经皮超选择性肾上腺动脉栓塞治疗原发性醛固酮增多症  

Management of primary aldosteronism by percutaneous super-selective adrenal artery embolization

作　　者：董徽[1] 蒋雄京[1] 关婷[1] 梁拓[1] 彭猛[1] 吴海英[1] 张慧敏[1] 刘力生[1] 

机构地区：[1]北京协和医学院,中国医学科学院,阜外心血管病医院高血压诊治中心,北京100037

出　　处：《中华高血压杂志》2013年第6期536-541,共6页Chinese Journal of Hypertension

基　　金：首都临床特色应用研究(Z111107058811001)

摘　　要：目的评估经皮超选择性肾上腺动脉栓塞(SAAE)治疗原发性醛固酮增多症(PA)的安全性和有效性。方法 2010-03-2011-07入选行SAAE治疗的PA患者10例(7例醛固酮腺瘤、2例双侧肾上腺增生和1例单侧肾上腺增生)。术后随访血压、降压药使用、血浆肾素活性、血浆醛固酮、血钾水平的变化和不良事件的发生情况。结果年龄28～51(40±8)岁的患者10例,其中SAAE技术上成功9例(90%),因肾上腺下动脉的起源异常未成功1例。与术前相比,9例SAAE成功患者术后6月的诊室血压、24h平均血压及使用降压药种类均降低[分别(132.7±7.7)/(82.3±5.3)比(148.7±7.7)/(88.9±6.5)mmHg,(129.8±5.9)/(80.0±5.7)比(145.0±7.1)/(87.8±6.2)mmHg,(1.6±0.7)比(3.4±0.5)种,均P<0.05],普食立位醛固酮水平亦降低[(285.9±39.4)比(518.0±127.4)pmol/L,P<0.05],而普食立位血浆肾素活性和血钾升高[分别(1.2±0.4)比(0.4±0.2)μg/(L·h),(4.0±0.2)比(3.1±0.4)mmol/L,均P<0.05]。SAAE成功的9例患者中,7例治愈,2例双侧肾上腺增生患者改善,1例单侧肾上腺增生患者术后12月复发,行二次栓塞后治愈。1例醛固酮腺瘤患者因术中血压骤升出现高血压脑病,给予对症处理后完全恢复。围手术期和随访期间无其他严重不良事件发生。结论 SAAE治疗PA有效、可行,但因样本量小,仍需进一步研究验证。Objective To evaluate the safety and efficacy of percutaneous super-selective adrenal artery embolization （SAAE） for primary aldosteronism [PA）. Methods Ten PA patients treated with SAAE were enrolled between March 2010 and July 2011, including seven cases of aldosterone adenoma, two of bilateral adrenal hyperplasia and one of unilateral adrenal hyperplasia. The blood pressure, current antihypertensive medications, plasma renin activity, aldosterone, serum potassium and adverse events were assessed. Results Ten patients with a mean age of 28- 51 （ 40 ± 8） years were performed SAAE, of which 9 patients were successful （90% ） and one patient was failure due to the abnormal origin of inferior adrenal artery. Compared with baseline, the clinic blood pressure, 24-hour mean blood pressure, types of antihypertensive drugs and standing plasma aldosterone were reduced after 6 months [（132.7±7.7）/（82.3±5.3） vs （148.7±7.7）/（88.9±6.5） mm Hg, （129.8±5.9）/（80.0±5.7） vs （145.0±7.1）/ （87.8±6.2） mm Hg, （1.6±0.7） vs （3.4±0.5）, {285.9±39.4） vs {518.0±127.4）pmol/L, all P〈0.05], while standing plasma renin activity and serum potassium were increased [（1.2± 0.4） vs {0.4± 0.2）μg/（ L · h）, （4.0±0.2） vs （3.1±0.4）mmol/L, all P〈0.05]. In 9 successful patients, 7 patients were cured and 2 patients with bilateral adrenal hyperplasia were alleviated, while one patient with unilateral adrenal hyperplasia required the second SAAE for recurrence after 12 months and was cured. Due to a surging blood pressure during surgery, one patient with aldosteronoma underwent hypertensive encephalopathy and recovered completely after active treatment. There was no other severe adverse event in perioperative and follow-up period. Conclusions SAAE for PA patients is feasible and effective, however further research should be well grounded with larger samples.

关 键 词：原发性醛固酮增多症 经皮超选择性肾上腺动脉栓塞 治疗 

分 类 号：R586.24[医药卫生—内分泌]