肾上腺静脉取血在原发性醛固酮增多症分型诊断中的应用  

Role of adrenal venous sampling in differential diagnosis of subtypes in primary aldosteronism

作　　者：贾国瑜[1] 邸阜生[1] 王璐[1] 李强[1] 杨莉[1] 李娜丽[1] 

机构地区：[1]天津市第三中心医院内分泌代谢病科,天津市人工细胞重点实验室,300170

出　　处：《国际生物医学工程杂志》2015年第6期353-356,共4页International Journal of Biomedical Engineering

摘　　要：目的探讨肾上腺静脉取血（AVS）检查在原发性醛固酮增多症（原醛症）分型诊断中的应用价值。方法选取2011年11月至2014年7月在天津市第三中心医院内分泌代谢病科住院并明确诊断为原醛症的患者共22例，经AVS检查，分别于双侧。肾上腺静脉及下腔静脉采血，检测各点醛固酮和皮质醇水平，并将结果与影像学检查（。肾上腺薄扫＋增强CW）及术后病理结果进行比较。另选取筛查及确诊实验不支持原醛症，但结节直径〉4cm，并经泌尿外科术后病理证实为肾上腺无功能瘤患者8例纳入分析。结果原醛症患者中高血压的发生率为95．4％，低血钾的发生率为81．8％。与特发性醛固酮增多症（特醛症）患者相比，醛固酮瘤患者收缩压、尿钾、血醛固酮及醛固酮肾素比值（ARR）较高，血钾则较低，差异均有统计学意义（P〈0．05），而无功能瘤组临床及生化均在正常范围内。肾上腺增强CT检查在原醛症分型诊断中总的准确率为77．27％（17／22），其中醛固酮瘤符合率为78．95％（15／19），特醛症符合率为66．7％（2／3）；AVS检查以醛固酮与皮质醇之比为判定标准，符合率为100％。结论单纯依赖影像学检查对于原醛症患者进行分型诊断易发生误诊，AVS在原醛症的分型诊断中有较好的准确性，可为影像学检查有疑问的患者提供良好方法。Objective To evaluate the role of adrenal venons sampling （AVS） in differential diagnosis of subtypes in primary aldosteronism. Methods Twenty-two patients diagnosed as primary aldosteronism in the Third Central Hospital of Tianjin from November 2011 to July 2014, were undergone AVS for measurement of plasma aldosterone and cortisol levels in each adrenal vein and infrarenal inferior vena cava. The data were compared with the results of the thin slice incremental scanning in adrenal and postoperative pathologic diagnosis. Other 8 patients, whose screening test and confirmed diagnosis did not support the primary aldosteronism, with nodule larger than 4 cm pathologically confirmed as non-functioning adrenal adenoma, were also recruited. Results Among all the 22 patients with primary aldosteronism, the incidence rate of hypertention was 95.4%, and the incidence of hypokalemia was 81.8%. Compared with idiopathic hyperaldosteronism patients, the patients with aldosterone producing adenoma had higher blood pressure and aldosterone level in plasma,but lower plasma potassium, while the clinical and biochemical index of the non-functioning adrenal adenoma group were within the normal range. The overall accuracy rate of adrenal CT in the diagnosis of subtypes of primary aldosteronism was 77.27% （17/22）, and the accuracy rates were 78.95% （15/19） in atdosterone producing adenoma and 66.7% （2/3） in idiopathic hyperaldosteronism, respectively. The accuracy rate of AVS was 100% with the ratio of aldosterone to cortisol as the criterion. Conclusions Misdiagnose may occur when using CT scan only to differentially diagnose primary aldosteronism. Compared with CT imaging of the adrenal glands, AVS has higher coincidence rate and is an elective approach to establish the subtype diagnosis of questionable primary aldosteronism.

关 键 词：肾上腺静脉取血 原发性醛固酮增多症 分型诊断 

分 类 号：R586.24[医药卫生—内分泌]