原发性醛固酮增多症亚型诊断金标准——分侧肾上腺静脉采血  

Gold standard for primary aldosteronism subtype diagnosis: adrenal vein sampling

作　　者：刘圣琢 董强[1] 陈涛[2] 周亮[1] 刘志洪[1] 朱育春[1] Liu Shengzhuo;Dong Qiang;Chen Tao;Zhou Liang;Liu Zhihong;Zhu Yuchun(Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Endocrinology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科,610041 [2]四川大学华西医院内分泌科,610041

出　　处：《中华内分泌外科杂志》2019年第4期343-345,共3页Chinese Journal of Endocrine Surgery

摘　　要：分侧肾上腺静脉采血技术(adrenal vein sampling, A VS)作为原发性醛固酮增多症亚型诊断的金标准,可通过将取血导管分别插入两侧肾上腺静脉采血而直接反映肾上腺激素分泌情况。肾上腺肿瘤大致可分为无功能腺瘤、肾上腺皮质腺癌、醛固酮瘤、皮质醇瘤及嗜铮细胞瘤。传统主要通过激素检查联合影像学检査对于肾上腺肿瘤做出功能性质诊断,但其特异性和敏感性不高。AVS可反映肾上腺肿瘤分泌功能状况,对双侧肾上腺肿瘤及肾上腺早期腺瘤等无法通过CT做出侧别指数诊断的患者,可通过AVS做出功能优势侧诊断。AVS技术在采血顺序上分为双侧同时采血和序贯采血,根据采血前是否应用促肾上腺皮质激素(adrenocorticotropic hormone, ACTH)分为激发后采血和非激发后采血。本文拟对上述情况做一综述。Adrenal vein sampling (AVS), as the gold standard of subtype diagnosis for primary aldosteronism, can directly detect the hormone concentration in adrenal vein by adrenal vein cannulation. Adrenal tumor can be categorized into no function adenoma, adrenal carcinoma, aldosterone producing adenoma (APA), cortisol producing adenoma (CPA) and pheochromocytoma. Traditionally, peripheral blood hormone testing and image examination were performed to make functional diagnosis of adrenal tumor, which exhibits low specificity and sensitivity. On the contrary, AVS can help make a distinct lateralization diagnosis according the aldosterone concentration of each gland, even in the condition of bilateral adrenal tumor and early stage tumor, which is difficult to make functional lateralization diagnosis by traditional methods. AVS can be categorized into simultaneous sampling and sequencing sampling, according to the order of sampling. According to using adrenocorticotropic hormone (ACTH) or not, AVS can be categorized into no stimulus sampling and post-stimulus sampling.

关 键 词：原发性醛固酮增多症 肾上腺静脉采血 醛固酮瘤 

分 类 号：R586.24[医药卫生—内分泌]