Prevalence and impact of diabetes and prediabetes on presentation and complications of primary hyperaldosteronism at diagnosis

BACKGROUND Primary hyperaldosteronism(PH)is considered to contribute to increased risk of developing type 2 diabetes mellitus(T2DM)and prediabetes.Both PH and DM are associated with increased risk for hypertension,cardiovascular diseases,and chronic kidney diseases.However,data on prevalence of T2DM and prediabetes in PH,and impact of T2DM and prediabetes on presentation and cardio renal complications in PH at presentation is sparse.AIM To determine the prevalence of T2DM and prediabetes in PH at diagnosis and impact on presentation and complications of PH.METHODS A retrospective cohort study was conducted in tertiary care settings in individuals with confirmed diagnosis of PH at presentation.Demographic variables,clinical presentations,duration and degree of hypertension,complications,laboratory parameters including sodium,potassium levels,plasma aldosterone concentration(PAC),plasma renin activity(PRA),and aldosterone to renin ratio(ARR)and cardio-renal parameters were collected.Comparison was done between three groups:PH with no DM(Group A)or with pre-diabetes(Group B)or with T2DM(Group C).P<0.05 was statistically significant.RESULTS Among 78 individuals with confirmed PH,62%had pre-diabetes or diabetes;with 37%having DM.Mean duration of T2DM was 5.97±4.7 years.The mean levels of glycaemic parameters among the group A vs B vs C individuals were fasting plasma glucose(mg/dL):87.9±6.5,105.4±9.02,130.6±21.1;post prandial plasma glucose(mg/dL):122.7±9.8,154.9±14,196.7±38.0;glycated haemoglobin(%)(5.3±0.2,5.9±0.2,7.5±0.6,P<0.05),respectively.There was no significant difference in the biochemical parameters(PAC,PRA,ARR,sodium,potassium levels),presentation and complications between the groups.Cardio renal parameters or degree and duration of hypertension were comparable between the groups.CONCLUSION Significant prevalence of T2DM and prediabetes in PH at diagnosis does not impact its presentation or complications.Early screening for undetected PH in T2DM and prediabetes subjects with hypertension may prevent complications.

基于影像组学和自动机器学习的PA患者肾上腺静脉取血结果的研究

目的建立基于高分辨率增强CT影像和自动机器学习技术的原发性醛固酮增多症(Primary Aldosteronism,PA)亚型术前预测模型。方法回顾性研究经肾上腺静脉取血(Adrenal Venous Sampling,AVS)结果亚型诊断的PA患者312例,其中,207例诊断为单侧优势(AVS-右∶AVS-左=93∶114),105例诊断为双侧优势。纳入患者初诊CT影像,基于薄层静脉期图像提取双侧肾上腺影像组学特征,并定义影像组学商值特征为双侧肾上腺对应影像组学特征的比值,再将特征向量输入自动机器学习进行模型训练。结果根据自动模型筛选,随机森林分类器在预测AVS结果方面取得了较好的整体性能,其中准确度为0.7500,召回率为0.7466,受试者工作特征曲线下面积为0.8792。结论本系统在预测PA患者的AVS结果方面展示出了一定的潜力,因此,机器学习模型可以在常规临床实践中辅助预测PA的亚型诊断。

Advances in Medical Treatment of Primary Aldosteronism

Primary aldosteronism(PA)is the most common form of secondary hypertension,with its main manifestations including hypertension and hypokalemia.Early identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation,stroke,and myocardial infarction.The past decade has witnessed the rapid advances in the genetics of PA,which has shed new light on PA treatment.While surgery is the first choice for unilateral diseases,bilateral lesions can be treated with mineralocorticoid receptor antagonists(MRAs).The next-generation non-steroidal MRAs are under investigations.New medications including calcium channel blockers,macrophage antibiotics,and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.

Adrenal Venous Sampling in Patients with Primary Aldosteronism: Which Is the Best Evaluation Method for Laterality Assessments?

Purpose: The purpose was to investigate the most accurate method of adrenal venous sampling to diagnose unilateral primary aldosteronism (PA) prior to laterality assessment. Materials and Methods: Sixty-four consecutive PA patients were enrolled in this retrospective study. A catheter was placed in the common-trunk-vein (CTV), below the confluence of the inferior-phrenic-vein and the central-adrenal-vein (CAV) and the right-adrenal-vein (RAV). Blood-sampling was performed both pre- and post-adrenocorticotropic hormone stimulation. Lateralized ratio [LR;aldosterone/cortisol ratio (ACR) on high-value side/ACR on low-value side], contralateral ratio (CR;ACR on low-value side/ACR on inferior-vena-cava ratio), and plasma aldosterone concentration (PAC) were evaluated. The diagnostic accuracy of LR, CR and PAC in CTV/ CAV/RAV during pre- and post-ACTH was compared by receiver-operating-characteristic (ROC) analysis. Results: LR-CAV post-ACTH showed the highest detection rate for unilateral adrenal lesions (93.3%;14/15), with a sensitivity of 0.93 and a specificity of 0.84 at a cut-off value of 2.5. CR-post-ACTH had the highest Az value (0.89), with a detection rate of 86.7% (13/14), a sensitivity of 0.98, and a specificity of 0.88 at a cut-off value of 0.8. Conclusion: CR-post-ACTH and LR-CAV-post-ACTH are accurate predictors for laterality assessment in PA.

Comparison of Cardiac Structural Improvement in Patients with Primary Aldosteronism after Surgical Therapy and Drug Therapy: A Meta-Analysis

Background: At present, in clinical practice, patients with primary hyperaldosteronism (PA) are mainly treated by surgery or medical drugs (spironolactone/spironolactone, epridone, etc.). Some studies show that the left ventricular hypertrophy of patients can be significantly improved after treatment. However, at present, the relevant research is very limited, and there is still controversy on the improvement of cardiac structure and function between the two treatment methods. No reliable conclusions have been drawn. Objective: We conducted this meta-analysis to compare the improvement of cardiac structure of patients after surgical treatment and drug treatment, so as to clarify the efficacy of surgical treatment and drug treatment for PA patients. Methods: In order to examine the cardiac color ultrasound data of PA patients receiving surgical treatment and drug therapy (spironolactone, antisterone), randomized or observational studies were searched through Pubmed, Cochrane Library, and Embase. Meta-analysis was then carried out on the comprehensive and individual outcomes. The ROINBS-I scale is utilized to assess the offset risk of study inclusion. Outcomes: A total of nine studies involving 799 patients with PA into meta analysis, according to the results of the surgery in the treatment of patients with PA, left ventricular mass index (LVMI) changes in value (drop range) is significantly higher than drug therapy (Mean difference IV: —2.32, P In 6 studies, after surgical treatment of interventricular septal thickness (IVSD), changes in value (drop range) are also higher than drug therapy (Mean difference IV: —0.35, P In 2 studies, the surgical treatment of plasma aldosterone concentration (PAC) drop degree is superior to drug therapy (Mean difference IV: —12.63, P < 0.05), and blood pressure to improve the degree of surgery and drug treatment has no obvious difference. Conclusions: This meta-analysis result confirmed that after medical and surgical treatment of PA can obviously improve the patient’s blood pressure, and no difference between the two treatments. But for the heart structure improvement, including left ventricular hypertrophy and interventricular septum thickness, surgical treatment effect is significantly better than the medicine treatment, so the adrenalectomy can be used as unilateral PA optimal choice of treatment.

4 F MPA1导管经右肘静脉完成双侧肾上腺静脉同步采血可行性和安全性研究——附51例报道

目的 探讨2根4F MPA1导管经右肘静脉行双侧肾上腺静脉同步采血术(AVS)的可行性和安全性。方法 连续纳入2021年10月至2022年10月在襄阳市中心医院需行AVS的51例原发性醛固酮增多症患者,采用2根4F MPA1导管(其中1根塑形成猪尾形)经右肘静脉行双侧同步AVS。统计选用导管、双侧肾上腺静脉同步采血成功率、并发症发生率。结果 对右肾上腺静脉均使用4 F MPA1导管,左肾上腺总干静脉、左肾上腺中央静脉均使用经特殊塑形的4 F MPA1导管。双侧同步AVS成功率为92.2%(47/51)。发生1例(1.96%)肾上腺血肿。结论 经右肘静脉使用2根4 F MPA1导管行双侧同步AVS,导管选择及操作简单、创伤小、安全可行,但因样本量小,仍需进一步研究验证。

Primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome:A case report

BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical setting.It has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of AI.However,the coexistence of PA and SCS has been reportedly observed.Recently,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic adrenalectomy.We believe that there were some clinical implications in the diagnosis of the present case.CASE SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 mm.After the disappearance of right abdominal pain,subsequent endocrinological examinations were performed.Aldosterone-related evaluations,including adrenal venous sampling,revealed the presence of bilateral PA.In addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then performed.The histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this adenoma.However,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical micronodules.CONCLUSION Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.

4 F MPA1导管经右肘静脉完成双侧肾上腺静脉同步采血术1例

探讨4 F MPA1导管经右肘静脉行双侧肾上腺静脉同步采血术(AVS)的安全性和可行性。选择1例右肾上腺中央静脉汇入副肝静脉的原发性醛固酮增多症患者,经右上肢贵要静脉、头静脉处分别置入2个6 F鞘管,选择2根4 F MPA1导管(1根塑形成猪尾状),分别插入左右肾上腺静脉,分3个时间段同步采集双侧肾上腺静脉及外周静脉血样,检测醛固酮、皮质醇激素水平。肾上腺静脉醛固酮/皮质醇:左侧13.2,右侧2.9,左侧优势指数9.9,左肾上腺为醛固酮优势分泌侧。4 F MPA1导管经右肘静脉行同步AVS具有技术可行、导管选择简单、创伤小、安全性高、不需卧床制动等优点。

卡托普利抑制试验在原发性醛固酮增多症诊断和分型以及临床转归中的应用

背景 原发性醛固酮增多症(PA)作为继发性高血压中发病率最高、心脑血管危害大但手术后治愈率高的疾病,已被各大高血压指南推荐扩大筛查、早期诊断和治疗。但该类患者的确诊、分型和治疗后临床转归判定方式繁多且存在较多争议。卡托普利抑制试验(CCT)因其便捷、安全可直接用于社区、门诊,期望CCT能对PA患者进行全程管理以改善预后。目的 探究CCT对PA的诊断、分型以及临床转归的判断能力。方法 选取2020-10-01—2022-12-30在四川大学华西医院内分泌代谢科接受内分泌性高血压病因筛查并登记的824例患者为研究对象。经筛选后最终370例患者纳入研究,其中123例原发性高血压(EH)患者纳入EH组,247例PA患者分别纳入单侧醛固酮瘤(APA)组81例、特发性醛固酮增多症(IHA)组55例和未分型PA(u-PA)组111例。比较4组间差异并绘制CCT后各指标及联合诊断PA的受试者工作特征(ROC)曲线,确定最佳截断值。其次绘制CCT后各指标诊断APA和IHA亚型的ROC曲线,计算ROC曲线下面积(AUC)评估CCT对APA和IHA的分型判断能力。最后根据术后临床结局将单侧肾上腺切除患者分为3组:未缓解组11例、临床改善组27例和临床缓解组54例,比较3组间差异并判断CCT对APA患者术后临床转归的判断能力。结果 CCT后血浆醛固酮浓度(PAC)对PA的诊断效能最高(AUC=0.921,95%CI=0.893~0.950),最佳截断值为11.7 ng/dL,灵敏度、特异度分别为84.6%和86.0%;CCT后醛固酮/肾素比值(ARR)对PA也有较好的诊断效能(AUC=0.868,95%CI=0.823~0.923),最佳截断值为2.8(ng/dL)/(mU/L),灵敏度、特异度分别为82.2%和81.0%。CCT后PAC>17.0 ng/dL可协助诊断APA亚型,CCT后PAC<11.7 ng/dL同时ARR<2.8(ng/dL)/(mU/L)的患者可排除APA亚型。在接受手术治疗的患者中,有87.2%患者经CCT后PAC<11.7 ng/dL,89.7%患者CCT后ARR<2.8(ng/dL)/(mU/L)均接近术后临床缓解水平(88.0%)。结论 CCT可全程用于PA患者的诊断、分型和临床转归评价,CCT后PAC及CCT后ARR诊断PA的最佳截断值分别为11.7 ng/dL和2.8(ng/dL)/(mU/L),也可用于APA的分型判断以及术后生化缓解的判断。CCT前采血检验临床意义小,可适当简化流程。

醛固酮合成酶抑制剂治疗原发性醛固酮增多症的可行性探讨

近年来,醛固酮合成酶抑制剂(aldosterone synthase inhibitor,ASI)治疗高血压受到广泛关注,osilodrostat、baxdrostat、lorundrostat和dexfadrostat等药物相继被研发并开展了一系列临床研究。本文拟对当前ASI治疗高血压的临床研究结果及存在的问题和争议进行阐述,并探讨ASI治疗原发性醛固酮增多症的可行性。

原发性醛固酮增多症患者腹部内脏脂肪与腰椎骨密度的相关性

目的探讨原发性醛固酮增多症(PA)患者腹部内脏脂肪分布与骨密度(BMD)的相关性。方法回顾性分析2017年1月至2021年2月因“高血压查因”于郑州大学第一附属医院确诊为PA的54例患者,利用定量CT(QCT)测量腰1~3椎体的BMD值,测量腰2椎体层面的腹部总脂肪面积(TFA)、腹部内脏脂肪面积(VFA)及腹部皮下脂肪面积(SFA)。按照BMD值将患者分为两组:A组(骨量减少及骨质疏松组,24例)、B组(骨量正常组,30例)。结果与B组相比,A组年龄、VFA、总胆固醇及立位的血浆醛固酮浓度(PAC)与肾素活性(PRA)的比值增高,立位的血浆肾素水平降低(P<0.05);相关分析显示BMD与年龄(r=-0.521、P<0.05)、VFA(r=-0.373,P<0.05)呈负相关;多元线性回归分析显示,校正年龄后,VFA是BMD的独立影响因素(P<0.05);进一步研究显示内脏脂肪增多较非内脏脂肪增多的PA患者BMD值降低(P<0.05)。结论内脏脂肪增多的PA患者更容易表现为低骨量,VFA增高可能是PA患者BMD降低的危险因素。

原发性醛固酮增多症的影像学研究进展

原发性醛固酮增多症(PA)的准确诊断和分类,对于临床上治疗方法的选择及预后具有重要意义。目前,CT、MRI、超声、分子成像以及影像组学已用于PA的诊断和鉴别诊断。简要介绍PA的病理基础及临床诊断方法,并就多种影像技术在PA中的应用研究及进展进行综述。

原发性醛固酮增多症患者选择性肾上腺动脉造影的影像学特征

目的:明确原发性醛固酮增多症(PA)患者数字减影血管造影(DSA)下肾上腺动脉的影像学特征。方法:回顾性分析2018年1月至2019年12月在南昌大学第二附属医院确诊PA并行经皮超选择性肾上腺动脉栓塞的119例患者的DSA图像,描述肾上腺动脉的数量、起源、分布、角度和直径。结果:119例PA患者的平均年龄为(49±11)岁,其中男性71例(59.7%)。所有患者均成功找到至少1条肾上腺动脉,共获得192条肾上腺动脉,其中肾上腺上、中、下动脉分别有20条(10.4%)、40条(20.8%)、132条(68.8%),起源于肾动脉、腹主动脉、膈下动脉的肾上腺动脉分别有82条(42.7%)、72条(37.5%)、38条(19.8%)。72.8%(83/114)的左肾上腺动脉和60.3%(47/78)的右肾上腺动脉分布在第1腰椎水平。28.1%(54/192)的肾上腺动脉分布在第2腰椎水平,4.2%(8/192)的肾上腺动脉分布在第12胸椎水平。左肾上腺动脉与起源动脉肾动脉、副肾动脉、腹主动脉的夹角范围分别为35.90°~160.07°、27.08°~171.99°、0°~158.70°,右肾上腺动脉与上述起源动脉的夹角范围分别为18.43°~172.53°、69.26°~114.62°、12.32°~232.85°。左、右肾上腺动脉的平均直径分别为(0.98±0.45)mm和(1.27±0.42)mm。结论:本研究提供了PA患者较为详细的肾上腺动脉放射学解剖特征,作为人体解剖学特征的补充,可为肾上腺动脉介入治疗提供实用的指导。

基于一次风精细配风的生物质炉排炉燃烧数值模拟

生物质炉排炉内一次风沿炉排长度方向的配风方式会显著影响其燃烧特性,但目前未见相关报道。该文以某130t/h的秸秆直燃炉排炉为研究对象,探究一次风配风方式对炉内燃烧和污染物生成等关键参数的影响。开展一次风均匀(基准)、分段和精细分段配风下,炉排和炉膛气固两相燃烧的耦合数值模拟。结果表明:1)基准工况的模拟值与现场实测的炉内温度和出口NO等相对误差均在10%以内;2)与均匀配风相比,分段和精细分段配风提高了挥发分和焦炭燃烧段的氧气含量,促使更多的可燃物在固相燃烧,焦炭燃尽率由76.5%升至87.8%和95.5%;相应的从床层逸出到气相的可燃气体减少,使炉膛内烟气温度峰值降低且分布更加均匀;3)后两个工况中避免了炉内出现局部高温、富氧区域,NOx的形成受到抑制,出口NO由172mg/m^(3)(11%O_(2))降至161mg/m^(3)和156mg/m^(3)。综上,沿炉排长度进行一次风的分段或精细分段配风,可明显改善生物质的燃尽和污染物生成特性。

基于肾小球滤过率的肾上腺醛固酮瘤列线图预测模型的建立与验证研究

背景醛固酮瘤(APA)是原发性醛固酮增多症的常见类型。对于单侧肾上腺腺瘤者,虽然共识推荐血浆醛固酮与肾素比值(ARR)作为APA的筛查指标,由于缺乏统一的检测方法和诊断流程,ARR切点值范围变化大。因此临床需要一种可靠、快捷的预测模型协助鉴别APA。目的探讨肾小球滤过率(GFR)与APA的相关性,基于此构建APA的列线图预测模型并验证。方法收集2012—2022年石河子大学第一附属医院经肾上腺内分泌激素评估后行手术治疗病理回报为单侧肾上腺肿物患者493例,根据APA和肾上腺无功能腺瘤的诊断标准,最终纳入APA组155例,无功能腺瘤合并原发性高血压组113例。收集患者的病史资料、生化资料等。按照GFR四分位数水平将患者分组,分析GFR与APA的相关性。通过多因素Logistic回归分析筛选APA的危险因素并构建列线图预测模型。采用受试者工作特征(ROC)曲线分析预测模型的区分度,一致性指数(C-index)评价模型的预测精准度,Hosmer-Lemeshow检测模型的拟合度,运用决策曲线与临床获益曲线评价模型的诊断效能。结果按照GFR四分位数进行分组(Q1~Q4组),Q1组:≥107.4 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q2组:99.7~107.3 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q3组:88.6~99.6 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),Q4组:≤88.5 mL·min^(-1)·(1.73 m^(2))^(-1)(n=67),各组APA发生率分别为47.8%(32/67)、53.7%(36/67)、58.2%(39/67)、71.6%(48/67)。Logistic回归趋势性检验提示随着GFR水平降低,APA患病风险呈趋势性升高(P<0.05)。多因素Logistic回归分析结果显示:收缩压>160mmHg(OR=5.209,95%CI=2.531~10.720)、高血压病程≥59个月(OR=4.326,95%CI=1.950~9.595)、血钾<3.25 mmol/L(OR=4.714,95%CI=2.046~10.860)、GFR[Q4组:≤88.5 mL·min^(-1)·(1.73 m^(2))^(-1)](OR=4.106,95%CI=1.492~11.300)、基础血浆醛固酮>13.42 ng/dL(OR=8.756,95%CI=4.320~17.749)为APA发生的独立危险因素(P<0.050)。根据多因素筛选的变量构建列线图预测模型,该模型ROC曲线下面积为0.898(95%CI=0.859~0.936),以此建立的列线图预测模型C-index为0.898,模型有较好的预测精度。Hosmer-Lemeshow检验显示该模型有较好的拟合度(χ^(2)=14.059,P=0.080)。预测概率阈值在0.10~0.90时该模型具有显著的预测效能。结论随着GFR水平降低,APA患病风险呈趋势性升高。基于收缩压、高血压病程、血钾、GFR四分位分组、基础血浆醛固酮5种因素构建的APA预测模型具有较好的预测性、一致性和临床实用性,可帮助识别APA,有助于临床决策。

电视胸腔镜手术对原发性非小细胞肺癌患者GLU、WBC及PA的影响

目的分析电视胸腔镜手术对原发性非小细胞肺癌患者GLU、WBC及PA的影响。方法选取2013年1~12月在我院接受治疗的98例原发性非小细胞肺癌患者,随机分为对照组和研究组,对照组接受传统开胸肺叶切除术,研究组接受电视胸腔镜手术。比较治疗后两组患者GLU、WBC及PA水平。结果研究组患者切口长度、术后胸腔引流过量的天数、术后住院时间明显低于对照组,差异均具有统计学意义（P〈0.05）;两组术后1 d内该三项指标相差较大,差异具有统计学意义（P〈0.05）。结论电视胸腔镜手术治疗原发性非小细胞肺癌患者术后GLU、WBC及PA变化小,对患者影响更小且其疗效更好,值得临床推广应用。

PET/CT在原发性醛固酮增多症功能定位诊断中的应用价值

目的:探讨靶向CXC趋化因子受体4型(CXC chemokine receptor type 4,CXCR4)的68Ga-Pentixafor PET/CT核素显像在原发性醛固酮增多症(primary aldosteronism,PA)的优势侧功能定位以及预后的应用价值。方法:选取2022年3月至2023年5月重庆医科大学附属第一医院确诊为PA的66例住院患者。所有患者均接受PET/CT及肾上腺静脉取血(adrenal vein sample,AVS),且行腹腔镜下单侧或部分肾上腺切除术,分析比较PET/CT和AVS对PA分侧诊断的符合率;根据术后随访血压、用药改善情况及血钾水平,判断PET/CT对PA优势侧功能定位诊断的准确率及病灶最大标准化摄取值(maximum standardized uptake value,SUVmax)对患者术后预后的预测价值。结果:66例手术患者中行单侧肾上腺切除术63例、部分肾上腺切除术3例,术后病理检查结果中有腺瘤58例、增生8例,PET/CT和AVS对PA分侧诊断的符合率83.3%(55/66);以术后临床获益为标准,PET/CT对PA优势侧功能定位诊断的准确率为88.14%(52/59),AVS对PA优势侧功能定位诊断的准确率为93.22%(55/59);术后治愈患者病灶SUVmax[14.70(8.75~19.45)]要高于术后好转患者[10.90(6.65~14.10)],差异有统计学意义(P=0.026)。术前病灶SUVmax与术后醛固酮降低值、术后血浆醛固酮肾素比(aldosterone-to-renin ratio,ARR)降低值和术后血钾升高值呈正相关(r=0.267、0.365、0.392,P=0.034、0.003、0.001)。结论:靶向CXCR4的68Ga-Pentixafor PET/CT对PA优势侧定位诊断的准确率与AVS接近,但更具有可重复、无创等优势;病灶SUVmax越高,术后临床获益越明显,有一定的预后预测价值。

子宫肌瘤及子宫平滑肌PA/PAI差异表达与腹腔镜子宫动脉阻断术治疗子宫肌瘤相关性的研究

目的:观察纤溶酶原激活因子及纤溶酶原激活物抑制因子(PA/PAI)在子宫肌瘤及子宫平滑肌组织及原代细胞中表达的差异,为腹腔镜子宫动脉阻断术治疗子宫肌瘤提供理论依据。方法:组织学:采用荧光定量PCR检测子宫肌瘤及子宫平滑肌组织中组织型纤溶酶原激活因子(t-PA)和尿激酶型纤溶酶原激活因子(u-PA)以及纤溶酶原激活物抑制因子(PAI-1)的表达;用免疫组织化学方法检测3种蛋白的表达;细胞学:选取8例子宫肌瘤患者,分别培养子宫肌瘤及子宫平滑肌细胞并传代,应用实时定量PCR及免疫细胞检测u-PA及PAI-1。结果:组织学:(1)肌瘤组织中u-PA mRNA相对表达为(1.34±2.18)%,显著低于平滑肌组织的(2.84±2.97)%,差异有统计学意义(P<0.05);t-PAmRNA在肌瘤组织中表达为(1.46±1.64)%也低于平滑肌组织的(1.65±3.08)%,但差异无统计学意义(P>0.05)。PAI-1 mRNA在肌瘤组织中的表达为(2.67±1.82)%,显著高于平滑肌组织的(1.27±1.99)%,差异有统计学意义(P<0.05);(2)肌瘤组织u-PA蛋白表达显著低于平滑肌组织,差异有统计学意义(P<0.05);肌瘤组织PAI-1蛋白表达显著高于平滑肌组织(P<0.01);两种组织t-PA蛋白表达差异无统计学意义(P>0.05)。细胞学:(1)肌瘤细胞中u-PA mRNA相对表达为0.123±0.189,显著低于平滑肌细胞的0.331±0.306,差异有统计学意义(P<0.05);PAI-1 mRNA在肌瘤细胞的表达为0.091±0.036,显著高于平滑肌细胞的0.016±0.020,差异有统计学意义(P<0.05);(2)肌瘤细胞u-PA蛋白表达8.805±1.645显著低于平滑肌细胞的22.173±4.381,差异有显著的统计学意义(P<0.05);肌瘤细胞PAI-1蛋白表达44.765±1.090显著高于平滑肌细胞35.928±5.351(P<0.05)。结论:PA/PAI系统在子宫肌瘤及平滑肌细胞中表达存在差异,并与组织中的差异基本一致,提示该系统差异表达机制可以为腹腔镜子宫动脉阻断术治疗子宫肌瘤提供理论依据。

经贵要静脉路径行双侧同步肾上腺静脉取血的可行性与安全性的首次报道

目的:评估经贵要静脉路径行双侧同步肾上腺静脉取血(AVS)的安全性和可行性。方法:2023年7月至2023年11月连续入选中国医学科学院阜外医院经贵要静脉行双侧同步AVS的原发性醛固酮增多症(PA)患者21例。记录穿刺部位、选用的取血导管、手术操作时间、X线曝光时间、对比剂用量、取血成功率、不良事件及并发症发生情况。肾上腺静脉/外周静脉血浆皮质醇浓度比值≥2定义为AVS成功。结果:21例患者的平均年龄(49.3±7.7)岁,男性患者13例。所有患者右贵要静脉置入第一个5F鞘管成功,2例无法置入第二个5F鞘管而改用同侧头静脉。所有患者均使用5F MPA1导管插入右侧肾上腺静脉,5F TIG造影导管插入左侧肾上腺静脉。手术操作时间为17.50(12.00,22.00)min,X线曝光时间为5.90(4.75,10.55)min,对比剂用量为25.00(25.00,35.00)ml。所有患者双侧AVS均成功。2例患者术中出现不良事件,其中1例为术中导管缠绕导致5F TIG造影导管滑出肾上腺静脉,1例为穿刺部位血管痉挛。无手术并发症发生。结论:在大多数PA患者中经贵要静脉路径行双侧同步AVS安全可行,但需进一步验证。

血清脂联素和瘦素与原发性醛固酮增多症靶器官损害和术后临床转归的相关性

目的:探索基线血清脂联素和瘦素与原发性醛固酮增多症(primary aldosteronism,PA)靶器官损害和术后临床转归的相关性。方法:纳入68例行单侧肾上腺切除术且有术后至少6个月随访信息的PA患者,检测患者基线血清脂联素和瘦素浓度,依据PA手术结局(primary aldosteronism surgical outcome,PASO)标准进行术后临床转归分型,分析脂联素和瘦素与靶器官损害指标和不同术后分型的相关性。结果:28例(41.2%)PA患者术后临床治愈,40例(58.8%)临床未治愈。临床治愈组基线脂联素和估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)水平均高于临床未治愈组(P均<0.05),体重指数(body mass index,BMI)、高血压药物限定日剂量值、高脂血症占比和糖尿病占比低于临床未治愈组(P均<0.05),两组间瘦素水平差异无统计学意义。瘦素水平与心脏彩超指标二尖瓣舒张早期E峰峰值速度/舒张晚期A峰峰值速度比值和踝肱指数呈负相关(P均<0.05),脂联素水平与靶器官损害指标无相关。多因素逐步Logistic回归分析显示,低BMI(OR=0.422,95%CI:0.272~0.653,P<0.001)和高脂联素(OR=1.359,95%CI:1.004~1.840,P=0.047)水平与临床治愈独立相关。进一步按BMI分层,在非肥胖PA患者中高eGFR(OR=1.074,95%CI:1.023~1.127,P=0.004)和高脂联素(OR=1.816,95%CI:1.261~2.616,P=0.001)水平与临床治愈有关。结论:基线血清脂联素和瘦素检测有助于评估PA靶器官损害,预测术后临床转归,协助指导PA精准管理。