronism were compared.Results According to the international histopathology consensus for unilateral primary aldosteronism,among 241 patients with unilateral primary aldosteronism,223 were classical(92.5%),17 were non-classical(7.1%),and 1 was aldosterone producing carcinoma(0.4%).Among classical cases,189 were aldosterone producing adenoma and 34 were aldosterone producing nodule.In the non-classical cases,8 cases were multiple aldosterone producing nodule and 9 cases were multiple aldosterone producing nodule.Compared with the classical group,the non-classical group had a longer duration of hypertension(9.0 vs 5.0 years,P=0.062)and a lower baseline plasma aldosterone concentration(273 vs 305 pg/mL,P=0.147),but the difference was not significant.There was no significant difference between the two groups in the proportion of patients who achieved a complete biochemical response after surgery(98%vs 92.3%,P=0.281),but the proportion of patients who achieved a complete clinical response was significantly lower in the non-classical group(23.1%vs 52.9%,P=0.046).Conclusion The pathological types of unilateral primary aldosteronism are predominantly classical,with aldosterone-producing adenoma being the most common.There were no significant differences in the clinical characteristics and postoperative biochemical remission rates between classical and non-classical patients,but the clinical prognosis of the latter was inferior to the former.