肾上腺CT扫描在门诊高血压患者中筛查肾上腺高血压的应用价值  

Diagnostic value of adrenal CT scan for screening adrenal hypertension in out-patients with hypertension

作　　者：李晓牧[1] 易茜露[1] 饶圣祥[2] 刘莹[1] 曾蒙苏[2] 陆志强[1] 高鑫[1] 

机构地区：[1]复旦大学附属中山医院内分泌科,上海200032 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《中华内分泌代谢杂志》2012年第2期126-131,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家“十一五”攻关课题《继发性内分泌高血压的诊治规范》（编号2004BA720A29）;上海市科委重大课题《原发性醛固酮增多症的筛查和发病机制研究》（09411954500）

摘　　要：目的 以优先应用肾上腺薄层CT扫描的方法,在门诊高血压患者中筛查肾上腺病变的患病情况,评价该方法在高血压人群早期诊断肾上腺高血压的应用价值.方法 本研究对象来自本院心内科门诊患者（2009年1月至2009年8月）,排除已知继发性高血压（包括已诊断的内分泌及肾性高血压）和恶性肿瘤.应用肾上腺薄层CT进行筛查,对于肾上腺形态学异常者进一步完善其肾上腺病变的各项内分泌功能检查,得出肾上腺病变和肾上腺高血压的检出率,从而评价影像学优先筛查策略的诊断价值.结果 入选高血压患者362例,其中男性162例,女性200例,平均年龄（60.9±9.3）岁,平均高血压病程为（13.8±5.3）年.经肾上腺薄层CT扫描发现,肾上腺形态学异常35例（9.6％）,其中肾上腺腺瘤20例（5.5％）,肾上腺增生15例（4.1％）.经内分泌功能评价结果发现,从35例肾上腺形态异常者中确认肾上腺高血压患者17例,肾上腺高血压总检出率为4.7％,其中原发性醛固酮增多症14例（3.9％）,皮质醇增多症2例（0.6％）,嗜铬细胞瘤1例（0.3％）.优先应用肾上腺薄层CT扫描在门诊高血压患者中检出肾上腺形态学异常率为9.6％,联合功能评价,肾上腺性高血压总检出率为4.7％.结论 影像检查优先的策略在门诊高血压患者中筛查肾上腺高血压具有良好的应用价值.Objective To evaluate the priority application of thin adrenal CT scanning in out-patients with hypertension for early diagnosis of adrenal hypertension.Methods The patients with hypertension were collected from January to August 2009,in whom the secondary hypertension （ including endocrine and renal hypertension） and malignant cancers were excluded.All patients accepted the adrenal CT scan firstly,and then the patients with the positive result of morphological abnormalities in the adrenal CT（ including adenoma and hyperplasia）were evaluated for endocrine function of adrenal glands.Results A total 362 cases of hypertension were studied,in.cluding 162 males and 200 females.The average age was （60.9 ±9.3 ） year-old,the average duration of hypertension was （ 13.8 ±5.3 ） year.After adrenal thin layer scanner CT scan,35 patients （ 9.6% ） with adrenal abnormalities were found.Endocrine functional assessments of adrenal glands were carried out among these patients,17 cases （4.7%） with functional lesions were diagnosed,including 14 cases（3.9% ）with primary hyperaldosteronism,2 cases（0.6% ）with Cushing＇s syndrome,and 1 case （ 0.3% ） with pheochromocytoma.Conclusion This study revealed that the percentage of adrenal lesions in outpatients with hypertension was 9.6%.The percentage of adrenal hypertension was 4.7%.Thin layer CT scan seems to effectively screen the adrenal hypertension with adrenal lesions,and would be helpful to the diagnosis of endocrine hypertension.

关 键 词：肾上腺性高血压 体层摄影术 X线计算机 肾上腺病变 原发性醛固酮增多症 

分 类 号：R651.15[医药卫生—外科学]