肾上腺静脉采血在醛固酮瘤与肾上腺无功能瘤患者中的应用比较  

Comparison of adrenal vein sampling value between aldosterone-producing adrenal adenoma and non-functioning adrenal adenoma

作　　者：张炜[1] 汤正义[1] 王卫庆[1] 吴景程[1] 张华[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌科,上海市内分泌代谢病临床中心,上海市内分泌代谢病研究所,200025

出　　处：《上海医学》2007年第7期477-480,共4页Shanghai Medical Journal

基　　金：十五国家科技攻关计划资助项目(2004BA720A29)

摘　　要：目的探讨肾上腺静脉采血检查对醛固酮瘤的诊断价值,并与肾上腺无功能瘤进行比较。方法我院近5年来临床确诊的醛固酮瘤患者21例(APA组),均行肾上腺静脉插管检查,取双侧肾上腺静脉及肾静脉水平下的下腔静脉,测各点醛固酮和皮质醇水平,并将结果与同期收治的23例肾上腺无功能瘤患者(nFAA组)进行比较。结果①APA组体位激发后血醛固酮升高者占61.9%(13/21例),其中升幅≥30%者占23.8% (5/21例)。②APA组肾上腺B超与病理检查符合率为61.9%(13/21例),nFAA组为60.9%(14/23例);APA组肾上腺CT与病理检查符合率为85.7%(18/21例),nFAA组为100.0%(23/23例)。③nFAA组病变侧及对侧肾上腺静脉血醛固酮和皮质醇的测值均显著低于APA组(P值均<0.05),下腔静脉血醛固酮测值也显著低于APA组,APA组病变侧与病变对侧醛固酮之比均≥2.0,而nFAA组均<2.0,两组间差异有统计学意义(P<0.05)。结论原发性醛固酮增多症的分型诊断单纯依赖影像学检查或体位激发试验并不可靠,肾上腺静脉采血检查对原发性醛固酮增多症的分型诊断具有重要价值,可作为影像学检查的补充,并可明确鉴别肾上腺占位性病变是否为醛固酮瘤。Objective To evaluate the adrenal venous aldosterone producing adrenal adenoma （APA）. Methods sampling（AVS） values in patients with or without In recent five years, twenty-one patients clinically diagnosed as having APA were examined with adrenal venous sampling for measurement of plasma aldosterone and cortisol levels. Selection of AVS was assessed by the plasma aldosterone levels in each adrenal vein and in the infrarenal inferior vena cava. The results were compared with 23 patients of non-functioning adrenal adenoma （nFAA）. Results （1）It was found that the plasma aldosterone after postural stimulation test（PST） in 61. 9% patients with APA.（2）The coincidence of adrenal ultrasonography was 61.9% in APA and 60.9% in nFAA. The coincidence of adrenal CT was 85.7% in APA, and 100% in nFAA. （3）The measurements of plama aldosterone and cortisol were lower in both adrenal veins with nFAA patients than those with APA patients. The ratio of Asiae/Acontr was greater than 2.0 in all APA patients, and less than 2.0 in all nFAA patients. Conclusion The CT scan and PST are not reliable in the differential diagnosis of primary aldosteronism. Adrenal venous sampling has a higher coincidence rate and should be performed in patients with negative CT, which can distinguish adrenal mass due to nonfunctioning tumor.

关 键 词：肾上腺静脉采血 原发性醛固酮增多症 醛固酮瘤 肾上腺无功能瘤 

分 类 号：R736.6[医药卫生—肿瘤]