肾上腺静脉采血在原发性醛固酮增多症患者中的临床应用

Clinical application of adrenal vein sampling in patients with primary aldosteronism

目的探讨肾上腺静脉采血(AVS)在原发性醛固酮增多症患者治疗方案决策与疗效评估中的临床意义。方法回顾性分析2020年1月至2023年12月遵义医科大学附属医院泌尿外科收治的77例原发性醛固酮增多症患者的临床资料。基于术前检查方式的不同,研究对象被分为仅接受CT检查的A组(40例)和接受CT检查及AVS的B组(37例)。比较两组患者术前术后血钾、皮质醇、醛固酮、血压、住院费用等相关资料。结果B组患者的平均住院费用高于A组(P<0.01)。A组患者肾上腺CT结果显示以单侧病变为主,B组患者则以双侧病变为主,且A组患者单侧病变手术瘤体体积、双侧病变手术侧瘤体体积均大于B组患者(P<0.01)。A组和B组患者术后外周血皮质醇、醛固酮、收缩压、舒张压均低于术前(P<0.05)。结论术前是否行AVS对肾上腺手术疗效的影响无明显差异,均能有效控制血压,但AVS可用于指导原发性醛固酮增多症患者的肾上腺切除手术侧别决策,特别是对于单侧小腺瘤和双侧肾上腺病变的患者提供了手术依据。

Objective Explore the clinical significance of adrenal vein sampling(AVS)in the decision-making and efficacy evaluation of therapy strategy for patients with primary hyperaldosteronism(PA).Methods A retrospective analysis was conducted on clinical data from 77 patients with primary aldosteronism who were admitted to the urology department of the affiliated hospital of Zunyi medical university from January 2020 to December 2023.Based on different preoperative examination methods,they were divided into the CT examination group(Group A,40 cases)and the CT plus adrenal venous sampling group(Group B,37 cases).Preoperative and postoperative blood potassium,cortisol,aldosterone,blood pressure,hospitalization expenses,and other related data between the two groups were compared.Results The average hospitalization cost for group B was found to be significantly higher than that for group A(P<0.01).CT results of the adrenal glands in group A showed that predominantly unilateral lesions were present,while group B predominantly had bilateral lesions and the tumor volume of unilateral lesions in group A was observed to be larger than that in group B and the tumor volume on the surgical side of bilateral lesions in group A was found to be larger than that in group B(P<0.01).Postoperative peripheral blood cortisol and aldosterone levels were lower than preoperative levels in both group A and group B,both groups were observed to have lower postoperative systolic and diastolic pressures compared to preoperative values(P<0.05).Conclusion The impact of preoperative AVS on surgical efficacy of adrenal gland is not shown to have significant differences;both can effectively control blood pressure.However,the decision of adrenal gland resection side in patients with primary aldosteronism can be guided by AVS,especially providing a surgical basis for patients with unilateral adenoma and bilateral adrenal lesions.