原发性醛固酮增多症患者左侧肾上腺中央静脉和总干静脉取血结果的比较  

Results Comparison of Left Adrenal Venous Sampling From the Central Adrenal Vein and the Common Trunk of the Left Adrenal Vein in Chinese Patients With Primary Aldosteronism

作　　者：何际宁 董徽[1] 邹玉宝[1] 陈阳[1] 华倚虹[1] 马文韬[1] 李弘武[1] 蒋雄京[1] HE Jining;DONG Hui;ZOU Yubao;CHEN Yang;HUA Yihong;MA Wentao;LI Hongwu;JIANG Xiongjing(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心内科,北京市100037

出　　处：《中国循环杂志》2021年第10期991-996,共6页Chinese Circulation Journal

摘　　要：目的:比较原发性醛固酮增多症(原醛症)患者左侧肾上腺中央静脉和总干静脉取血的取血成功率和醛固酮/皮质醇比值的差异。方法:连续入选中国医学科学院阜外医院2019年8月至2021年1月同时行左侧肾上腺中央静脉和总干静脉取血的原醛症患者。收集手术操作和相关临床资料,比较这两个取血位置的取血成功率和醛固酮/皮质醇比值。结果:共入选56例患者,其中男性36例,年龄(50.1±10.8)岁。56例插管成功患者中,左侧肾上腺中央静脉取血的皮质醇浓度、选择指数、取血成功率均高于总干静脉取血(P均<0.05)。44例两个取血位置均取血成功患者中,左侧肾上腺中央静脉取血的皮质醇浓度、醛固酮浓度均高于总干静脉取血(P均<0.05);醛固酮/皮质醇比值在两个取血位置间的差异无统计学意义(P=0.89)。Pearson相关分析显示,左侧肾上腺中央静脉和总干静脉醛固酮/皮质醇比值比相关性较强(r=0.83,R^(2)=0.69,P<0.01)。Bland-Altman图显示,左侧肾上腺中央静脉和总干静脉醛固酮/皮质醇比值比一致性好。结论:经肘前静脉路径行左侧肾上腺静脉取血,其取血成功率中央静脉显著高于总干静脉,如果这两个取血位置均取血成功,则其醛固酮/皮质醇比值差异无统计学意义。Objectives:To compare the results of left adrenal venous sampling(AVS)at the central adrenal vein and the common trunk of the left adrenal vein in Chinese patients with primary aldosteronism(PA)in terms of sampling success and aldosterone to cortisol(A/C)ratios.Methods:Consecutive PA patients,who underwent AVS via an antecubital approach from August 2019 to January 2021,were enrolled in this study.Clinical and procedural data were collected,and A/C ratios were calculated,the differences on successful AVS rates and AVS results were compared between AVS at the two sites.Results:A total of 56 PA patients(mean age:(50.1±10.8)years and 36 cases male(64.3%))were included.Successful AVS rates at central adrenal vein and common trunk were 96.4%(54/56)and 80.4%(45/56),respectively(P=0.01).Of 44 patients with successful sampling at both locations,the cortisol levels of central adrenal vein and common trunk were 115.4(46.3,349.8)μg/dl and 69.7(36.0,129.4)μg/dl,respectively(P<0.01).The aldosterone levels were 360.0(77.5,895.6)ng/dl and 177.5(74.0,643.6)ng/dl,respectively(P=0.02).The A/C ratios were 2.1(1.0,3.3)(ng/dl)/(μg/dl)and 1.9(1.0,5.7)(ng/dl)/(μg/dl),respectively(P=0.89).A/C ratios of central adrenal vein and common trunk divided by the A/C ratio of inferior vena cava were 1.5(0.6,3.2)and 1.1(0.6,3.0),respectively,which presented a good consistency in Bland-Altman analysis and showed a strong correlation by Pearson correlations analysis(r=0.83,R^(2)=0.69,P<0.01).Conclusions:AVS at the central adrenal vein via antecubital approach is associated with higher successful AVS rate as compared to sampling form common trunk.A/C ratios are comparable in patients with successful sampling at the two locations.

关 键 词：原发性醛固酮增多症 左侧肾上腺静脉取血 肾上腺中央静脉取血 肾上腺静脉干醛固酮/皮质醇比值 

分 类 号：R54[医药卫生—心血管疾病]