多层螺旋CT与肾上腺静脉取血对原发性醛固酮增多症患者定位诊断价值的比较  

To compare the role on determining the functional location of primary hyperaldosteronism by multi-slice spiral CT and by adrenal vein sampling

作　　者：陈宸[1] 何云锋[1] 张尧[1] 吴小侯[1] 蒲军[1] Chen Chen;He Yunfeng;Zhang Yao;Wu Xiaohou;Pu Jun(Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《中华泌尿外科杂志》2019年第5期385-388,共4页Chinese Journal of Urology

摘　　要：目的比较多层螺旋CT(MSCT)与肾上腺静脉取血(AVS)对原发性醛固酮增多症(PHA)患者的定位诊断价值,探讨MSCT和AVS在PHA定位诊断中的合理应用策略。方法回顾性分析2014年6月至2018年6月收治的78例PHA患者的病例资料,男27例,女51例。年龄(47.5±11.2)岁。收缩压(190±24)mmHg(1 mmHg=0.133 kPa),舒张压(111±16)mmHg。高血压病程(6.0±6.0)年。血钾(2.4±0.6)mmol/L;血浆醛固酮浓度(PAC)(415.7±235.4)pg/ml,血浆肾素活性(PRA)(3.2±5.7)ng/(ml·h),血浆醛固酮/肾素活性比值(ARR)409.0±434.9。所有患者均接受MSCT检查和AVS检查,以术后病理结果及临床最终结局为金标准,比较MSCT与AVS对PHA的定位诊断准确率,分析肾上腺病变大小及性质对MSCT定位诊断准确率的影响。结果 AVS对PHA的定位诊断准确率高于MSCT [100.0%(78/78)与71.8%(56/78),P<0.05]。当MSCT提示分别为肾上腺肢体增厚、肿瘤≤1 cm、1 cm<肿瘤≤2 cm、肿瘤>2 cm时,其定位诊断准确率分别为50.0%(4/8),81.0%(17/21),92.9%(26/28),100.0%(9/9),差异有统计学意义(P<0.05)。MSCT对腺瘤和增生的诊断符合率分别为79.6%(43/54)和58.3%(7/12),差异无统计学意义(P>0.05)。结论 AVS是PHA定位诊断的金标准。当MSCT提示肾上腺未见明显异常、单侧肢体增厚、单侧较小(≤2 cm)肿瘤、双侧肾上腺病变时均应同时行AVS,并将AVS结果作为最终判定优势分泌侧的依据。当MSCT提示肾上腺孤立性较大(>2 cm)肿瘤时,MSCT定位诊断的准确性极高,可不进行AVS。Objective To compare the role on determining the functional location of primary hyperaldosteronism (PHA)by multi-slice spiral CT (MSCT)and by adrenal vein sampling (AVS), and to discuss the reasonable method to use MSCT and AVS in localization diagnosis of PHA. Methods Clinical data of 78 patients with PHA were analyzed retrospectively. These patients were diagnosed in our department from June 2014 to June 2018. There were 27 male and 51 female patients. With mean age of (47.5±11.2)years old. The mean systolic blood pressure was(190±24)mmHg and mean diastolic blood pressure was (111±16)mmHg. The mean history of hypertension was (6.0±6.0)years. The mean serum potassium was (2.4±0.6)mmol/L. The mean plasma aldosterone concentration(PAC) was (415.7±235.4)pg/ml. The mean plasma renin activity(PRA) was (3.2±5.7)ng/(ml·h). The mean aldosterone/renin ratio(ARR) was 409.0±434.9. All PHA patients underwent MSCT and AVS, the accuracy on determining the functional location of PHA by MSCT and by AVS were evaluated based on the pathological results and clinical outcomes. The influence of adrenal size and character on the accuracy of determining the functional location of PHA by MSCT were analyzed. Results The rate of accuracy of determining the location of PHA by AVS was higher than that by MSCT[100.0%(78/78)vs. 71.8%(56/78), P<0.05]. When MSCT indicated: adrenal hyperplasia, adrenal tumor volume less than 1 cm, 1 cm<adrenal tumor volume ≤2 cm, adrenal tumor volume >2 cm, the rate of accuracy in localization diagnosis with MSCT was 50.0%(4/8), 81.0%(17/21), 92.9%(26/28), 100.0%(9/9) respectively. Its trend has statistical significance (P<0.05). The diagnostic accuracy rate of MSCT for aldosterone adenoma was 79.6%(43/54), while that of adrenal hyperplasia was 58.3%(7/12). There was no statistical significance between two diagnostic accuracy rate of MSCT(P>0.05). Conclusions AVS is the gold standard for localization diagnosis. When MSCT indicates that there is no obvious abnormality in the adrenal gland, adrenal hyp

关 键 词：原发性醛固酮增多症 多层螺旋CT 肾上腺静脉取血 定位诊断 

分 类 号：R586.24[医药卫生—内分泌]