原发性醛固酮增多症308例经肾上腺静脉取血术定位诊断结果分析  

Analysis of 308 cases with primary aldosteronism lateralized by adrenal venous sampling

作　　者：李南方[1] 王红梅[1] 李娟[1] 马轩[1] 王梦卉[1] 王新国[1] 周克明[1] 王国亮[1] 祖菲娅[1] 王新玲[1] 欧阳玮进[1] 成秋燕[1] 

机构地区：[1]新疆维吾尔自治区人民医院高血压中心,新疆高血压研究所,乌鲁木齐830001

出　　处：《中华高血压杂志》2011年第7期625-629,共5页Chinese Journal of Hypertension

摘　　要：目的探讨肾上腺静脉取血(AVS)术在原发性醛固酮增多症(原醛)定位诊断中的应用价值,分析单、双侧病变的构成比和临床特征差异。方法针对经过醛固酮肾素比值(ARR)初筛、静脉盐水负荷试验等确诊实验定诊并行AVS术定位诊断的原醛患者,回顾性收集其临床及生化资料进行分析。结果原醛患者308例[男193例,女115例,年龄(45.8±8.4)岁]中单侧106例(34.4%),双侧202例(65.6%);与双侧病变组相比,单侧病变组坐位肾素活性更低[0.29(0.18～0.79)比0.48(0.23～1.01)μg/(L.h),P<0.05]、坐位ARR更高[61.7(25.4～140.4)比36.7(16.1～71.2),P<0.05]。单、双侧病变组肾上腺CT阳性率分别为69.2%、65.0%;男性患者中双侧病变的构成比高于女性(68.9%比60.0%,P<0.01),肥胖组(体质量指数≥28kg/m2)双侧病变的构成比高于非肥胖组(71.8%比60.8%,P<0.01),低血钾组单侧病变的构成比高于正常血钾组(39.6%比31.6%,P=0.006)。结论在原醛患者中,双侧病变发生率较高;单侧病变的临床特征较双侧病变者典型;男性中双侧病变的构成比高。Objective To investigate the value of adrenal venous sampling（AVS）in the subtype classification of primary aldosteronism（PA）and the proportion,clinical feature of unilateral and bilateral PA.Methods Three hundred and eight PA patients including 193 males and 115 females were recruited in this study.PA was diagnosed by aldosterone-renin ratio（ARR）screening;confirmation tests and AVS subtype classification.The patients were classified into two groups,which made of 106 unilateral PA cases and 202 bilateral PA cases.Then we compared the proportion and the clinical feature between the two groups.Results The proportion of the unilateral and bilateral lesions were 34.4% and 65.6%,respectively.Compared with the bilateral group,the unilateral group had lower plasma renin activity（PRA）[0.29（0.18-0.79）vs 0.48（0.23-1.01）μg/（L·h）,P0.05] and higher ARR [61.7（25.4-140.4）vs 36.7（16.1-71.2）,P0.05].The positive rates of adrenal computerized tomography（CT）in unilateral and bilateral lesions were 69.2% and 65.0%,respectively.The proportion of bilateral lesions in male patients was higher than female（68.9% vs 60.0%,P0.01）.The proportion of unilateral cases in the hypokalemic group were higher than in normal serum potassium group（39.6% vs 31.6%,P=0.006）.Conclusion The prevalence of bilateral lesion is more common while the clinical characteristics of unilateral lesion are more typical in PA patients.Compared with the female patients,the proportion of bilateral lesion was more common in male.

关 键 词：原发性醛固酮增多症 肾上腺静脉取血 诊断分型 

分 类 号：R586.24[医药卫生—内分泌]